Trigger Finger (Catching Finger) and Surgery

The finger flexor tendons travel within a sheath from the palm towards the fingertips. At certain points, pulley-like bands hold the tendon close to bone. The A1 pulley, where the palm meets the base of the finger, is the most frequent problem site in trigger finger.

When the tendon or its sheath thickens here, the tendon has difficulty passing beneath the pulley. The thickened area catches as the finger bends and is released only with effort when it straightens; patients describe the finger as 'catching, then snapping open'. Because this sound and sudden release resemble pulling a trigger, it is called trigger finger.

It most often affects the thumb, ring finger and middle finger, and may involve several digits at once. Although sometimes mistaken for 'finger arthritis', trigger finger is not joint osteoarthritis: the problem lies in the tendon sheath, not the joint itself.

Symptoms usually start with tenderness in the palm, followed by catching and locking:

• Pain and a firm, palpable nodule in the palm at the base of the finger
• Catching when bending the finger, followed by sudden release with a click
• The finger remains bent in the morning and needs the other hand to straighten it
• Pain when gripping or holding; difficulty holding a jar, steering wheel or hammer
• In later stages, inability to straighten or bend the finger at all (fixed locking)

Most patients have no single identifiable cause. Prolonged gripping, vibrating tools and repetitive squeezing with scissors, hoes or shovels can irritate the sheath. In Ordu, symptoms often increase during hazelnut harvesting and gardening periods.

Diabetes, rheumatoid arthritis and thyroid disease substantially increase the frequency of trigger finger; several fingers may be affected and response to treatment may be slower. Coexistence with carpal tunnel syndrome, De Quervain's tenosynovitis and Dupuytren's contracture is also common, so the whole hand is examined rather than only the catching finger.

Imaging is usually unnecessary for diagnosis; history and examination are sufficient. The palm nodule is palpated, active and passive finger movement observed, and the stage of catching and ability to straighten fully assessed. In a persistently locked finger, the joint itself is also checked for stiffness because this changes the treatment plan.

Ultrasound is used when needed to show sheath thickness and tendon condition. X-rays are requested if joint osteoarthritis or an old fracture is suspected. Swelling and morning stiffness involving several finger joints may warrant further assessment for rheumatic disease.

For recently developed, infrequent triggering, treatment starts without surgery. A splint holds the digit straight, particularly at night, reducing repeated catching and allowing sheath irritation to settle. This is combined with temporarily reducing gripping activities and simple changes such as thickening tool handles.

Corticosteroid injection into the tendon sheath is widely used for trigger finger and reduces symptoms in many patients. The benefit is long-lasting in some but temporary in others, with catching returning. The number of injections is limited; repeated injections into the same finger may be unsuitable for the tendon. In people with diabetes, a temporary rise in blood glucose is possible and is discussed beforehand.

Anti-inflammatory medicines may ease pain but do not remove narrowing in the sheath. A completely locked finger or inability to straighten it warrants early surgical assessment, because waiting with non-surgical methods may cause joint stiffness.

Surgery is considered when catching persists despite splinting and injection, the finger locks frequently or remains fixed. It may be discussed earlier in diabetes and when several fingers are affected.

The procedure is A1 pulley release: a small incision is made in the palm at the base of the finger, and the band catching the tendon is divided lengthways. The tendon and nerves are left intact. Regional anaesthesia numbing the hand is usually sufficient, and the patient goes home the same day. Free finger movement can be checked during surgery while the patient is awake.

If another problem, such as carpal tunnel syndrome, affects the same hand, assessment determines whether both procedures can be performed together.

Triggering disappears immediately after surgery in most patients. Move the finger from the first day; immobilisation causes stiffness. Keep the hand dry until the wound heals; stitches are usually removed within two weeks.

Pressure sensitivity at the palm incision may last several weeks; return to heavy gripping is planned as it improves. Joints may have stiffened in fingers locked for a long time; these patients may need hand rehabilitation to restore movement, and improvement may take weeks.

Desk work can often resume within a few days, while physically demanding hand work and machinery work take longer. Timing is clarified during follow-up.

In babies and young children it most often appears as persistent bending of the thumb's tip joint; families notice that the thumb looks "broken" or will not straighten. Unlike adults, children usually have little pain, and a fixed bent position is more prominent than catching.

Some cases improve spontaneously in the first years of life, so observation and stretching when appropriate may be advised. Release surgery is planned for persistent cases that restrict use of the digit. The decision depends on the child's age, how far the digit can straighten and symptom duration. For other related subjects, see paediatric orthopaedics.

Taking breaks from prolonged forceful gripping, thickening tool handles and wearing gloves reduce load on the sheath. Forcing the digit straight can increase pain and swelling; a doctor-recommended splint is preferable to forcefully pulling a catching finger open with the other hand.

If you have diabetes, blood glucose control is part of treatment. If symptoms affect several fingers or recur, a whole-hand assessment at AC CLINIC in Altınordu, Ordu, is recommended.