Ask Dr. Parisi About Causes of Trigger Finger
Do you know the four causes of trigger finger?
Our fingers spring into action as we greet each new day. We use them to stir cream into our morning coffee, gather up our keys, and communicate our observations to the world. When trigger finger prevents our fingers from functioning, the rhythm of our day comes to an abrupt halt. Hand specialist Dr. Debra Parisi discusses the causes of this painful condition and describes the symptoms that signal trigger finger.
What is trigger finger?
“We have 2 tendons which run through the palm of our hand and into each finger,” explains Dr. Parisi. “As these tendons reach the base of the finger, they enter a tendon sheath. You can think of the sheath as a tunnel for the tendons. When everything is functioning properly, the tendons glide smoothly through the tunnel as we move our finger. However, function can be impaired If the sheath begins to thicken or if the tendons swell. When these things occur, the tendons can start to get caught as they move into the sheath entrance, which is also known as the A1 pulley. That catching can be painful and may make it gradually more difficult to straighten or bend your finger.”
Dr. Parisi tells us that when this condition is not treated, the finger may become stiff and ultimately lock in a bent position. “When the finger is stuck down, a patient may forcefully try to straighten it,” she says. “As the tendons are pulled through the restricting point in the tunnel, the finger pops or “triggers” open. That sudden pop inspired the name “trigger finger” for this condition.”
This finger condition can affect any finger of the hand. “It is most common in the thumb and ring finger,” says Dr. Parisi. “However any finger can be affected. This condition can affect multiple fingers on one or both hands, but most commonly, only one finger is affected.”
Causes of trigger finger
“Most often, this condition is related to aging,” explains Dr. Parisi. “Over time, degeneration of tissues in the hand can cause this condition. However, there are a number of factors that can increase the likelihood of this disorder.” Dr. Parisi identifies these additional factors.
- Overuse. Repetitive use of the hand and fingers may contribute to inflammation of the tendon sheath or tendon.
- Rheumatoid arthritis. “When rheumatoid arthritis patients develop inflammation around their joint linings and tendons, they are more likely to develop trigger fingers,” explains Dr. Parisi. “When you have more inflammation around the tendon, you are more vulnerable.”
- Diabetes and thyroid disorders. “People with diabetes or thyroid disorder are more likely to develop trigger finger because both these disorders have an impact on tendon vascularity,” points out Dr. Parisi. “With both these conditions, vascularity to tendons is less than optimal. This means that the tendon isn’t getting as much blood supply as it should get. In these circumstances, the tendon responds by thickening the tendon sheath. As the tendon sheath gets thicker, the tendon begins to get caught as it glides back and forth within the sheath.”
In conclusion, the risk factors for trigger finger include advancing age, tendon aggravation by arthritis, systemic diseases like diabetes and thyroid conditions, and the possibility of repetitive motion injury. “You are much more likely to see this condition as you enter the mature phase of your life,” notes Dr. Parisi. “However, this is not necessarily true if you are diabetic, and particularly if you are a brittle diabetic. In diabetic populations, we have seen this finger disorder in much younger patients.”
Symptoms of trigger finger
“Symptoms of trigger finger include pain and difficulty bending or straightening your finger,” notes Dr. Parisi. “Sometimes, patients feel a crackling sensation when they try to move their finger at the point where the tendon enters the sheath. The medical term for this sensation is crepitus. If early symptoms are not treated, the condition may progress. In later stages, patients may find that they are not able to straighten the finger all the way. They may also experience a contracture, or an inability to straighten the finger.”
Diagnosis of the condition
“This condition has a very classic, clinical diagnosis,” states Dr. Parisi. “We can palpate the tendon as it goes in and out of the tendon sheath. We’ll feel either a crackling sensation or a nodule in the palm, which is the thickened tendon sheath. And when patients experience finger triggering, the diagnosis is very clear.”
Dr. Parisi notes that imaging is not usually needed to diagnose trigger finger. “Sometimes,” she says, “I will send patients for X-rays. That’s because I want to make sure we’re not missing another stiffening factor like arthritis.”
Although a trigger finger can go away on its own, it often doesn’t. “If you don’t treat it, you are probably going to see the problem increase in severity over time,” says Dr. Parisi. “However, your finger will still be treatable. The biggest danger in delaying treatment is loss of finger motion. The longer the condition goes untreated, the more likely you are to develop a finger contracture. Sometimes, the finger becomes completely stuck down. This symptom is not permanent and can be fixed with surgery. However, depending on how long treatment is delayed, the patient may lose motion at the mid-finger PIP joint.”
Some patients fear that this finger disorder may spread to other fingers. Dr. Parisi assures us that this fear is unfounded. “It won’t necessarily spread to the other fingers,” she says. “But if you have a trigger finger, you are more likely to get it again—regardless of treatment. If you get this finger condition once, then it’s much more likely to recur in either the same finger or a different finger in either hand.”
Summit Orthopedics provides personalized hand and wrist expertise
The function of our hands is integrated through our wrists and arms to our shoulders; a problem anywhere along our arm may have a significant impact on hand function and quality of life. If you experience an injury or uncomfortable symptoms, our fellowship-trained hand and wrist surgeons are here to help. Summit physicians receive the highest levels of training and exclusively provide individualized care for conditions of the hand, wrist, and elbow.
Summit has convenient locations across the Minneapolis-St. Paul metro area, serving Minnesota and western Wisconsin. We have state-of-the-art centers for comprehensive orthopedic care in Eagan, MN, Plymouth, MN, Vadnais Heights, MN, and Woodbury, MN, as well as additional community clinics throughout the metro and southern Minnesota.
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