As a hand surgeon, I often encounter common misconceptions about certain conditions, often stemming from the colloquial names they’ve been given. Take Tennis Elbow, for instance—this condition affects many adults at some point, regardless of whether they play tennis.
Another widely misunderstood condition is Trigger Finger. Despite its name, this ailment has nothing to do with shooting.
Medically known as stenosing tenosynovitis, Trigger Finger is a common condition that can affect anyone. While it is more prevalent in individuals with diabetes, rheumatoid arthritis, gout, hypothyroidism, or those of advancing age, it can also affect people of any age who engage in repetitive hand movements, such as scrolling a mouse, knitting, or gaming.
Although many believe Trigger Finger to be a joint or bone issue—sometimes thinking of it as a dislocated digit—it is, in fact, a tendon problem. This means X-rays are not helpful in diagnosing the condition. They can occasionally be useful to rule out other problems such as calcific tendonitis or arthritis.
Trigger Finger occurs when inflammation develops around the tendon’s pulley, the tunnel through which it naturally glides. This swelling can cause the tendon to get “stuck,” leading to pain. In severe cases, the affected finger may become locked in a flexed or extended position, or it may snap through the tunnel during movement.
While the thumb and ring finger are most commonly affected, the middle finger follows, with the pinky being less frequently involved. Surprisingly, the index finger—the one typically associated with the “trigger” in the name—is actually the least common digit to be affected.
Many people think of Trigger Finger as merely a “sticking” or “popping” digit. However, in the early stages, it often causes pain around the A1 pulley without the dramatic clicking or locking. A prominent hand surgeon once famously remarked, “Mystery hand pain is almost always an early case of Trigger Finger.”
While this condition can be bothersome and painful, understanding its causes and treatment options can lead to effective relief. Trigger Finger arises when the tendons and their sheaths swell or become inflamed, disrupting the smooth movement of your fingers. This can cause the tendon to catch or lock, creating a clicking or popping sensation.
Though the clicking itself isn’t harmful, it can be painful, and symptoms vary. Some individuals experience no pain at all with the clicking, while others suffer significant discomfort. Importantly, Trigger Finger doesn’t develop into arthritis or any other major pathology. However, in some cases, particularly with the middle finger, long-standing Trigger Finger can lead to stiffness. Without intervention, the inability to fully straighten the middle finger may become permanent.
In some cases, Trigger Finger resolves on its own, though this may take 8 months on average. Some patients experience relief before this time, while others may need more than 8 months for improvement. Many patients, however, do not experience spontaneous resolution at all.
Because Trigger Finger can be painful and take time to resolve, many individuals eventually seek medical treatment. Even though the condition may seem minor, complications can arise without proper care. A fellowship-trained hand surgeon is best equipped to treat this condition and prevent potential issues like infection, tendon instability, and stiffness.
Treatment options vary depending on the severity. Mild cases often respond well to anti-inflammatory medications, rest from repetitive activities, and protective splinting. However, finger splints should always be used under the guidance of a specialist, as improper use can lead to stiffness or deformities.
Certified hand therapists (CHT) can also assist with reducing inflammation, improving range of motion, and alleviating pain. In some cases, they may also be able to cure or even prevent trigger finger, by improving the biomechanics of the hand.
For painful and/or persistent cases, a steroid injection can be beneficial. These injections, though effective, do not work immediately; it typically takes about a week for results to appear. Although the success rate of a single steroid injection is about 60%, a second injection can sometimes be administered for further relief.
In situations where conservative treatments fail or are no longer appropriate, surgery may be recommended. Trigger Finger release is a minor surgical procedure in which the constricting tendon pulley is divided, allowing the tendon to glide more freely. This surgery has a quick recovery period and is highly effective with a low complication rate.
Recent advancements in surgical techniques have made Trigger Finger release a relatively simple procedure for patients. The WALANT (Wide Awake Local Anesthesia No Tourniquet) technique allows the procedure to be performed while the patient is awake and under local anesthesia. WALANT has revolutionized the experience, making the process more comfortable and convenient.
With WALANT, there’s no need for general anesthesia, meaning you can avoid the groggy feeling and extended recovery times associated with it. The procedure, typically lasting about 5 minutes, allows you to move your finger during surgery, confirming complete and immediate results. The absence of sedation also means you can go home right after the procedure and resume your normal activities more quickly.
WALANT can also reduce costs by eliminating the need for anesthesia support and shortening operating room time.
Trigger Finger may be a nuisance, but with the right treatment, you can regain full function of your hand. Whether it’s through rest, medication, splinting, injections, or surgery, there are many ways to find relief.
If you have hand pain, consult a hand specialist. If surgery is recommended, ask your doctor about WALANT to see if it’s the right option for you. Always seek professional medical advice to determine the best treatment for your specific situation.
Joseph A. Rosenbaum, M.D., is a board-certified, fellowship-trained hand and upper extremity specialist orthopedic surgeon. He serves as the clinical director of hand surgery at Holy Name Medical Center and sees patients in Teaneck.
