If you understand that your fingers are constructed of pulley-like tissue known as tendons, and that these are what bend and flex the thumb and fingers, it is a very helpful visual for a diagnosis of trigger finger. This is because the condition, which is technically known as stenosing tenosynovitis, occurs when one of the pulleys at the bottom of a finger (or thumb) thickens and can no longer move fluidly. Essentially, it will lock the finger in an unnatural, curved position, and become an ongoing and worsening condition.
To envision what is happening when you suffer trigger finger, try to envision a series of pulleys, which are ring shaped structures through which ropes run in order to lift or move objects. So, your finger is a series of bones, and connected to them are those pulleys, and through those pulleys run tendons that connect to muscles and which cause the fingers to bend and flex when needed.
Imagine if a pulley at the bottom of a finger got clogged with a sticky residue that caused the tendon to catch or be unable to glide freely through the pulley. This would cause the tendon to become irritate with repeated catching issues, and this irritation would lead to swelling. This is what happens with trigger finger, and eventually, the tendon below the lowest pulley will swell to such as degree, or even form a nodule, that it cannot pass back upward through the pulley. This locks the finger in that hooked position, that looks similar to someone pressing the trigger of a pistol.
Why Does This Happen?
Obviously, it makes many wonder why the pulley would swell in the first place, and experts are not quite sure on the underlying cause. (ASSH.org, 2015) Some patients with arthritis may get this condition, and some with diabetes or gout will develop it. However, there are some who suffer trigger finger without any apparent cause, though trauma to the hand does seem to be related to the development of some cases.
It doesn’t happen instantly, though, and there are indicators that you may be developing trigger finger. You may have discomfort in your palm or tenderness when pressure is applied. Additionally, the sensation of the middle or large knuckle catching is often an indicator (though it is not the precise location of the problem) that trigger finger may be developing.
Trigger Finger Treatment
How does a hand doctor unlock this caught tendon? The first steps are to attempt to reduce the swelling and allow the tendon to begin moving freely again. This can often be done with a combination of splinting and anti-inflammatory medications. Injectable steroids may also be used to release or reduce the swelling. Should these conservative efforts fail, the next step is to perform a surgical release that opens the pulley and allows the tendon to return to its normal position.
Any treatment must be done by a hand doctor, and therapy is often required to ensure that the problem has been resolved and that the pulley is no longer causing the tendon to be captured.
