Trigger finger (in medical language "stenosing tenosynovitis") is an inflammation of the tendon of the finger that triggers it involuntarily. If the problem is severe, the finger gets stuck in the bent position and sometimes makes a snap when forced to open, much like a gun trigger. People who perform work that requires repeated grasping of an object are at high risk for this condition, as are individuals with arthritis or diabetes. The treatments are different and depend on the severity of the situation; for this reason it is essential to obtain a diagnosis.
Steps
Part 1 of 3: Managing the Snap Finger at Home
Step 1. Take a break when doing repetitive tasks
In most cases this disorder is triggered by the repeated movement of the hand to grab something or when the thumb and forefinger are flexed several times. Farmers, typists, workers or musicians are the categories most at risk, because they constantly repeat certain movements of the fingers and thumb. Smokers can also suffer from snapping thumbs, due to the movement they make when using the lighter. For these reasons, stop or limit repetitive activities that can inflame your finger if you can, in the hope that the pain and contracture you feel will resolve on their own.
- Tell your manager at work about the situation, who may be giving you different tasks.
- Trigger finger occurs most among people aged between 40 and 60.
- It is a more common pathology among women.
Step 2. Apply ice to your finger
Cold proves effective for all minor musculoskeletal injuries, including trigger finger. The inflamed tendon (which usually appears as a lump or small, sore bump on the underside of the finger or palm of the hand) should be subjected to cold therapy (an ice pack wrapped in a thin cloth or a frozen gel pack) to reduce pain and swelling. Apply ice for 10-15 minutes every hour, then reduce the frequency as the swelling subsides.
Keep the ice in contact with your finger or hand by securing it with a bandage or elastic support to control inflammation. However, do not tie it too tightly, as this could prevent good blood circulation and make the situation worse
Step 3. Take over-the-counter NSAIDs
Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen or aspirin are short-term solutions that allow you to manage pain and inflammation. The dosage for an adult is typically 200-400 mg (taken orally) every 4-6 hours. Remember that this class of drugs has side effects on the stomach, kidney and liver, so don't use anti-inflammatories for more than two weeks.
The typical signs and symptoms of trigger finger are: stiffness (especially in the morning), "snapping" sensation when moving the finger and difficulty in straightening it, presence of a painful lump at the base of the affected finger
Step 4. Try to stretch the contracted tendon
This way you can reverse the process, especially if you address the problem from the start. Place the palm of the affected hand on the table and slowly extend the wrist by increasing the pressure on the hand. Hold this position for 30 seconds and repeat the exercise 3-5 times a day. Alternatively, grab the affected finger and gradually extend it by applying more and more force and massaging the inflamed lump (if any).
- Soak your hand in warm water and Epsom salts for 10-15 minutes before performing the stretching exercises; in this way you release tension and reduce pain in the inflamed tendon.
- Usually the fingers affected by this disorder are the thumb, middle and ring fingers.
- Multiple fingers and sometimes the whole hand can be affected.
- A massage from a physical therapist may be the best choice.
Part 2 of 3: Medical Care
Step 1. Get a prescription for a splint or brace
Your doctor may recommend that you use a splint at night to keep your finger stretched out while you sleep - that way it can stretch a bit. You may need to wear the brace for up to six months. This device also prevents you from closing your hand into a fist during sleep, which would make the situation worse.
- During the day, periodically remove the splint for stretching exercises and gently massage the area.
- Alternatively, you can immobilize your finger by purchasing an aluminum finger splint at the pharmacy and securing it with strong medical adhesive tape.
Step 2. Get a corticosteroid injection
A cortisone drug is injected into or near the affected tendon sheath to quickly reduce inflammation and restore smooth, normal finger motion. This type of injection is considered to be the first-line treatment for trigger finger. Bites are usually required 3-4 weeks apart and are effective in 90% of cases. The most used drugs are prednisolone, dexamethasone and triamcinolone.
- Among the various complications that can occur following these injections are infections, haemorrhages, tendon weakness, localized muscle atrophy and irritation / damage to the nerve.
- If corticosteroid injections fail, then surgery should be considered.
Step 3. Undergo surgery
If trigger finger does not resolve with home treatments, immobilization and steroid injections, then the basis for a surgical solution exists; the operating room is also used in cases where the finger is severely bent or irremediably blocked. There are two surgical procedures in this regard: percutaneous release of the trigger finger (percutaneous release) and tenolysis of the flexors. The latter involves a small incision at the base of the affected finger to free the tendon sheath from adhesions and blocks. In percutaneous release, on the other hand, a needle is inserted into the tissue surrounding the tendon to free it from adhesions.
- This kind of surgery is usually performed in day surgery with local anesthesia.
- Possible complications of an operation are an infection, an allergic reaction to the anesthetic, nerve damage, and chronic pain or swelling.
- The relapse rate is only about 3%, but the operation may be less successful in diabetic patients.
Part 3 of 3: Troubleshooting and Differential Diagnosis
Step 1. Treat basic infections or allergic reactions
Some localized infections can have the same symptoms as trigger finger or cause true tendon contraction. If your joints or muscles in your finger turn red, hot, and become severely inflamed within a few hours, go to the emergency room immediately as there may be an infection or allergic reaction, for example, to an insect bite. Treatment, in this case, consists of an incision to drain the liquid, baths in warm salt water and sometimes systemic antibiotics.
- Bacterial infections are the most common and are the result of mishandling of cuts, stings or ingrown toenails.
- Allergic reactions to insect bites are relatively widespread, especially those of bees, wasps and spiders.
Step 2. Treat a dislocation
A dislocated finger sometimes behaves like a trigger finger because it is unnaturally bent or deformed and causes pain. Dislocations are mainly caused by severe trauma and not repetitive strain, so they must be treated immediately by an orthopedic doctor to re-establish joint alignment. Once the joint position is restored, a dislocated finger is treated more or less like a trigger finger: rest, anti-inflammatory, ice and brace.
- An X-ray of the hand immediately reveals a fracture or dislocation of the finger.
- Dislocations are treated and managed in the emergency room by an orthopedic doctor but, in extreme cases, you can also contact a physiotherapist or osteopath.
Step 3. Manage arthritis
Sometimes the cause of an inflammation and contracture of a finger tendon is to be found in a gout attack or in an acute phase of rheumatoid arthritis. The latter is an autoimmune disease that severely affects the joints of the body, requiring the intake of strong anti-inflammatories, available only by prescription, and immunosuppressive drugs. Gout is an inflammatory disease caused by uric acid crystals that are deposited in the joints (especially in the feet, but the hands can also be affected); this also affects the tendons and causes them to contracture.
- Rheumatoid arthritis mainly affects the hands and wrists, and over time deforms their joints.
- Your doctor may order blood tests to look for markers for rheumatoid arthritis.
- To reduce the risk of gout, eliminate purine-rich foods such as offal, fish, and beer.
Advice
- You can eat strawberries and increase your vitamin C intake to fight gout attacks naturally.
- Recovery time from trigger finger surgery depends on the severity of the situation and the surgical procedure performed, but typically takes around two weeks.
- The congenital snap thumb of newborns must be surgically corrected to prevent the development of flexion deformity in adulthood.
