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Trigger finger / trigger thumb

What is a trigger finger (or trigger thumb)?

A trigger finger or trigger thumb occurs because the flexor tendons of the fingers or thumb can no longer move properly. The tendons to the fingers run through tunnels in the hand and fingers so that they stay close to the bone. These little tunnels are called pulleys. When the flexor tendon swells or the pulley thickens, the tendon no longer fits properly under the pulley. This causes pain and difficulty bending or stretching. Also, the tendon can get pinched which gives the so-called "trigger phenomenon.

Trigger fingers or thumbs are relatively more common in people with diabetes and those with rheumatoid arthritis.

What are the symptoms of a trigger finger?

Most people experience a lofty finger when stretching the finger. Stretching may be accompanied by pain. Sometimes when waking up (or during the day after fully flexing the finger), the finger is in a bent position and can only stretch with the help of the other hand. This, too, is experienced as painful. A painful thickening may be felt in the palm of the hand. If the symptoms last longer, a stiffness of the finger may develop so that it can no longer be fully extended or bent.

Diagnosis

The diagnosis is made based on pattern of symptoms and physical examination. Normally, no additional examination is necessary. An ultrasound may reveal the possible presence of a cyst. An X-ray of the hand may be taken to rule out wear and tear.

Treatment:

Non-operative (conservative) treatment

In the case of an incipient trigger finger or thumb, conservative treatment can often be given first, with the goal of allowing the tissue to decongest, allowing the tendons to run smoothly again. Avoiding painful activities and hand therapy can help. Wearing a brace (splint) can also help. The (temporary) use of anti-inflammatory medications, if overall health permits, can reduce pain symptoms and make the tendon calmer.

However, most trigger fingers are already no longer incipient and the most commonly used therapy is then an injection of corticosteroids.

Surgical treatment

If the injection of corticosteroids does not help sufficiently, or if the patient explicitly prefers this, then surgical treatment is chosen. Surgery is performed in day surgery. A local anesthetic is given in the surgical area in the palm of the hand. The top of the pulley is opened to restore enough space for the tendons to slide back and forth properly. If severe irritation is present, the mucosa of the tendons is cleaned. If there is a cyst on the tendon or pulley it is removed.

The wound is sutured with stitches that can be removed after 7-10 days. After the procedure, you will have a pressure bandage for several days. This bandage must be kept dry. You may move the finger(s) immediately and use the hand in daily activities within the pain limit. During the consultation hour, you will be given detailed information about postoperative treatment and recovery, as well as an information brochure about the procedure.

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