Trigger finger, also known as stenosing tenosynovitis, is a condition where one finger gets stuck in a bent position. Inflammation that narrows the space within the sheath surrounding the finger tendon, most commonly at the level of the first annular (A1) pulley, results in difficulty flexing or extending the finger. The finger may straighten with a snap - like a trigger on a gun. Trigger finger is a common hand condition among adults between 40 and 60 years of age, and repetitive gripping and grasping is often the underlying cause. While the condition can occur throughout the day, it is often worse in the morning. The condition occurs more frequently in women and in patients with diabetes, gout, kidney disease, and rheumatoid arthritis or other inflammatory conditions.
Trigger digits that fail to respond to two corticosteroid injections usually require surgical treatment (usually outpatient, under local anesthesia), in the form of a surgical release of the A1 pulley. The surgeon cuts the sheath that is restricting the tendon using one of two methods. In the percutaneous method, either a small needle or a needle-like device is inserted into the skin and used to sever the A1 pulley. This method is often better for the index, middle, and ring fingers. In the open technique, a small incision is made in the skin (in most instances with minimal scarring). This has proven more effective for the thumb or little finger.
Surgical consultation for operative treatment may be required. Typically, such procedures are performed by an orthopedic hand surgeon or a plastic surgeon. Surgical release of the A1 pulley is generally an elective procedure and may not be covered by insurance.