Trigger finger is one of the most common problems hand surgeons encounter. The medical term for the condition is stenosing tenosynovitis of the flexor sheath. People who have it notice tightness and a popping or clicking when they flex – or open – their fingers. In severe cases, the hand or affected finger becomes locked in a closed or bent position. Mark R. DeHaan, M.D., hand and upper extremity specialist at Orthopaedic Associates of Michigan, sees his share of patients with this condition. “I treat several people every week with this condition,” says Dr. DeHaan. “That’s true of my colleagues, as well,” he points out, referring to the team at the OAM Hand & Upper Extremity Center. Trigger finger is actually a swelling – or tendonitis – of the flexor tendon that controls the flexing movement of a finger or thumb. It can include inflammation of the tubular sheath that the tendon slides through when the hand is opened and closed. When the tendon is inflamed, it is unable to slide normally through the tendon sheath. It tends to catch and create a locking sensation when the person tries to open their hand.
Who gets Trigger Finger?
While the condition is quite common, it strikes certain populations more frequently than others. “It’s more frequent in people over 40, and it tends to be a little more common in women than in men,” says Dr. DeHaan. In the general population, trigger finger is typically brought on when people overuse their hands doing activities that require a great deal of gripping or pinching. “We think it’s more common in women because their hands are a little smaller. When they do activities that put too much stress on the tendons, they tend to swell more,” explains Dr. DeHaan. “However, men certainly get this condition in the course of their daily work and other activities.” But the population with the highest incidence of trigger finger is diabetics. “People with diabetes will commonly get trigger finger in multiple digits. Some patients I see get it in all 10 fingers over a period of several years – and it doesn’t really have anything to do with their activities,” says Dr. DeHaan.
“Take two ibuprofen and call me in the morning.”
Often times, if the condition comes on suddenly after a particular activity, it will go away on its own. “If you’re able to refrain from the activity that brought it on, rest your hand, try not to flex your fingers, and take an anti-inflammatory medication, it will commonly go away over a period of a few weeks,” advises Dr. DeHaan. “If it doesn’t subside and the patient’s symptoms aren’t severe, the next line of treatment may be an injection with a steroid medication. But the success rate of injection treatment is about 50-50 in the general population, and injections are not successful for people with diabetes.” So how does a patient know if more aggressive treatment is called for? If the condition has become painful and caused finger stiffness, persisted for longer than six weeks, or if the patient is diabetic, surgical treatment is usually needed.
Surgery: A simple, safe, and certain cure
Fortunately, the surgical procedure available to correct trigger finger in most patients is as simple and successful as the condition is common. For most patients, Dr. DeHaan recommends a very brief, safe and simple office procedure called a percutaneous release. While the technique has been around for about 20 years, Dr. DeHaan is one of the few hand surgeons in West Michigan who is regularly using this procedure. “This surgery is done using local anesthetic in an office setting,” explains Dr. DeHaan. “Instead of making an incision, we use a local anesthetic and insert a special needle in the skin to get access to the tendon. The tendon sheath is right under the skin, so it’s easy to find it without a scope. We use the blade on the needle to make a cut in the tendon to relieve the tension. The needle is removed and there is no need for sutures. That eliminates the problems of a painful scar, weeks of healing time, and possible infection. Patients don’t have to come back to get stitches removed, and they’re able to use their hand almost immediately.” The patient is awake throughout the surgery – in fact, they have to be in order to use this technique. “Basically, the patient comes in and their fingers are literally locked down. After anesthetizing the area, I’ll insert the needle and start releasing the sheath,” says Dr. DeHaan. “I ask the patient to move their finger during the surgery and when their finger stops locking, you know you’ve opened up the sheath.” Start to finish, the percutaneous release takes only about two to three minutes – and the patient experiences immediate relief. Because the surgery is done in an office setting, not a hospital or surgical center, and there is no general anesthesia, overnight stay, or incision to care for, its very convenient and cost effective. Most importantly, studies over several years have shown that the procedure is a very safe and effective treatment for trigger finger. In some cases – depending on the person’s medical condition or anatomy – a patient may not be a candidate for the percutaneous release. In these cases, the surgeon will use a technique called an open release. The ultimate results and success rates are similar, but the surgery requires a small incision and sutures, and the scar will be tender for about three to six weeks. But the vast majority of trigger finger patients Dr. DeHaan treats are able to have the simpler, non-invasive surgery.
Dr. DeHaan and the team at the OAM Hand & Upper Extremity Center often advise that patients try more conservative treatments, when available, before considering surgery. But in the case of persistent trigger finger, Dr. DeHaan doesn’t hesitate to recommend surgery. “This surgery is simple, it’s quick, it’s safe, it’s effective, the problem never comes back, you can use your hand right after surgery, and there’s virtually no recovery time,” he says. Problem solved.