Joseph Yao, M.D.

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Painful catching fingers

Painful catching (called triggering) can affect one or more fingers. A visible catch occurs when the involved finger is bent (flexed) and straightened (extended). The catching appears to affect the first joint of the finger. However, the catching actually occurs in the palm at the base of the finger.
     This condition is called trigger finger. It often affects the thumb (called trigger thumb), but can involve any of the fingers. Some people have triggering of more than one finger. The problem occurs because the flexor tendon (the tendon on the bottom of the finger that bends the finger) becomes pinched by a thickened area of the flexor tendon sheath (the tunnel in which the flexor tendon glides) called the Annular-1 (A-1) flexor pulley.
     Trigger fingers are often due to overuse. They occur more frequently in people with diabetes. Truck drivers might notice that a trigger finger becomes “stuck” in a bent position as it is wrapped around a steering wheel. The finger has to be forced to straighten (extend) so it can be removed. There is a painful pop as the finger is straightened and the flexor tendon snaps through the A-1 flexor pulley.
     In the beginning, it is possible for a person to flex and extend the finger, although this results in pain-ful popping. In advanced cases, the finger becomes “stuck” in a flexed (bent) position and the person may have to use their other hand to help straighten the finger. Straightening the finger results in a pop and moderately severe pain. In severe cases, the finger becomes fixed in a flexed position, and the person can no longer extend the finger.
     Trigger fingers begin with inflammation where the tendon is pinched at the A-1 flexor pulley. Swelling is usually not visible from the outside of the hand. Oral anti-inflammatory medications can be tried, but these are not generally very effective. A rigid finger splint can be used to immobilize the finger, putting it to rest by avoiding gliding of the flexor tendon through the A-1 flexor pulley area. This can relieve the inflammation and solve the problem. A more effective treatment during the inflammation stage is a local steroid injection into the A-1 flexor pulley area. The injection can often eliminate triggering if it is given soon enough after the problem begins.
     Steroid injections are ineffective once the problem progresses from simple inflammation to the point where the A-1 flexor pulley becomes permanently too tight for the flexor tendon to glide smoothly through it. Surgery becomes necessary and consists of cutting the A-1 flexor pulley to eliminate pinching of the flexor tendon. No splinting is necessary, and the finger can be moved right away. Skin sutures are removed one week after surgery.
     Dr. Joseph Yao has undertaken extensive subspecialty training in joint replacement after completing an orthopedic surgery residency. Dr. Yao has been in private practice orthopedic surgery since 1987, and he has treated many truck drivers for joint and nerve ailments.