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Trigger finger, as its name suggests, is a condition in which one or more fingers lock in a bent position before abruptly straightening, resembling the action of pulling a trigger. It develops when inflammation causes the flexor tendon sheath to narrow, restricting movement and leading to pain, stiffness, and discomfort.
While it may seem like a minor inconvenience, untreated trigger finger can lead to significant discomfort and impaired hand function, affecting daily activities like gripping objects, writing, or even typing. Fortunately, a variety of treatment options, including physiotherapy, shockwave therapy, and steroid injections, can help manage symptoms and restore function.
Causes and Risk Factors
Many causes are risk factors are attributed to the development of this condition - including;
Repetitive Hand Movements
Frequent gripping, pinching, or repeated finger movements (such as in musicians, factory workers, or people who use handheld tools) can strain the tendons, leading to inflammation and the development of trigger finger.
Underlying Medical Conditions
The risk of trigger finger is increased with certain medical conditions, such as:
Diabetes: Diabetic people (both type 1 and type 2) are more likely to have tendon inflammation and thickening.
Rheumatoid Arthritis: Autoimmune conditions can cause chronic tendon irritation.
Gout: Uric acid deposits can contribute to tendon irritation and stiffness.
Age and Gender: Trigger finger is more common in individuals over 50, and women are more frequently affected than men due to hormonal influences on connective tissue.
Trauma or Injury: A direct injury to the palm or fingers may cause scarring or thickening of the tendon sheath, leading to the development of trigger finger.
Treatment Options For Trigger Finger
Treatment options aim to reduce pain, restore normal finger function, and prevent worsening symptoms. Depending on the severity, both non-invasive and surgical approaches are available. Here are the treatment options:
Non-Surgical Treatment Options
Physiotherapy plays a crucial role in managing trigger finger by improving flexibility, reducing inflammation, and preventing stiffness. Some effective physiotherapy techniques include:
Stretching Exercises: Gentle stretching of the affected finger can prevent further stiffness and improve range of motion.
Massage Therapy: Helps break down adhesions and improve blood circulation to the tendon.
Splinting: A night splint wearing routine helps keep the finger in a straight position, preventing it from locking and minimizing strain on the tendon.
Heat and Cold Therapy: Alternate heat and cold therapy is shown to help alleviate pain, reduce inflammation, and improve flexibility in the affected finger.
Shockwave therapy is an FDA-approved treatment for trigger finger. This non-invasive technique is useful in reducing inflammation and promoting tendon and soft tissue healing. It has been increasingly used as an alternative treatment for trigger finger, especially for patients looking to avoid steroid injections or surgery.
How Shockwave Therapy Works
ESWT delivers high-energy sound waves to the affected area, creating microtrauma within the tissue. This stimulates the body's natural healing process by improving blood circulation, reducing inflammation, breaking down scar tissue, and encouraging the repair of healthy tendon fibers. Here’s how it helps with trigger finger:
Increases Blood Circulation
The shockwaves promote angiogenesis (formation of new blood vessels) in the affected tissue, enhancing oxygen and nutrient delivery to the tendon, which accelerates healing and tissue regeneration. This speeds up healing and reduces inflammation.
Breaks Down Scar Tissue
Chronic inflammation in the trigger finger can lead to scar tissue formation around the A1 pulley (the sheath that holds the tendon). Shockwave therapy helps soften and break down this fibrotic tissue, allowing smoother tendon movement.
Reduces Pain and Swelling
The waves disrupt pain pathways, reducing nerve sensitivity and providing long-lasting pain relief.
It decreases the production of inflammatory chemicals, reducing swelling in the tendon sheath.
Promotes Collagen Production
Collagen is essential for tendon repair. Shockwave therapy boosts collagen synthesis, making tendons stronger and more flexible over time.
Shockwave Therapy Procedure
● A handheld device is positioned over the affected finger or palm.
● The machine delivers controlled pulses of radial or focused shockwaves to the tissue.
● A typical session lasts 10–20 minutes, and most patients require 3–6 sessions (once a week).
