Trigger finger
Trigger finder is a common cause of finger pain. In its typical form it may be the cause of a blocking phenomenon affecting the bent or straightened finger, often initially predominant in the mornings.
Summary :
Definition
Trigger finger is a common cause of pain in the fingers.
In its typical form it may be the cause of a blocking phenomenon affecting the bent or straightened finger, often initially predominant in the mornings.
Left untreated, the phenomenon may develop into the complete blocking of the finger or a rupture of the flexor tendons.
Symptoms
Pain at the base or over the whole length of the finger, a “clunck” or blocking phenomenon affecting the finger in flexion or extension. All of the fingers may be affected. The phenomenon is often associated either simultaneously or at different times with carpal tunnel syndrome.
Diabetic patients are more often affected by this phenomenon.
Causes
- Trigger finger is often due to inflammation of the synovial sheath surrounding the flexor tendon, causing the latter to thicken and thus enter into conflict with the entrance to the digital canal. An actual nodule can form inside the tendon and will gradually become lodged at the entrance to the canal. This phenomenon may also be congenital and diagnosed in early childhood.
- Trigger finger may occur following the surgery related to carpal tunnel syndrome without it constituting a complication to the latter.
Diagnosis
Diagnosis is clinical, and usually further examinations are unnecessary.
Medical Treatment
First of all, treatment is medical, a corticoid infiltration is realised in the digital canal.
In cases of failure or recurrence, and in cases of functional discomfort, surgery may be proposed. The procedure consists in opening the entrance to the digital canal, removing the hypertrophic synovial membrane around the tendon, removing the salient part of any tendinous cyst in order to allow the flexor tendons to slide freely in the canal.
Surgical procedure
- Length of hospital stay: outpatient (no overnight stay)
- Anaesthetic: loco-regional
- Immobilisation : none
Surgery is performed under regional anaesthetic (only the arm is put to sleep), a pneumatic garrotte is fixed at the top of the arm to prevent bleeding and an overnight stay in the hospital is not necessary.
A short transversal incision is made at the root of the finger.
The entrance to the digital canal is opened and the tendons freed.
A large dressing is applied and is to be kept in place for 48 hours and then replaced by a simple adhesive dressing for 2 weeks. Everyday activities may be resumed immediately, and strenuous efforts, sports activities or heavy work involving the affected hand may be undertaken after approximately 1 month.
Possible secondary complications
- Persistent pain on pressure and flexion/extension of the finger
- Lesions of the nerves possibly leading to persistent tingling sensations or to a loss of sensitivity in the fingers
- Algodystrophy, i.e. the hand may become swollen and painful and there may be transpiration and persistent stiffness for several months or years
- Recurrence