Triggering results from the tendons catching as they glide underneath the small straps (pulleys) which normally hold them next to the finger bones. The pulleys at the base of the ring or little finger in the palm are most commonly affected but all the fingers and the thumb can develop this condition.
To some extent, the thickening is part of ageing but only about 10% of the population suffer with this condition. It can be associated with arthritis as well as gout, diabetes and following unaccustomed trauma to the palm but usually no cause can be identified.
The process starts with thickening of the pulley, followed by irritation of the tendon as it glides through an increasingly narrow tunnel. A cycle of inflammation can ensue. Sometimes the tendon will become stuck past the pulley, with the finger bent into the palm, and the digit then has to be painfully straightened manually with the other hand.
The affected fingers are often worst in the morning. Sometimes the joints further down the finger can become stiff if the finger is not straightened regularly.
In severe cases, the finger can become stuck in a bent position in the palm and cannot be corrected, even using the other hand.
Severe inflammation can also start to interfere with sleep and damage the internal structure of the tendons.
Usually the history and examination are so characteristic that no investigations are required. Occasionally, other conditions might need to be excluded with an x-ray or a scan.
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If the triggering is mild then rest and use of an anti-inflammatory medication, either locally or by mouth, may solve the problem. It is important to keep the joints of all the fingers fully mobile, if necessary using the other hand to stretch out the fingers.
A local anaesthetic and steroid injection around the tendon will resolve the majority of resistant cases.
Some patients still have symptoms after injections and they can be considered for a small operation to release the strap over the top of the tendon which allows free gliding of the tendon again. This is a local anaesthetic, day case procedure.
After the operation there will be a small adhesive dressing on the wound and a padded bandage around the finger and palm. Finger exercises to keep the digits moving are encouraged immediately after surgery.
Patients will need to keep the hand and arm elevated for a few days after the surgery to avoid swelling, but the hand can be used for light activities.
After 2 days, the padded bandage is removed but the wound is kept covered and must be kept clean and dry until the stitches are removed 2 weeks after the operation.
Once the wound has healed, massaging the scarred area with some hand cream can help soften the scar and make it more comfortable.
Most people return to work once the stitches have been removed but it might be sooner for those with light jobs or longer (up to six weeks) for those with physically demanding occupations, such as manual labourers.
Driving can be undertaken when you feel safe to control the car but most people avoid this for the first two weeks or until the wound is healed.