Trigger Fingers My Finger Clicks and Locks!

Also known as as stenosing tenosynovitis, trigger fingers are painful conditions of the fingers and thumbs where they get stuck in a bent position and then straighten with a “click” or a snap – kind of like a trigger being pulled and released. If a trigger finger is severe, you may find your finger locked in a bent position, unable to straighten.

What happens is the protective covering, the tendon sheath that surrounds the tendon of the affected finger, becomes narrow because of inflammation. This usually happens to people who have work or hobbies that require repetitive gripping actions, though they are more common in women and anyone who has diabetes.

How would you know you have trigger fingers?

Most of the time, trigger fingers or thumbs happens more frequently in your dominant hand, and mostly affects the thumb, index or ring finger. Sometimes, more than one finger is affected at the same time, and sometimes fingers on both hands may be involved. Triggering incidents are usually more often in the morning, or firmly gripping an object or when you bend and straighten the affected finger.

The common tell-tale signs and symptoms of trigger finger, in progression from mild to severe:

  • Stiffness in the finger, especially in morning or after periods of rest
  • A clicking and snapping sensation as you bend and straighten your finger
  • A “bump” (nodule) that is sensitive or tender at the base of the affected finger
  • Finger “catches” or “locks” frequently, followed by suddenly popping straight again
  • Finger becomes locked in a bent position, and you’re unable to straighten without pain

When you should see a doctor?

If you find that you have any of the signs above, for example, stiffness, tenderness at the base of your finger or catching in your finger joints, visit your doctor as soon as you can so that he or she can review your symptoms and do a physical evaluation of your hand. If you find that your finger joint is hot and swollen, get medical care as soon as you can, as those signs indicate possible infection.

What are the main causes of trigger fingers?

The culprit is the narrowing of the tendon sheath that surrounds the tendon in the affected finger. Tendons are thick, fibrous cords that attach muscles to bones; and each tendon is surrounded by a tendon sheath, which is lined with a substance called tenosynovium. This functions as a disperser of the lubrication which allows the tendon to glide smoothly in the protective sheath as you bend and straighten your finger, like a rope through a lubricated container.

But if the tenosynovium becomes inflamed often or for long periods, the space inside the tendon sheath becomes tight, making it difficult for the tendon to glide. The “catch” is when the tendon kinks in a bent position before popping straight . Every time the tendon kinks and snaps, the tendon becomes more irritated and inflamed, further worsening the problem. If the problem is prolonged and more inflammation occurs, the tendon can develop scars and thicken (fibrosis), and cause the tender bumps (nodules) to form.

Testing and diagnosing trigger fingers

It often doesn’t require in-depth or elaborate testing to confirm diagnosis of trigger finger. Usually your doctor will make the diagnosis based on your medical history and a hand physical exam. During the physical exam, your doctor will ask you to bend or straighten your finger, check the base of your finger for tender bumps / nodules, how smooth your finger move, and look out for the evidence of joint catching.

Treatment for trigger fingers

Avoiding repetitive gripping. For at least four to six weeks, avoid activities that require repetitive gripping or any forms of movements or activities that aggravate the problem, repeated grasping or the prolonged use of vibrating hand-held machinery.

Splinting. Your doctor may require you to wear a finger extension splint for up to six weeks to protect the injury and allow the tendon and the tendon sheath to heal. It’s especially useful to prevent you from bending your finger when you sleep, which is often painful enough to wake you up.

Finger exercises. Protected exercises – Be seated comfortably, with your hand supported. Use your unaffected fingers to bend the affected finger joints without causing the joint to click and snap. Repeat for five minutes. Gently massage the nodule at the base of your finger for five minutes. You may be referred to a hand therapist who will teach you protected mobilisation exercises to maintain mobility in your finger.

Anti-inflammatory injection. Another faster and effective way is to inject anti-inflammatory medication to the affected tendon sheath. The medicine will help to reduce the inflammation and swelling of the tendon sheath gradually.

Surgery. If your trigger finger is severe and does not respond well to conservative treatment. Surgery – trigger finger release may be another option. It is a minor day surgery and it is done under local anaesthesia.

See a doctor to treat your trigger finger

If you find that preventive or self-management measure aren’t working, see a doctor as soon as possible. Prompt medical attention can mean the difference between a quick recovery and a lifetime of suffering. And, by all means, be sure the doctor you choose is familiar with these disorders.

Who are at risk for trigger fingers?

There are three main risk factors:

Repeated gripping – if your work or hobbies require you to routinely grip objects, such as power tools or musical instruments for a prolonged duration, you may be more prone to trigger fingers.

Certain health problems – you have higher risks if you have certain medical problems such as rheumatoid arthritis, diabetes, amyloidosis, and certain infections.

Gender – trigger fingers are more prevalent in women than in men.

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