The flexor tendons to the fingers and thumb are the structures that attach our muscles of the forearm to the bones and allow our muscles to move the joints of the fingers and thumb. The flexor tendons in the fingers and thumb move through an elaborate system of rigid fibrous bands called pulleys which form a sheath around the tendons. Normally, the flexor tendons are able to smoothly glide through the pulleys to provide us with free, unrestricted motion of our fingers and thumb. When thickening and inflammation of the pulley lining and synovial lining of the tendon occurs, the flexor tendon is no longer able to glide smoothly and begins to catch or trigger on the edge of the pulley. As one can imagine, it is like trying to pull a rope with knots through a pulley. The problem typically starts as pain with intermittent clicking or catching of the tendon towards the base of the finger or thumb, and eventually, the finger or thumb will frankly trigger, lock, or pop. When more advanced, stiffness of the finger or thumb joints can occur.
Most trigger fingers or thumbs can be successfully treated with non-operative treatment. Your physician will discuss use of “trigger” splints, importance of range of motion exercises to prevent stiffness, and use of corticosteroid injections (also referred to as “cortisone” injection). More than one injection may be necessary for recurrence of the triggering problem. If the triggering is more advanced and fails conservative treatment, surgery is recommended to resolve the problem. The surgery involves opening the first pulley of the tendon sheath to release the tendon constriction which restores catch-free gliding of the flexor tendon. The surgery is typically performed with a local anesthetic. Dr. Katz will discuss these various options to help you choose the treatment that is best for you.