Dr Sachin Tapasvi: Trigger-happy? Ouch!

The trigger finger is not a happy finger. When it triggers, it hurts, it pains, it locks, it jams and it is miserable.

Our fingers are a unique prehensile structure. They flex, they extend, they help us grip, they help us reach and they help us to find as well as do activities of daily living. These fingers are moved by rope like structures in our hand, which are known as tendons. These tendons are continuation of muscles, which arise in the forearm and taper as they reach the fingertips. As one would imagine these rope-like structures need to be guided in their proper place, otherwise if they slip and deviate then the movements would become extremely awkward. Just like a railways runs on tracks and travels beneath a tunnel so that it does not loose its position, these tendons move or pass through a tunnel at the level of each joint.

These tunnels are made of fibrous tissue and they are called as pulleys.  Typically, when a pulley thickens, it does not allow smooth gliding of the tendon. As a result, the obstruction created is like a ball valve mechanism, which means that the finger can bend and it can course pass the thickened contracture but return to the full extension or the straight finger position becomes painful and often is associated with a jerk; and in extreme cases may even lock. This is known by trigger finger.

A trigger finger may usually occur when there is a small occult injury to this area of the pulley. As a result of the injury, the pulley gets thickened thereby leading to the further course of events. The pulley may be felt in the palm as a tight painful bulbous or cord-like structure. Occasionally it may be felt like a hard nodule as well. So how exactly do we tackle this condition?

In the mild to moderate stages, taking some mild inflammatory pills for a couple of days is useful. A gentle oil massage can be done to the tendon and pulley area to decrease any scar tissue or adhesions that may be increasing the nature of the problem. However, once the symptoms are grossly advanced, invasive treatment may be required. Injections mainly of Cortisone are given in the area of the pulley and they may help resolve the inflammation in the pulley leading to resolution of symptoms. In advanced cases a small surgery under short general or local anesthesia is required in which a small incision is given in the pulley which allows the fingers to move easily. Recovery from this procedure is very rapid and one could easily join back work in a day or two. No extra special care is required thereafter.

If left untreated, the condition may progress to an extent that this tendon may get locked and may rupture. If it ruptures, the whole procedure gets quite complicated and may require two or three surgical procedures and prolonged rehabilitation.

This same issue is also seen underneath the thumb where it assumes another name – de Quervain’s disease. The problem is the same, but due to its unique location, it is named differently.

So friends, do not be trigger-happy because trigger finger is not a very pleasant thing to have. I wish all my readers a Very Happy and Prosperous Diwali and a Long Healthy Life.

Dr Sachin Tapasvi

Dr Sachin Tapasvi

Dr Sachin Tapasvi is one of India’s leading joint replacement surgeons. He practises in Pune and has been awarded several fellowships with experience garnered internationally as well as in India. Dr Tapasvi writes every Wednesday on Pune365.
Dr Sachin Tapasvi