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Hand Health Resources 2006 unless otherwise noted



TRIGGER FINGER (STENOSING TENOSYNOVITIS)

 

GENERAL INFORMATION

  • Trigger finger is a swelling of the tendon or tendon sheath in the palm of the hand of the tendons which bend the fingers
  • The swelling prevents the tendon from gliding smoothly through the sheath and the "pulley" (ligament) which holds the tendon to the bone
  • Trigger finger occurs most frequently in the middle finger and the ring finger, but it can occur in any finger or the thumb.

 

SYMPTOMS

  • A locking, snapping, popping or catching sensation in the finger while making a fist
  • This "triggering" of the finger can be quite painful at times
  • The finger may "lock" into a bent position
  • There will most likely be pain or tenderness in the palm of the hand over the site of the pulley which holds the tendon close to the bone
  • There may be joint stiffness and pain in the affected finger

 

OCCUPATIONAL CAUSES

  • Repetitively grasping an object
  • Sustained gripping of an object
  • Using tools that have handles with sharp or hard edges

 

ERGONOMICS

  • Avoid repetitive grasping and releasing of objects; Modify the activity if you are unable to avoid it
  • Avoid sustained grasp
  • Use the appropriate tool for the job
  • Purchase tools with padded, comfortable handles
  • Handles should have some texture for easier holding; slippery surfaces require more forceful grasping
  • Minimize repetition; Periodically rest the hands briefly during repetitive or stressful activity; Stretch frequently during repetitive activity
  • Slow down the activity
  • Use the lightest grip possible (on tools, pens, the mouse, the steering wheel, etc.) that still allows you to maintain good control
  • Use the least amount of force necessary during the activity
  • Use the appropriate tool for the job
  • Use ergonomically designed tools if available (modified or padded handles, larger grips with good traction, handles with modified designs)
  • Make sure that tools are in good condition and that cutting edges are sharp (reduces the force needed to use the tool)
  • Alternate work activities if possible so the hands are not performing any one task repetitively for any length of time
  • Use good ergonomic practices at work; Apply these tendon and nerve protection principles to daily and leisure activities as well.
  • Practice good health habits

 

EARLY TREATMENT (pre-surgical healing)

  • Day-time splinting (custom fit or pre-fabricated) which holds the large knuckle of the finger straight, but allows the tip and middle joint to bend.  Night-splint which holds the entire finger straight.
  • Avoid the activities that cause pain; If unable to avoid, modify the activity
  • An ergonomic consultation to modify work environment stressors
  • Use of ergonomic equipment and tools such tools with modified or padded handles
  • Education in tendon and nerve protection techniques including modification of sleep and work habits
  • Hand therapy techniques to improve circulation, decrease swelling and reduce pain
  • A supervised exercise program to stretch tight muscles, strengthen weak muscles, promote postural balance;  the program should include tendon and nerve gliding exercises as necessary and forearm and finger stretches
  • The M.D. may prescribe anti-inflammatory medications such as naprosyn or ibuprofen;  if these medications cause stomach irritation, the M.D. may also prescribe a stomach calmer such as zantac
  • The M.D. may recommend a cortisone injection near the area of friction at the palmar pulley

 

SURGICAL PROCEDURE

  • A minor operative procedure in which a small piece of the tendon sheath is cut open to release the swollen tendon
  • A small incision in the crease of the palm over the tender area

 

WHAT SHOULD I DO AFTER SURGERY?

  • Keep the incision clean and dry
  • Change the bandages as needed, especially if saturated with blood
  • Keep the fingers moving - make a gentle fist and hook fist, spread the fingers apart
  • Use your hand for light activity, as normally as possible, but respect pain
  • Once the stitches are removed, begin gently massaging the scar
  • Use a silicone based scar bandage if the scar is thick, stuck, red or painful
  • Gradually increase strength activities at 6 weeks post-surgery

 

POST-SURGICAL THERAPY

  • Cleaning and dressing of the incision until healed
  • Scar management including massage, the use of scar molds or silicone gel sheeting, ultrasound, hot packs
  • Swelling reduction techniques including instruction in elevation of the arm, compression wraps, retrograde massage, cold packs
  • Desensitization techniques if the scar is sensitive
  • Active motion including tendon and nerve gliding exercises as necessary
  • Strengthening and work conditioning activities beginning at about 4 weeks after surgery to tolerance

 

WHAT CAN I EXPECT AFTER SURGERY?

  • The pain that travels or radiates up or down the finger and hand is often relieved almost immediately.  Pain becomes more centered around the surgical site while the hand is healing. 
  • The surgical area in the palm of the hand will likely be tender for 3-4 months after surgery.  
  • There will be some amount of swelling over the surgical area for months as well
  • You may still notice a trigger in the finger until some of the post-operative swelling has gone down

 

 

 

 

 

 

 

 

 

 

 

 

 

 
 
 


 

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