Trigger Finger Treatments

A trigger finger is a common condition that causes fingers to snap and get stuck in the palm. Often worse in the morning, patients complain that they awaken with their finger stuck in the palm of the hand. Straightening the finger can be painful and can cause a snapping sensation that is the source of the name "trigger finger." Each of the fingers and thumbs can be affected by triggering, and all treatments discussed are useful for any digit.

Trigger finger can be painful and can get in the way of many activities. However, it's not a life-threatening condition; therefore, treatment is never mandatory. If someone chooses, they can live with the symptoms, which sometimes resolve on their own.

Patients with minimal symptoms may want to try some simple treatments first. These may include an oral anti-inflammatory medication, hot or cold wraps, massage and even a splint.

The success of these noninvasive treatments depends on the severity of the trigger finger. Most people with few symptoms don't seek any treatment. Most people with more painful symptoms have passed the point when simple steps are helpful. That said, a trial of simple treatments is certainly reasonable.

Very few doctors are still splinting trigger fingers, as the success of this treatment is debated, and often the splints have to be worn for several months to be helpful. Since other treatments are successful, splinting is seldom used any more.

The most common treatment of trigger finger is with an injection of steroids (cortisone) into the tendon sheath. The cortisone often decreases swelling sufficiently to restore normal mechanics.

Usually a single cortisone injection will resolve the problem at least temporarily. The chance of the cortisone providing a lasting solution is about 50%.

Side-effects of a cortisone injection are most often minimal, but for some people, they can be quite significant. That is why some doctors and patients choose to skip the shot and move right into more definitive treatment, such as surgery.

Surgery for a trigger finger (called a trigger-finger release) is a same-day procedure that can be done under local anesthetic or regional nerve block. A small (less than two centimeters) incision is made in the skin, and the tight portion of the tendon sheath is released. This allows the tendon to glide smoothly again without catching.

Following the trigger-finger release, activity of the finger is encouraged, as this will help prevent scar tissue from forming where the surgery was performed. Patients are advised to avoid pressure on the healing incision for a few weeks. Full recovery is expected.

Trigger finger surgery is very safe, but there are possible complications. The most common problem is that the trigger finger can come back if the tendon sheath is not adequately released. Other possible problems include infection, stiffness and damage to the nerves of the finger. The likelihood of these problems is small, and surgery has a very high success rate.

There is not necessarily a best option for trigger finger. There has been some evidence that early treatment with a surgical release can speed overall recovery, as patients tend to have less stiffness and inflammation in the finger. Therefore, some surgeons will recommend more aggressive treatment by skipping over the simple steps and going directly to surgery.

However, many patients want to avoid the surgical knife. In those cases, there are very reasonable options that do not include surgery. Discuss with your doctor the best treatment for your situation.

_Sources:

_{Saldana MJ. "Trigger Digits: Diagnosis and Treatment" J Am Acad Orthop Surg July/August 2001; 9:246-252.}