There is help for trigger finger

Special to the Herald-LeaderJune 10, 2013 

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"Trigger finger" is an inflammation of the flexor tendons that bend our fingers.

Flexor tendons enter the hand through the wrist and attach to the bones of the fingers to allow them to flex and bend. The tendons glide smoothly within tunnels with narrow segments called pulleys. The pulleys function to maintain the tendons within the tunnels against the bones to provide efficient motion.

With trigger finger, the tendons develop a lump or swelling. The smooth gliding of the tendon within the tunnel is interrupted as the tendon becomes stuck just as it enters the finger at the narrow portions or pulley of the tunnel.

Patients will describe pain or discomfort in the palm associated with a knot or nodule that can be felt. A painful locking, popping or catching sensation of the finger occurs when the tendon becomes caught.

Initially, patients might think there is a problem with the finger knuckle, not realizing the problem lies with the tendon.

At times the triggering may be so severe that the other hand must be used to straighten or extend the locked finger. More than one finger can be affected, and the fingers of both hands also may be involved.

Specific causes of trigger finger are not entirely clear but can be associated with other conditions such as gout, osteoarthritis, diabetes and rheumatoid arthritis. Trauma such as a deep cut to the finger can injure the tendon and result in a trigger finger, as well.

The majority of patients with trigger finger will respond to oral anti- inflammatories and cortisone injections. Typically a short series of injections is performed in a clinic setting with the majority of patients experiencing complete relief.

Some patients might experience only short-lived relief or no relief at all from the injections. In this group of patients, surgery is offered.

The goal of surgery is to cut the first pulley of the tunnel open. This provides room for the swollen tendon, allowing it to pass freely. The procedure is performed in an outpatient surgery facility and typically takes a few minutes to perform.

After surgery, patients are placed in a soft dressing to protect the incision and stitches. Pain after surgery is minimal in the majority of patients.

Active motion of the fingers is encouraged. After a few days, the stitches are removed and more activity and scar massage are encouraged. In a few cases, physical therapy might be needed.

Dr. Margaret Napolitano, a hand surgeon with Kleinert, Kutz & Associates, practices at Baptist Health Lexington.

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