What is it?
A condition affecting the flexor mechanism of the fingers, characterised by "triggering" of the affected finger(s), and pain. The thumb may also be affected. It is sometimes called "stenosing tenosynovitis".
The majority of cases have no identifiable cause, but patients with Diabetes and rheumatoid arthritis are at more risk than the general population of developing this condition.
What are the symptoms?
One or more fingers catches or locks, making it difficult to extend the finger from a flexed position. When the finger does extend, it releases suddenly with a click - hence the name "trigger finger". There may be associated pain. The symptoms are often worse at night or early in the morning.
How is it diagnosed?
In the majority of cases the diagnosis is made clinically (i.e. from the patient's history and examination findings). Occasionally people with this condition simply complain of pain and exhibit tenderness at the palmar aspect of the relevant MCP joint, without frank triggering.
How is it treated?
Steroid injections to the most proximal region of the flexor sheath (the so-called A1 pulley) are helpful in treating the symptoms of this condition. The symptoms can return within a few months however, or may not be alleviated. It is normal practice to try up to two steroid injections, as around 50% of patients can have their symptoms resolved without resorting to surgery. If surgery is required, it can be carried out under local anaesthetic - the procedure involves simple division of the A1 pulley. In the thumb I prefer to carry out the surgery under regional block (see section on anaesthesia), as a more careful exposure of the area is required to avoid damage to the sensory nerves of the thumb.
Trigger finger in rheumatoid patients is a special situation and it usually more appropriate to carry out a flexor tenosynovectomy (removal of the inflamed lining of the tendon) than to divide the A1 pulley.
Mr. Gidwani will be able to discuss the pros and cons of surgical treatment in more detail during your consultation.