Check Up: 'Trigger finger' making man's life hard

August 20, 2018

Dear Readers,

Rodger has a problem with his right hand. He is a 48-year-old construction site worker. He is unable to open out his right index finger once it is bent. He has to help it open. He has been strapping it to the adjacent finger, but it isn’t helping at all. It was hurting before but not so much now. Rodger asks Check Up what is happening and if he needs to go to a doctor.

Rodger has 'trigger finger'. This is a painful disorder where the finger/s or thumb lock when bent. What occurs is that the tendons in the affected finger becomes inflamed and thickened and cannot pass easily through the tissue (sheath) which covers it. Sometimes even scarring occurs to the inflamed tendon. When this occurs, bending or extending the finger causes the inflamed tendon to be forced through the now narrow and usually lubricated covering, sometimes resulting in a popping sound.

It occurs because of repeated movement or forceful use of the finger/thumb involved, maybe with repeated use of a hammer or other tool? Trigger finger is also seen more often in people who suffer with inflammatory bone and joint disorders like Rheumatoid Arthritis, gout and Diabetes Mellitus. Musicians also often suffer with trigger finger because of the repeated finger movements such as the strumming of a guitar.
Symptoms of trigger finger are: soreness or pain at the base of the finger; painful clicking when bending or straightening the finger; locking of the finger in a bent or straight position, which as the condition worsens requires the help of the other hand to straighten it out or bend it; and sometimes a bump may be felt over the finger joint in the palm of the hand.

To treat the condition, sometimes the entire hand can be splinted to keep the finger immobile and anti-inflammatory drugs such as Brufen and Advil can be obtained over the counter at the pharmacy. Stronger anti-inflammatory medication is also available with doctor’s prescription. Your doctor might also prescribe a steroid injection into the inflamed tendon and sheath.

SPLINTING THE FINGER

When the disorder is fairly mild, resting the finger with splinting and taking anti-inflammatory drugs might resolve the condition in a few weeks. If splinting for six weeks doesn’t work, your doctor may refer you to a surgeon for a simple, in office procedure, which is certain to resolve the problem (so maybe this is the really preferred route of treatment). If splinting works then you’ll need to avoid activities which need repeated gripping or grasping or wear padded gloves while involved in the activity or it will likely recur.

The surgical procedure is one where the doctor anaesthetises the palm and inserts a needle into the swollen tendon sheath. Moving the needle around, the doctor breaks apart the constriction that’s preventing the smooth movement of the tendon. This must be done by a skilled surgeon, usually an orthopaedic surgeon, to avoid destruction of nearby nerves or other tendons.

Check Up advises Rodger to visit the doctor for examination and possible referral to the orthopaedic clinic. 

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