Is trigger finger just a DIY injury?

An underlying condition may be to blame for trigger finger explain Dr Emma Lackey and Mr Ron Sutton.

A flare-up of trigger finger is often caused by DIY activities such as using screwdrivers or pistol-grip power tools requiring repetitive grasping actions with pressure into the palm.

The condition involves the clicking, locking or snapping of a finger at the metacarpophalangeal joint. In adults, the middle and ring finger are most commonly affected. The peak incidence is in those aged between 55 and 60.

Patients with diabetes, rheumatoid arthritis, gout or hypothyroidism are more likely to develop trigger finger.

A congenital form of the condition is occasionally seen in children's thumbs, and patients with this condition should be referred to a specialist for surgical correction.

In adults, the problem develops where the finger flexor tendon runs into its sheath. The sheath becomes irritated, the tendon cannot slide smoothly and itself becomes swollen.

A vicious circle is generated with constriction aggravating the swelling and vice versa. The enlarged tendon may be palpable as a nodule in the palm at the distal palmar crease.

Symptoms

The first symptom is often discomfort at the affected finger base, with uneven and painful finger movement. Patients then find that, when they relax a fist, the affected finger remains flexed and can be straightened only by passive movement, with a click. In severe cases, the finger is locked in the bent position.

The differential diagnoses include suppurative tenosynovitis (which needs urgent referral to a hand surgeon) or a Dupuytren's contracture.

Treatment

The tendon sheath is injected with steroid to reduce swelling. This is successful in about three quarters of cases. A maximum of three injections is advised. Care should be taken not to inject the tendon itself.

Warn patients to report signs of infection or excessive bleeding after injection. Patients with diabetes may notice transient elevation in blood sugars.

Although nerve injury is uncommon, the finger may be numb for a few hours after the injection. Patients should avoid excessive stress on the finger for the next few weeks.

Surgery is indicated if three steroid injections fail to produce improvement.

After the operation, the patient is advised to take anti-inflammatories and elevate the hand for a few days to minimise swelling. Active movement is encouraged on the day of surgery.

Nerve damage is rare but may require operative repair.

Patients should be aware that activities using the affected hand may be restricted for four to six weeks. Recurrence in the same finger is rare, but triggering may subsequently occur in other fingers.

- Dr Lackey is a GP in Killingworth, Tyne and Wear and Mr Sutton is a consultant orthopaedic surgeon in Northumberland

KEY POINTS

- Trigger finger involves the clicking, locking or snapping of a finger at the metacarpophalangeal joint.

- Multiple trigger fingers may suggest an underlying cause, such as diabetes.

- If three steroid injections are unsuccessful, surgical treatment is indicated.

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins

Register

Already registered?

Sign in

Follow Us:

Just published

What medico-legal challenges will GPs face in 2019?

What medico-legal challenges will GPs face in 2019?

The MDU's head of advisory services, Dr Caroline Fryar, predicts which medico-legal...

GP practices providing online consultations doubled in 12 months, survey suggests

GP practices providing online consultations doubled in 12 months, survey suggests

The proportion of GP practices in England providing online consultations has almost...

Dr Nikita Kanani: Why peer support is the key to building a stronger general practice

Dr Nikita Kanani: Why peer support is the key to building a stronger general practice

NHS England's acting director of primary care Dr Nikita Kanani says connecting with...

Next-day GP appointments three times as likely to be missed as same-day bookings

Next-day GP appointments three times as likely to be missed as same-day bookings

Patients are nearly three times as likely to miss appointments booked with GP practices...

Outsourcing GP services overseas could be 'legal minefield', experts warn

Outsourcing GP services overseas could be 'legal minefield', experts warn

Using digital technology to outsource GP consultations overseas could leave the NHS...

RCGP sets out advice for GPs on prescribing cannabis

RCGP sets out advice for GPs on prescribing cannabis

GPs should warn patients hoping to access cannabis-based medicines that the process...