Trigger finger release

Cause, clinical and ultrasound findings

• Trigger finger is the result of stenosing tenosynovitis which may be the result of repeated mechanical use – for example, gripping a hand tool for a long time. It is also associated with rheumatoid arthritis, gout, complications of diabetes and Dupuytren’s contractures. The condition is more common in women than in men and most frequently occurs between the ages of 40 and 60.

• Soreness at the base of the finger or thumb may be present, with painful clicking or snapping when bending or straightening the finger. The condition improves after exercise but worsens after rest. Conservative treatment includes reduced activity, splinting and nonsteroidal antiinflammatory drugs. Some will offer steroid injections around the trigger point, but we recommend percutaneous release without steroids.

• The tendon sheath and A1 pulley are thickened at the site of triggering. Dynamic ultrasound examination shows a visible obstruction to tendon movement with bunching of the tendon. The click may be observed on ultrasound video loops. It is important to identify the exact location before performing percutaneous release.