Trigger Finger: Cause and Treatment

Have you ever woken up in the morning with your finger stuck in your palm? Trigger finger or “flexor tenosynovitis,” is a common hand condition can that can be painful and annoying. Finger splints, even a simple popsicle stick, are one way of addressing the problem.

Trigger finger involves the tendons in your palm. Flexor tendons connect your forearm muscles to the finger bones; when a forearm muscle pulls, a tendon causes the finger bones to bend and the finger curls down to the palm. The tendon is held in place by little bridges called “pulleys.”  The “trigger” occurs when your tendon becomes caught as it tries to pass under a pulley. The most common place for this problem to occur is at the A-1 pulley, which is just under the skin in the area of the horizontal skin lines of your palm.

When the tendon gets caught, it is just like the top of a 14-foot 8-inch truck scraping the bottom of 14-foot 6-inch bridge clearance. This rubbing causes inflammation within the tendon sheath, which is a fluid-filled structure that surrounds the tendon cord. As the fluid accumulates, the sheath gets thicker and catches more and more as you curl and straighten the finger. Often this makes the finger “click” in the palm or at the middle joint of the finger (called the PIP joint). This can be very painful in either or both of these areas. Some folks are fortunate that while the click is noticeable, it is not painful.

The click can continue for months and may even fade away on its own. Typically though, the more your finger clicks, the thicker the inflammation becomes. Eventually your finger may start to get stuck, and the condition can worsen until you can no longer move it. This problem is called “stenosing tenosynovitis,” and your finger may stay curled into the palm or you may not be able to bend it. It is often at this stage that folks seek advice or treatment, and that’s when the popsicle stick (splint) may be recommended.

By preventing the finger from “triggering,” the inflammation can subside. In hand therapy, we recommend a splint to keep the finger nearly straight, worn all night and even during the day if clicking or locking are occurring. We also encourage people to use an ice cube to massage the palm area for 15 to 30 second bursts, pausing a few seconds and repeating.  When done 8 to 10 times over a 4- to 5-minute period, this can help cool the area, reduce the inflammation and help alleviate the problem. Heat, massage, motion exercises and ultrasound can be done in hand therapy, but the success rate varies depending on whether you wear the splint and limit the amount of times you “trigger” the finger.

When these treatments do not work, an orthopedic physician can inject anti-inflammatory and pain medication into the trigger area. This may cause some initial pain, but can resolve the problem for some patients. Persistent trigger fingers may require a relatively simple surgery in which the doctor releases the pulley, similar to how a drawbridge can be opened to let a tall boat through.

If you have any questions about trigger finger or other hand problems, contact the Good Shepherd Hand Unit at 610-776-3345 or e-mail Randy Wolfe, OTR/L, CHT, at rwolfe@gsrh.org