Trigger thumb is a condition in which the flexing of the thumb is affected. When the thumb is flexed, a locking sensation is experienced. In more severe cases, pain is also felt. However, this condition is not limited to just the thumb – other fingers too can get affected and result in what is known as trigger finger. Nevertheless, the thumb is most often affected.

Before we proceed, we need to know a little about the finger anatomy to understand why trigger finger happens.

Anatomy of a Finger

• Our hands have tendons that connect our forearm muscles to the bones in our fingers. These tendons are known as flexor tendons.
• Contraction of the muscles pulls on the particular tendons which causes the respective fingers to bend.
• The flexor tendon for every finger passes through its own tendon sheath (a tubular structure) on the way from the palm to the fingers.
• When this tendon sheath due to some reason gets inflamed, trigger finger occurs.
• In trigger finger, the tendon’s movement through the sheath is hindered causing mobility restriction and in some cases pain.
• Over time, a nodule may develop on the tendon which results in restricting mobility further and this causes even more pain when the finger is flexed.

Causes of Trigger Thumb  

While the exact reason as to why trigger thumb or trigger finger happens is not known, the following have been seen to increase the risk of the condition:

• When the thumb and other fingers are put to repetitive usage due to a person’s occupation – for example, typing on the laptop and clicking on the mouse repeatedly for many hours a day and for many days at a stretch, the risk of the condition increases significantly.
• A person with a diabetic condition or rheumatoid arthritis is also at increased risk.
• Adults in the age group of 40-60 are often affected. Children are rarely affected.
• Women are more affected compared to men.

The condition can cause hindrance to normal activities like buttoning a shirt, gripping a key or even holding on to the steering wheel while driving.

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Symptoms of Trigger Thumb (Trigger Finger)

The condition can affect more than one finger at a time and it is possible that both hands could be affected as well. The symptoms include the following.

• The affected digit feels stiff, particularly in the mornings after waking up.
• Movement of the finger may result in a popping or clicking sensation.
• A bump may be felt at the base of the affected finger.
• Pain may be felt at the base of the finger and this pain is worse when trying to hold an object.
• Pain is also felt while flexing the finger.
• Finger locks in a position and then needs to be released with the help of the other hand.

Diagnosis

A physical examination is done wherein the doctor will check for finger stiffness, pain and locking. The history of the condition will also be recorded. The doctor will want to know if any particular activity worsens it. An x-ray or ultrasound may be advised.

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Treatment

The treatment decided on depends on the severity of the condition.

• Medication: The doctor will start with NSAIDs in the form of tablets, creams or patches.
• Rest: Resting the hand and not performing the activity that brought on the pain might help. The doctor may recommend avoiding any kind of activity that involves grasping or gripping. If it cannot be avoided, wearing padded gloves while performing the activity may be advised.
• Splint: The doctor may advise using a splint to prevent movement of the finger.
• Stretching: Simple stretching exercises will be taught to relieve stiffness and maintain finger mobility.

If the above-mentioned conservative treatments do not work, the following might be tried:

• Steroid Injections: A steroid injection may be administered on or near the inflamed tendon sheath to help control inflammation and allow free movement of the tendon. The injection will usually offer relief for up to a year.
• Needle Procedure: Here, a local anesthetic is applied to numb the area to be treated. A needle is then inserted and manipulated to break the tissue that is preventing the motion of the tendon.
• Surgery: Surgery for the condition has been shown to have a high success rate with the condition returning only in very rare cases.
  • To being with, the hand is secured so that it does not move. The anesthesia to be administered will be decided by the doctor keeping the best interests of the patient in mind.
  • Then, a cut is made at the base of the affected finger.
  • The tendon sheath is then opened up to allow free motion of the tendon.
  • Recovery after surgery varies with every patient.
  • Painkillers to handle the post-operative pain will be given.
  • Finger movement should be possible immediately after surgery.
  • Physiotherapy will commence to keep the fingers mobile – mild exercises will be taught to begin with which will gradually progress to harder ones.
  • Stitch removal will be done around 10 days after surgery.
  • Complete recovery will take 4-6 months.

Prevention

• Avoiding overuse is the main way to prevent the onset of the condition.
• While playing sports or working, maintaining proper form is important.
• For those whose work involves typing or any activity that demands finger usage, it is crucial to take breaks in between and rest the fingers.

Trigger finger will not resolve on its own. If you feel you have symptoms of the condition or finger mobility is restricted, do get it checked by your doctor. Early diagnosis will help keep the treatment simple. If the condition is of sudden onset with finger mobility completely limited, emergency treatment should be sought.

However, trigger finger is treatable irrespective of severity. With proper treatment, return to normal activities should be possible.

Frequently Asked Questions

1. What is trigger thumb?

Trigger thumb is a condition where the thumb gets stuck in a bent position due to inflammation of the tendon sheath, causing pain, stiffness, and a “locking” sensation.

2. What causes trigger thumb?

Trigger thumb can result from repetitive thumb and finger use, certain medical conditions like diabetes or rheumatoid arthritis, and is more common in women and people aged 40-60.

3. What are the symptoms of trigger thumb?

Symptoms include stiffness in the thumb (especially in the morning), a popping or clicking sensation, pain at the base of the thumb, and sometimes the thumb getting locked in a bent position.

4. How is trigger thumb treated?

Treatment options include rest, NSAIDs, splinting, stretching exercises, steroid injections, a needle procedure, or surgery, depending on the severity.

5. Can trigger thumb be prevented?

To prevent trigger thumb, avoid repetitive finger movements, use proper form while working or playing sports, and take regular breaks to rest the fingers.

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