A Family Doctor's Tale - TRIGGER FINGER

DOC I HAVE TRIGGER FINGER

TRIGGER FINGER is the compression of the tendon sheath of one of the tendon to the fingers or thumb(trigger thumb)
The tendon sheath is a protective cover for the tendon which provides protection for the tendon as it travels across the finger's bones especially at the joints.

TRIGGER FINGER occur as a result of narrowing of the tendon sheath and the inflammation of the tendon.

When the tendon gets caught in the sheath, the finger becomes locked in the narrowed tendon sheath until the tendon is freed from the tight area from forced movement of the locked finger using the other hand.

If left untreated an affected finger can become permanently bent inwards.

Women are affected more than men.

Causes of Trigger Finger:
1.trauma of the tendon sheath especially carrying heavy plastic bags and other bags

2.pressure on the tendon sheath from exertion of pressure through use of chopper knife and tools on the tendon sheath

3.repetitive use of the fingers such as computer keyboard or mouse

4.tenosynovitis(inflammation of the tendon and their synovial sheath)as the tendon becomes swollen in the tendon shift preventing movement of finger.

5.common among middle-aged, taxi drivers gripping the wheel for long hours every day, housewifes and those who often use their fingers in a gripping motion.

6.Also common among people who use the computer or mobile phones

Symptoms:
The onset is usually spontaneous with gradual increasing pains and tightness of the finger which causes the patient to seek treatment:

1.Finger is unable to extend after bending.
As you try harder to straighten the finger, it snaps open as the swollen tendon that was restrained is freed suddenly

2.pain at the base of the affected finger on the palm

Physical examination
1.tendon nodules in flexor tendon at metacarpal head that moves with the tendon

2.no active finger flexion

3.finger locks in flexion in active movement;
extension only can be performed passively
slight pain occurs with clicking sound when passively moved

4.diagnosis is confirmed with CAT scan or MRI

Treatment of Trigger Finger:
1.Rest and splinting of affected finger

2.finger exercise usually good.

3.Non-steroidal anti-inflammatory drugs for inflammation and pain

4.Corticosteroid injection to reduce inflammation under the narrowed sheath

5.Surgery as last resort to release the tendon by cutting the top part of the  narrowed inflammed sheath

Prognosis of Trigger Finger:
1.usually good with injection of corticosteroid

2.recurrence may occur after injection in which case surgery should be done

Prevention:
1.Avoid forceful use of the fingers

2.Avoid carrying heavy plastic bags

3.Avoid repetitive movement of the fingers.