Information on Stenosing tenosynovitis or Trigger finger

Marc Darrow, MD, JD.

We see many people with finger problems. This includes “trigger finger.” For some people they have been to other doctors and have been diagnosed with the more technical term “stenosing tenosynovitis.” Whether a trigger finger or stenosing tenosynovitis diagnosis, you have been to the doctor because your finger is stuck or locked in a bent position and it is making a loud popping noise that you know is not right.

Over the course of time people try to manage trigger finger on their own. Many go online and look for quick remedies and suggestions.

Many people will:

  • Rest their fingers or avoid activities that irritate the situation. This is particular tough on a musician or someone who does a lot of dexterity work with their hands. So these people look for other things that may help.
  • They may alternate heat and ice therapy depending on whether they have inflammation or puffiness.
  • Sometimes they walk around with their hand a container of warm water to try to get the finger to relax and loosen up.
  • Add to this anti-inflammatories.
  • Some may also purchase a finger splint at the pharmacy and try to keep their finger extended with the splint and tape.

For those who did not find relief with these remedies, they sought out a doctor. At the doctors they got:

  • Stronger medications than the one they were taking: ibuprofen, naproxen or acetaminophen to help manage the pain.
  • A better splint

The A1 pulley

Doctors tend to get more technical when the patient is progressing their way towards surgery. Here a doctor may explain to the patient that they have a problem with their A1 pulley and their  flexor tendon. The flexor tendon attaches the muscles of the forearm to the bones of the fingers. In its path from forearm to finger, the flexor tendons passes through a band of tissue that holds it is place along the finger bones called the A1 pulley. When this tendon does not slide properly within the A1 pulley and it becomes irritated and inflamed. If the flexor tendon becomes too enlarged and swells up to the point that it can no longer glide back and forth within the A1 pulley. It gets stuck and so does your finger.

Is there a connection between carpal tunnel syndrome and trigger finger?

A May 2020 study (1) reviewed the connection between Carpal tunnel release and trigger finger. They wrote: “Carpal tunnel release is acknowledged as a predisposing factor for the development of the trigger finger. However, the incidence of new-onset trigger finger after Carpal tunnel release surgery has been inconsistently reported. In this study, we aimed to evaluate the prevalence of Carpal tunnel release as a risk factor of the development of the trigger finger.”

  • Post-Carpal tunnel release trigger finger was detected in 26.3% of the 57 patients of this study
  • The trigger finger occurred approximately six months after Carpal tunnel release surgery. The thumb and ring fingers were the most commonly involved fingers.
  • Ten out of 15 (66.7%) patients who developed a post-Carpal tunnel release trigger finger had mild-to-moderate Carpal tunnel syndrome, and five (33.3%) patients had severe Carpal tunnel syndrome. No significant difference was found between the patients who did and did not develop a trigger finger after Carpal tunnel release surgery.

“The rate of developing a post-Carpal tunnel syndrome trigger finger was remarkable in our study.” The authors of this study suggested that patients under going Carpal tunnel release be advised of the potential of developing trigger finger.

Research Cortisone and PRP

A July 2022 study (2) wrote: “Platelet-rich plasma (PRP) has emerged as a viable therapeutic alternative for a number of clinical applications and has potential benefit for use in trigger finger. However, PRP use has not been previously reported for this condition.” In this paper the doctors reported on a “63-year-old woman sustaining a refractory trigger finger after a series of three PRP injections over a 2-week period. There was resolution of triggering, with no symptom recurrence at 3-month follow-up. On the basis of this report, (the researchers assumed) that the treatment of trigger finger with PRP is a promising therapeutic option to be further explored with larger samples and high-quality studies.”

An April 2024 study (3) examined the records data of 275 patients with 283 trigger digits for the effectiveness of tendon release under ultrasound compared to an open surgical group for improvement in Quick Disability of Arm, Shoulder, and Hand score in the first month. The difference was not statistically significant in the 3-month follow-up period. Additionally, there is a significant difference in the days required for return to normal activities in favor of the ultrasound release approach. . .”Ultrasound-guided release showed advantages over open surgical release, resulting in improved Quick Disability of Arm, Shoulder, and Hand score and quicker return to normal activities. This offers a minimally invasive, successful alternative to open surgery, reducing associated risks.”

References

1 Aspinen S, Nordback PH, Anttila T, Stjernberg-Salmela S, Ryhänen J, Kosola J. Platelet-rich plasma versus corticosteroid injection for treatment of trigger finger: study protocol for a prospective randomized triple-blind placebo-controlled trial. Trials. 2020 Dec;21(1):1-9.
2 Medina-Porqueres I, Martin-Garcia P, Sanz-De-Diego S, Reyes-Eldblom M. Platelet-rich plasma in the management of trigger finger: A case report. Agri: Agri (Algoloji) Dernegi’nin Yayin Organidir= The Journal of the Turkish Society of Algology. 2022 Jul 1;34(3):222-4.
3 Hopkins RE, Bharat C, Buizen L, Close J, Ivers R, Draper B, Pearson SA, Degenhardt L, Gisev N. Age-related risk of serious fall events and opioid analgesic use. JAMA internal medicine. 2024 Feb 19.

 

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