The diagnosis of "Trigger finger", a common hand problem, is also known as "Stenosing Tenosynovitis" (an inflammation of the tenosynovium) and is similar in symptoms to de Quervain's disease. Early complaints include mild difficulty or catching when attempting to bend the finger or make a fist. Progressively the symptoms may require the use of the other hand to either bend or straighten the finger. Once the finger is moved you may feel a snap or click as the finger releases. This catching and releasing is known as triggering. The complaints are more noticeable in the morning. There is not always a direct cause for the condition.
Physical exam typically is the only service needed to confirm the diagnosis. Usually there is not need for more involved diagnostic tests unless there are multiple fingers involved in the triggering complaint.
Patients that exhibit "Trigger Finger" symptoms are usually involved in activities that involve high repetition, prolonged repetitive gripping(such as gardening), or construction/renovation activities using hand tools. Medical conditions that may predispose a patient to this condition are Diabetes, High Cholesterol, or Inflammatory Arthritis. This condition is more often seen in middle age women.
The tendons that pass through the palm of the hand course through a sling or pulley that form a tenosynovium sheath lined by fluid called synovium. When the synovium surrounding the tendon in either a finger or the thumb becomes chronically inflamed or thickened, a "trigger finger" may develop. The tendon will "catch" as it enters the tunnel and can gather on itself, creating a palpable nodule in the palm of the hand. The nodule is what catches as it enters the tunnel. Increased catching of the tendon creates increased inflammation and worsening of the condition.
Treatments can range from conservative (casting-splinting) to surgical. Initially, resting the catching tendon is recommended. Anti-inflammatories or steroid injections are options taking care to avoid multiple injections that can create damage to the tendon. In the event of a failed conservative approach, such as casting-splinting, surgery can alleviate the condition.
Surgery for this condition involved making a small incision in the palm of the hand to release the tight pulley and free the tendon. Post operatively, light finger exercises are recommended very shortly thereafter to maintain good mobility of the tendon. Recovery is usually achieved within 4 weeks. Long term results are excellent and additional surgery is rarely required.
For more information on how the de Quervain's disease specialists at Cary Orthopaedics can help you, contact us today at 919-467-4992 for an appointment!
Cary Orthopaedics serves patients from Raleigh, Garner, Cary, Apex, Holly Springs, Fuquay-Varina, Clayton, Chapel Hill, and Pittsboro, NC