Finger Catching and Locking, by David Katz, MD

            Do your fingers ever lock or catch? Do you ever wake up in the morning with a finger stuck in your palm? Do you ever have to use your other hand to pull the finger straight again? If so, you may have a condition known as trigger finger.

            Trigger finger, or stenosing tenosynovitis, involves the tendons in the hand that bend the fingers. These tendons can be thought of as ropes that connect the muscles in the forearm to the bones of the finger. As the tendon moves into the finger, it runs through a tunnel of sorts that we refer to as the flexor sheath. The entrance to the tunnel is actually a small pulley that helps to keep the tendon close to the bone. This system is truly a well oiled machine, as any disturbance to either the tendon or the tunnel can create difficulty in finger motion as well as pain.

            Fingers begin triggering when the pulley (i.e. the tunnel entrance) or the tendon becomes thickened. This makes it hard for the tendon to glide in and out of the tunnel. With increased resistance, one may feel pain, popping, or catching with bending and straightening of the finger. As the tendon triggers, it can lead to increased thickening in the system which can lead to worsening of this condition.

            The cause of trigger finger is not always known. It can be associated with medical conditions such as diabetes, rheumatoid arthritis, and gout. Occasionally patients recall some minor trauma to the area; however, the majority of the time there is no obvious cause.

            The symptoms of trigger finger often start with pain or tenderness at the base of the finger where it meets the palm. Some of the time a small nodule can be felt in this area. Frequently patients report pain in one of their knuckles; however, the problem is actually occurring in the pulley.

            Treatment of trigger finger is geared towards eliminating the catching while restoring pain free motion of the finger. This typically begins with nonsurgical options such as small splints, anti-inflammatory medications, or injections. Swelling around the tendon in the sheath must be reduced in order to improve gliding. Steroid injections can often be very helpful in decreasing the inflammation and relieving the triggering. Diabetics must be careful when receiving these injections, as they can temporarily raise their blood sugar levels.

            If non-surgical means fail to completely relieve the symptoms, your physician may recommend surgery. The surgery is performed as an outpatient, often with local anesthesia and minimal sedation. A small incision is then made in your palm overlying the site of the thickened pulley. Your surgeon will then cut open the pulley to allow the tendon to glide freely. You may even be asked during the operation to move your finger to ensure the triggering has ceased. Immediately after the procedure, most patients find they are able to bend their fingers without further catching or locking. Typically you may resume light use of the hand right away. It is very normal to have some degree of soreness over the surgical site afterwards. Occasionally your doctor may recommend hand therapy to optimize motion.

            If you notice catching or locking of one of your fingers, ask your doctor if these symptoms are from trigger finger.