Trigger Finger

Trigger finger (stenosing tenosynovitis) is inflammation and thickening of the sheath of finger flexor tendon. The tendon catches in the sheath during gliding, causing catching, popping, or locking when bending the finger. Common in 40-60 year old women. Diabetes, rheumatoid arthritis, hypothyroidism are risk factors. Most commonly affects thumb, middle finger, and ring finger.

Symptoms

The disease usually progresses in stages:

• Stage 1: Pain, tenderness at finger base (palpable nodule in palm)
• Stage 2: Mild catching with finger bending or straightening, "click" sound
• Stage 3: Finger locking in flexed position, needs other hand to extend
• Stage 4: Finger stays in flexed position, cannot be extended
• Usually more pronounced in mornings
• Sometimes palpable hard nodule in palm

Diagnostic Methods

Diagnosis is clear by clinical examination. Tenderness at finger base, often palpable nodule (thickened tendon sheath), and typical catching motion are characteristic. Imaging usually not needed; in unclear cases, ultrasound shows tendon sheath status.

Treatment Approach

Non-Surgical Treatments

First-line treatment is conservative and 50-70% of cases heal this way: short-term splint use (6-8 weeks), NSAIDs, physical therapy, and cortisone injection (into sheath, successful in 60-80% of cases). If first injection fails, second dose tried after 6 weeks. Response to injection is slightly lower in diabetic patients.

Surgical Treatment

Surgery is needed for cases not responding to 3-6 months of conservative treatment or for locked fingers. A1 pulley release (trigger finger release) is a short, effective, safe surgery. Can be done open (traditional) or percutaneous (with needle, closed). Surgical success rate is over 95%.

Surgical Process

Performed under local anesthesia (no sedation needed). Procedure lasts 10-15 minutes. A small 1.5-2 cm incision is made in the palm and the narrowed sheath is opened.

Hospital Stay

No hospital stay needed, same-day discharge. The finger can be moved immediately after the procedure.

Recovery Process

• Week 1: Light dressing, finger movements free, swelling control
• Weeks 1-2: Suture removal, return to normal activity
• Weeks 2-4: Full function, grip strength improvement

Return to Work

Desk work in 1-3 days, light hand work in 1 week, work requiring heavy hand use in 2-3 weeks.

Potential Complications

Surgery is extremely safe. Rare complications: incomplete release, nerve injury (especially digital sensory nerve of thumb, <1%), scar hardening, temporary fingertip tenderness.