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  • Alice Bremner-Smith

CASE OF THE MONTH : ‘A Triggering Little Finger’

Updated: Oct 28


Patient story

A pianist developed pain around the base of her left little finger. She found the finger didn’t work as well as normal when she played the piano. She hadn't injured the finger but had been playing and rehearsing more than usual in preparation for a performance. The symptoms worsened over 2-3 weeks and she saw her GP who prescribed anti-inflammatory tablets (ibuprofen) for possible tendonitis. These reduced the pain a little but she then noticed the finger start to 'stick' or ‘click’ when playing. In the mornings, especially, it would 'jerk' from a straight (extended) position to a bent (flexed) position and this sudden movement was painful.


Diagnosis : Trigger Finger

The flexor tendon (or sheath through which the tendon runs) develops a swelling which starts to ‘catch’ when the tendon moves. Triggering can affect any finger or the thumb.




Patient Story Continued.


The patient came to see me and underwent a steroid injection to the base of the finger in the clinic. This improved the symptoms within days and she was able to resume practising and playing the piano to her normal standard. The performance went well but unfortunately the symptoms recurred after approximately 4 months. A second steroid injection was applied, this time with ultrasound guidance, and this resolved the symptoms again so she is currently playing without problems. We have discussed options for further treatment if the symptoms recur again. We have decided to proceed with a local anaesthetic operation to release the triggering pulley if this happens.


Please read below for further information on this condition and get in touch if you'd like to know anything else about trigger fingers.


Symptoms

The finger suddenly ‘jerks’ when moving from a straight (extended) to a bent (flexed) posture or vice versa. This sudden movement may be painful. Sometimes it is necessary to use the other hand to move the affected digit because it is too difficult to move it unaided. The finger or thumb may become locked in a bent (flexed) position or straight (extended) position. You may be able to feel a little firm lump near the base of the finger on the palm side that moves when the finger is straightened and bent.




Treatment

Trigger finger is not a dangerous or harmful condition – it is, however, annoying and makes the finger more difficult to use. Sometimes the condition will spontaneously get better but not always. Sometimes it can deteriorate and become more painful or get increasingly stuck

Splints

Splints hold the finger straight (extended). As such they stop the finger triggering but they also make it difficult to use the finger for normal activities. Splints will sometimes allow the symptoms to settle over a period of time but they are not always effective.




Steroid injections

Steroid Injections relieve the symptoms in approximately 70% of cases. Sometimes they will resolve the symptoms permanently, sometimes temporarily and sometimes they reduce the severity of the symptoms. The procedure can be performed directly in the clinic setting or using ultrasound guidance. It takes a couple of minutes only and a small amount of local anaesthetic carefully applied is excellent for reducing discomfort. Usually the symptoms improve after this within 1-2 days. Side effects include an increase in pain temporarily (usually for 1-2 days – this is known as a ‘steroid flare’) and pigmentation of the skin. Other side effects are extremely rare




Operative Release

This is a quick procedure normally performed under local anaesthetic. It takes approximately 15 minutes. A small opening (approximately 1cm) is made near the base of the digit and the affected pulley is divided so there is no longer a barrier to the gliding of the tendon. After the procedure it is necessary to keep the hand clean and dry for approximately 10 days but otherwise useage for everyday activities is normal. The results of this procedure are good – usually permanent resolution of symptoms.






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