What Causes Trigger Finger? A 5-Step Guide for Patients
A trigger finger is by far one of the most common conditions I see in my office as a hand surgeon.
In fact, it is estimated that 2-3% of the general population has a trigger finger at any given time. That’s over 90,000 new trigger fingers in the United States every year. But maybe you’ve never heard of it?
Today, I will get you up to speed on the 5 most important things to know about a trigger finger so you can kick this annoying condition for good.
A: Straight finger
B: Bent finger - Notice the red nodule of swelling within the flexor tendon is caught under the green tunnel (ie, the A1 pulley), causing the finger to stick or ‘trigger’
If you’ve been reading my articles, you know the importance of anatomy to understanding any hand problem.
A trigger finger is a condition where a single finger gets stuck in a bent position after you make a fist (see Figure 1). You can open the rest of your fingers, but one finger remains bent, or in more mild forms, ‘triggers’ each time you open and close. This issue results from swelling along the flexor tendon, a long white ‘rope’ in your palm that contracts to bend your fingers into a fist. As you bend your finger down, that swelling gets lodged under a band of tissue in your palm known as the A1 pulley (see Figure 2). Each time that swelling catches on the band, your finger will trigger!
Now with that basic understanding, let’s dive into the ‘big 5’ of trigger finger:
1. It’s Not Dangerous
Though a trigger finger can be (not always) very painful, it is not a dangerous condition.
This is important to remember when you are selecting your treatment plan. With the help of your doctor, focus on weighing the pros and cons of the treatment versus how much the trigger finger bothers you.
2. Finger Motion Is Everything
Though I said trigger finger is not dangerous, you must be wary of any loss of finger range of motion.
If your trigger finger is painful, you may slowly start to lose your full finger range of motion. This is your brain’s subconscious way of protecting against pain. Before you know it, you cannot fully straighten your finger, or curl into a fist. Not ok!
Ideally, you want to treat and cure a trigger finger before you reach this point. Otherwise, you’re left with two problems. You have a trigger finger and you have a stiff finger. Stiff fingers need extensive therapy to correct, and in some cases, the stiffness can be permanent.
3. Avoiding Sharp Things
If you are like me, or many of my patients, you want to avoid sharp things. Nobody likes the sharp needle of an injection or thinking about surgery.
Unfortunately, when it comes to a trigger finger, avoiding ‘sharp things’ can be difficult. There is little to no evidence supporting treatments such as therapy or alternative medicine for trigger fingers. If you’re lucky, a percentage of trigger fingers will resolve on their own within a couple of months.
We also know that for trigger fingers that feel worse first thing in the morning, some will respond to wearing a finger splint overnight. But beyond that, our effective options are limited. If your trigger finger is bothering you, you may want to consider something ‘sharp’ (see fact #4).
A note on bracing. If you think you want to try nighttime splinting, you must understand that this means nighttime bracing ONLY. You can buy any over-the-counter finger splint as long as it keeps your finger straight. Wear this to bed and take it off immediately in the morning. Try this for an absolute maximum of 4-6 weeks before moving on. If you wear the splint for too many hours a day, you will end up with a stiff finger (see fact #2), a big problem in its own right!
4. Injections Often = Cure
Good news, bad news.
The good (great!) news: injections for trigger finger are highly effective. Nearly everyone gets at least temporary relief after the injection. 50% of people are completely cured with just one injection. In the other 50%, the trigger finger returns at some point in the first year after the injection. For those individuals, yet again, 50% are cured with the second injection. This is a very high success rate for something as simple as an injection.
The bad news: this injection involves a needle (albeit a small one) into your palm. It’s not terrible, but I won’t pretend it doesn’t hurt temporarily.
5. If You Need It, The Surgery Is Minor*
Huge caveat here. I will be the first to tell you that no surgery is minor surgery. Things can always happen, and you should go into any surgery with a full understanding of the risks and benefits.
But often, those risks and benefits are acceptable in the context of your pain. If you fail several trigger finger injections, you may want to consider surgery.
Trigger finger release surgery typically requires a 1 to 1.5 cm incision in your palm. Through this, I access and divide a small band of tissue called the A1 pulley. This band is where your finger gets caught when it triggers. I then will look at your tendons and clean up any associated inflammation that was causing the obstruction.
Typical recovery involves the removal of three or four stitches about two weeks after surgery. I do ask that you avoid heavy gripping for three weeks so you don’t pop open the wound. Some patients will have mild sensitivity over the scar for the first 4-6 weeks.
Your New Trigger Finger Knowledge
If you or someone you know are struggling with a trigger finger, I hope you can employ some of your new knowledge to pursue your optimal treatment strategy. I wish you a speedy recovery and a permanent solution from whatever you choose!
