Dear doctor, my mother’s finger is often "locked" when she wakes in the morning. Can an injection help?

16 May 2017

Q: My mother’s finger clicks and is often "locked" when she wakes in the morning. She has to forcibly straighten it and it is painful to do so. Can an injection help?

A: The symptoms you describe are commonly due to a trigger finger. The flexor tendons in the hand pass through a number of tight pulleys as they bend the fingers. Inflammation can cause swelling or the formation of a nodule on the flexor tendon - which jams in the pulley in the palm - as the finger tries to straighten.

It can lock and then suddenly release or, “trigger”. This is often painful and sometimes a little help is needed to forcibly straighten the finger when it gets stuck.  The tendon inflammation may occur after a period of repetitive or heavy hand use but often there may be no clear reason for the onset of symptoms. Triggering is commonly seen in diabetic patients and can also occur in the thumb.

Triggering can resolve spontaneously without any treatment, however if the problem persists, a steroid injection or in more severe cases minor surgery can help. A steroid injection is the preferred first initial treatment and can be administered in the outpatient clinic. The symptoms improve in about 60-90% of patients.

A minor surgical procedure called ‘trigger finger release’ is advised for recurrent triggering or fingers that remain locked. This is performed under local anaesthetic (while the patient is awake), in ambulatory care, so there is no overnight hospital stay required. The procedure takes 15-20 minutes and the wound has 2-3 stitches which are removed 7-10 days afterwards. The patient is encouraged to move the fingers and use the hand normally as soon as the stitches have been removed.

Mr Christopher Hobbs is a Consultant Orthopaedic Surgeon practising at Spire Portsmouth Hospital.

The content of this article is provided for general information only, and should not be treated as a substitute for the professional medical advice of your doctor or other health care professional.

 

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