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Senior Citizen's Guide to Southwest Ohio

Trigger Finger Tendonitis

Trigger finger tendonitis is a common cause of hand pain. The ability to make a fist depends in part on forearm muscles contracting to pull on belt-like cords called flexor tendons that run to the fingers. In the palm, these flexor tendons run under a series of pulleys, which resemble belt-loops. When the pulleys become swollen, and/or the tendons thicken from inflammation, then the tendons cannot glide smoothly under the pulleys and trigger finger tendonitis results. The term "trigger" refers to the catching of the flexor tendons on a pulley. The patient most often experiences a painful snapping motion of the finger. And, while pain is perceived in the palm near the base of the fingers, the snapping can be felt in the middle finger joints (proximal interphalangeal joints). The hand may not close into a fist, or may fail to open out of a fist smoothly.

Usually, the cause of trigger finger is unknown. Sometimes repetitive activity, such as gardening, or a fall that forces a finger into hyperextension, will cause inflammation and trigger finger tendonitis may follow. Sometimes there is an associated disease such as diabetes, rheumatoid arthritis or thyroid dysfunction.

People who think they may have a trigger finger should see their doctor. The doctor will take a history and do a physical exam to determine any associated conditions, the area of pain, co-incident arthritis, and joint range of motion.

Management of very early symptoms may include careful icing and splinting. Once the disease process is well established, cortisone injections are the most common non-operative treatment. Success from a single shot is unpredictable, but literature rates indicate resolution of the tendonitis in over half of patients (1). One and sometimes two separate injections are tried in patients who have no contraindications to steroids (2).

For patients who fail nonoperative management, or have developed loss of motion from long-standing trigger finger tendonitis, surgery is an option. Surgery can be accomplished from a variety of incision sizes, depending on surgeon preference, and the operation has the goal of releasing the belt loop-like pulley structure so the tendon can glide more smoothly. An occasional patient will have sufficient thickening of the tendon to require more extensive surgery whereby the tendon is shaved to make it narrower. Postoperative rehabilitation depends on how much inflammation and stiffness the patient had before surgery, but many patients can have limited use of their hand within a day. Most patients regain a smoother ability to make a fist.

Because trigger finger tendonitis can be painful and can affect hand function, if you feel you may have this condition, you should see your doctor.

Editorial provided by Drs. Danis, Barre, Berrettoni and AlSamkari, Hand and Reconstructive Surgeons, Inc.

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