Trigger Finger

A Trigger Finger or Thumb is what we call it when you have a finger that will bend to form a fist but won’t straighten out with the other fingers without quite a forceful click – like pulling a trigger. It can get bad enough that the finger own’t actually straighten out at all.

However it is quite an easy thing to sort out and often that can be done with a steroid injection. If it recurs then a little operation done under local anaesthetic will cure it for good.

So what actually happens? What causes it?

Your finger bends because a tendon attached to the tip of the finger is pulled by the muscle attached to it. That tendon runs through a series of tunnels of tissue that hold it down close to the bone and stop it bow-stringing across the hand. For whatever reason, a lump develops on the tendon which allows it to go through the tunnel one way – when you amke a fist – bit gets stuck going the other way – when you straighten the fingers. When it ‘clicks’ it often feels like the problem is at one of the joints in the finger but the actual problem is at the base of the finger where you might be able to feel a tender lump.

Tell me about the injection.

This is done in the clinic and only takes a few seconds. It is a jab with a needle but it’s quite a small one so it isn’t really that painful – as often with an injection it is the anticipation that is worse than the actual event. I place the needle through the skin and through the lining that surrounds the tendon (the tendon sheath) and move your finger up and down and if the needle moves then I know it is in the right place. Then I attach the syringe and inject a little of a mixture of local aneathetic and steroid into the space around the tendon. Pop on a sticky plaster and away you go.

And the operation?

If the triggering returns then you can have a little operation done under local anaesthetic and which only takes 5 minutes to do. Once the anaesthetic has been injected (sorry but that does sting a bit!) and your palm is nicely numb, I make a cut about 1 cm long about 1 cm proximal to where the finger bends. Then I locate the tunnel where the tendon is blocking – its technical name is the A1 Pulley – and divide it with a scalpel so the tendon can run smoothly with no trigger. A stitch, a bandage and home you go.

You can use the finger for normal day to day stuff pretty much straight away and, once the stitch is out, for whatever you like.

How do I manage my hand and my life afterwards? 

– you have a padded bandage over the palm for 48hrs which you just unwrap and take off at home.

– for baths and showers, pop your hand  in a rubber glove and tape it round your forearm.

– once the bandage comes off you need to use an Elastoplast bandage over the cut until the stitches come off at 10 days post-operation.

– you can use the hand pretty normally straight away but it can be a couple of weeks before you can grip and grab without discomfort for example to hold a tennis racquet and things like that.

– if you do a desk job you should be able to get straight back to work but for a physical job it may be up to two weeks before everything has settled and you may want to wear a glove for a bit longer.

Does it come back?

Never say never but it is very rare.

Will my other fingers get it?

That is much more likely and most people who have one triggering finger will suffer with others at some point. The worst case scenario is having all 4 fingers on both hands triggering at the same time. Thankfully that doesn’t happen very often but when it does I just free them all up at the same time.

 

For NHS patients you will only be offered surgery if your symptoms recur after two injections. If you want to get rid of it more quickly than I offer very, very competitive rates for the operation at The Syon Clinic in Brentford. See the costs sheet for details.