Trigger Finger

Trigger Finger is a condition where the finger locks at the first joint of the finger. The condition can be mild, moderate, or severe. The mild form is more of a nuisance and often requires no treatment. In severe forms, a Trigger Finger is painfully locked. One or multiple fingers can be involved. Conservative treatment with steroid injection can be used in mild forms of Trigger Finger. Surgical release is used for more severe forms.

So what causes the triggering? The flexor tendons of the fingers are located on the palmer side of the hand. As these tendon approach the fingers, they pass through a series of pulleys. These pulleys hold the tendon tightly to the bones. Without these pulleys, the tendons will “bow string” which results in an inability to completely flex the fingers. The pulleys are named and sequenced. For example, the first pulley is the A-1 pulley (A refers to the annular appearance and the C refers to a cruciate or criss cross—appearance). There is a C-1, A-2, C-2, A-3, C-3 and A-4 pulleys. The most important pulleys are the A-2 and A-4 pulleys.

As the tendon passes the A-1 pulley, there is a discrepancy in size between the pulley and the tendon. The tendon will stick where the size discrepancy is too great to allow the tendon to pass smoothly.  The condition can be so severe that the tendon can actually lock resulting in a flex joint.

If this is the case, the A-1 pulley can be divided surgically to allow the tendon to glide smoothly below the released A-1 pulley.

The patients who release the triggering surgically are expected to see relief immediately. It is a satisfying surgery for the patient because the problem is corrected easily. The surgery itself is a very short surgery and the recovery is also very short. The sutures are usually removed within a week of the surgery.