Trigger finger

It’s a generally painful blockage when flexing a finger.

The flexor tendons run in a sheath (tunnel) from the palm to the fingertips, surrounded by a synovial membrane that allows them to slide smoothly. When this synovium thickens around the tendons, they slide less smoothly and can become blocked in their tunnel. This phenomenon is at the root of the “trigger finger”.

Surgery on a trigger finger immediately releases the tendons and eliminates painful blockages, but it’s important to follow post-operative instructions to optimize recovery.

It’s a common condition, sometimes associated with carpal tunnel syndrome. There is no identifiable direct cause, but several factors can contribute to its appearance, such as repetitive hand movements, trauma or certain medical conditions like diabetes or rheumatoid arthritis.

Trigger finger surgery is often considered when conservative treatments fail and painful finger blockages recur. It frees the tendons and restores fluid movement to the finger.

The symptoms of a trigger finger may include .. :

• painful discomfort at the base of the finger
• finger locked in flexion, especially in the morning
• difficulty in straightening a finger
• finger protrusion.

Pain may vary in intensity, and may be accompanied by a “clicking” sensation when straightening the finger (sometimes at night). Some patients also report stiffness upon awakening or after periods of inactivity, as well as pain in the palm. Surgery to treat a protruding finger is effective and long-lasting.

The diagnosis of tunnel finger is based on clinical examination by the hand surgeon. Additional tests are not necessary to confirm the diagnosis.

An electromyogram (ENMG) may be prescribed to assess nerve function if carpal tunnel syndrome is suspected, in addition to the trigger finger.

Treatment depends on the age and severity of the problem.

Treatment is usually based on cortisone infiltration, with a 50% success rate in early cases.

In the event of recurrence, a trigger finger surgery is indicated to free the tendons and allow them to slide freely. This procedure is performed in the operating room at the Leman Hand Clinic, under local anaesthetic, with a mini-incision of around 1 cm in the palm at the base of the finger.

After surgery on a trigger finger, the blockage disappears as soon as the anaesthetic wears off. It is advisable to move the operated finger quickly and gradually to regain full mobility, especially extension. Stiffness may persist for a few weeks, particularly in older cases, and a postoperative orthosis can help prevent joint ankylosis.

Useful links

• The British Society for Surgery of the Hand