● Patients can resume their usual activities right after treatment since shockwave therapy involves no downtime or recovery period.
Who Can Benefit from Shockwave Therapy?
Shockwave therapy is most effective for individuals with mild to moderate cases of trigger finger, helping to reduce pain and improve mobility without the need for injections or surgery. It benefits
● Patients who want non-invasive treatment without injections or surgery.
● Patients who experience recurrent trigger finger despite previous steroid injections may benefit from shockwave therapy as an alternative treatment to reduce inflammation and improve tendon function.
Corticosteroid injections are one of the most effective non-surgical treatments for trigger finger, providing fast relief from pain and inflammation.
How Steroid Injections Work
A corticosteroid medicine is injected at the base of the tendon sheath of the affected finger. This treatment works by:
Reduces Inflammation
The steroid suppresses the immune response, reducing swelling around the flexor tendon and allowing smoother movement.
Lubricates the Tendon Sheath
By decreasing inflammation, the steroid improves gliding motion of the tendon within the sheath, reducing the locking sensation.
Pain Relief
Steroids block inflammatory chemicals like prostaglandins, leading to a rapid reduction in pain.
Effectiveness of Steroid Injections
● 60-90% of patients experience symptom relief with a single injection.
● Results typically become apparent within a few days, with benefits lasting from several months to a year.
● If symptoms persist, a second injection may be administered after 6–8 weeks to enhance relief and reduce inflammation further.
● Studies suggest that steroid injections are more effective for early-stage trigger finger than advanced cases with severe tendon thickening.
How the Procedure is Performed
Injection Site Preparation:
The clinician cleans the area and may apply a numbing agent.
Steroid Injection:
A fine needle is inserted into the tendon sheath, and the corticosteroid + local anaesthetic mixture is injected.
Post-Injection Care:
Patients are advised to gently move the finger to prevent stiffness.
Avoid heavy gripping or repetitive finger movements for 24–48 hours.
Who Should Consider Steroid Injections?
● Patients with moderate to severe trigger fingers.
● Those who need fast pain relief without undergoing surgery.
● People who don’t have a positive response to physiotherapy or shockwave therapy.
Surgical and Minimally Invasive Options
If non-surgical treatments fail, surgical intervention may be necessary.
1. Percutaneous Release
Performed under local anaesthesia, the percutaneous release is a minimally invasive procedure in which a needle is used to break apart the tightened tendon sheath, allowing smoother movement. The procedure offers a fast recovery with minimal discomfort.
2. Open Surgery
● This technique requires a small incision in the palm to release the constricted tendon sheath, allowing for smoother and unrestricted finger movement.
● Typically recommended for severe or long-standing cases.
● Recovery takes a few weeks, with physiotherapy required to regain full function.
Rehabilitation and Long-Term Management
1. Post-Treatment Care
Hand Exercises: Gentle exercises help restore function and prevent stiffness.
Avoid Repetitive Stress: Modify activities that strain the fingers.
Regular Physiotherapy: Continued therapy can prevent recurrence.
2. Preventing Trigger Finger Recurrence
● Maintain good hand ergonomics, especially for individuals who use tools or play musical instruments.
● Keep the hands warm and flexible with regular movement and stretching.
● Manage underlying conditions like diabetes and arthritis to reduce inflammation risks.
Conclusion
Trigger finger can severely affect a person’s daily activities, making simple tasks like gripping, holding, or writing challenging. However, prompt treatment can significantly alleviate the discomfort and restore function. Non-invasive options such as physiotherapy, shockwave therapy, and steroid injections can effectively manage the symptoms and reduce inflammation, helping individuals regain mobility and function in their hands. For more severe cases, minimally invasive procedures or surgical interventions may be necessary to provide lasting relief and prevent further complications.
Understanding the underlying causes and recognizing the symptoms of trigger finger are crucial steps in choosing the right treatment approach. Early intervention plays a key role in preventing the condition from worsening and improving the chances of a full recovery. By exploring all available treatment options, including both conservative and surgical methods, individuals are empowered to make informed decisions about their care, ensuring they can maintain healthy, functional hands for daily activities and overall well-being.
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