Uno pain at the base of the finger, a feeling of stiffness in the morning, then that sudden little “click” that surprises and annoys. The trigger finger it is a more common disorder than you think, especially among women and in menopause. Yet, it is often underestimated until movement becomes truly difficult. We’ll talk about it with Dr. Alessandra Scaleseorthopedist at the Hand Surgery Unit III at the San Siro Clinical Instituteto understand what it is, what signs not to ignore and when it is necessary to intervene.
What is trigger finger and what signs not to ignore
«The trigger finger, also called stenosing tenosynovitisis a pathology that affects the flexor tendons of the fingers at the base of each finger. The finger snaps when the tendons have difficulty sliding within their sheath at the base of the finger. The symptoms, however, can be different: it can present with a painful block in the flexion of the finger and with a jerk when extending it, but it can also present with a painful difficulty in movement. Sometimes the symptoms appear quickly, other times they appear gradually, with a slight initial pain and a progressive increase in symptoms. Precisely in the initial stages, a timely diagnosis can be useful in order to deal with this pathology with conservative treatment”, explains the expert. The key point? Don’t wait for your finger to freeze completely. Taking action early can make a difference.
Because it affects women and those over 50 more often
It is no coincidence that many patients are women over fifty. Hormonal changes play an important role, as do some systemic conditions. As Dr. Scalese explains, «Trigger finger may be idiopathic in nature, that is, not recognizing a precise cause, as well as it can engage in repetitive manual work, to systemic pathologies such as diabetes, thyroid disorders, rheumatic diseases or hormonal alterations. The women are more affected, although not exclusively and this may be due to a greater predisposition following hormonal changes, such as menopause”. A confirmation of how hand health is often intertwined with hormonal and metabolic balance.
When it can go away on its own and when treatment is needed
Trigger finger does not always require immediate intervention. In the initial stages it may also regress, but it should not be ignored if it persists.
«In the initial stages, sometimes, the symptoms can regress spontaneously with a reduction in use and, therefore, in the inflammatory state. When the symptoms do not resolve spontaneously it is necessary, in the initial stages, to undertake treatment conservative approach: the application of a night guardian, physical therapies until you get to cortisone infiltrations. If the symptoms are significant and failure of conservative therapy is observed, it may be appropriate to propose surgical treatment”, adds Scalese.
Non-surgical therapies: when they work
Before thinking about the operating room, there are several conservative options, which are particularly effective in the initial stages. «The therapies that can have a positive effect in the treatment of the initial stages are represented by the use of night guards, physical physiotherapy, pharmacological treatment with anti-inflammatories and local infiltrations of cortisone», explains Dr. Scalese. A gradual, personalized path that aims to reduce inflammation and restore the sliding of the tendon.
When intervention becomes necessary
If the pain persists or the finger remains blocked, the surgical option can be evaluated. «When conservative treatment has not led to a resolution of the symptoms or in extreme degrees that have been rooted for some time, surgical treatment may represent an appropriate choice. The Surgical treatment is called flexor tenolysis and consists of the section of a portion of the sheath, right at the point of difficulty in sliding. It can be performed in the open air or, lately, it is becoming widespread ultrasound-guided technique. This technique is performed with a incision of a few millimeters through which special instruments are inserted to section the sheath under strict ultrasound control. This allows the operation to be performed with a minimally invasive approachbut at the same time in great safety.” The most recent techniques therefore allow a less invasive approach, with minimal scarring and greater precision.
Recovery: how much time does it really take
One of the most frequent questions concerns shooting times, especially for those who do manual work. «Recovery times may vary based on the surgical technique used. In the traditional technique we say that the times of Tissue healing requires 10-15 days, then a recovery of all activities in about 3 weeks. The return to work activities depends greatly on the activity being carried out: an office job can provide a recovery in just over 15 days, a manual job can require 3 or even 4 weeks.
In case of ultrasound-guided technique the times are reduced: in about 5 days There is complete healing of the skin with recovery of complete functionality in 7/10 days. Heavy manual work requires recovery in 2/3 weeks, depending on the subject and the initial local situation”, specifies the expert.
Can trigger finger be prevented?
Prevention involves small daily precautions, especially for those who use their hands a lot for work or hobbies. «Prevention can be done by avoiding repeated movements of the fingers, providing for breaks during work and play activities and pay attention to the first signs of symptomatology. This attention is also fundamental to avoid a recurrence of the pathology.”
Doctor Alessandra Scalese
Doctor Alessandra Scalese, orthopedist at the Hand Surgery Unit III at the San Siro Clinical Institute (Photo Credit: Gruppo San Donato).
Dr. Alessandra Scalese is an orthopedist at the Hand Surgery Unit III at the San Siro Clinical Institute. In 2004 he graduated in Medicine and Surgery at the University of Milan where, in 2009, he specialized in Orthopedics and Traumatology. He began his training in hand surgery during his years of specialization at the Hand Surgery I department of the IRCCS Galeazzi Orthopedic Institute, where he assumed the role of medical director after obtaining his specialization diploma.
He has attended specialization courses in Italy and abroad, especially regarding the treatment of fractures, the use of hand and wrist prostheses, ultrasound and ecosurgery and the arthroscopic treatment of fractures and capsuloligamentous lesions of the wrist and hand.
Dr. Scalese takes care of the pathologies affecting the hand, wrist and elbowgiving them back the lost functionality. Specifically about arthritic degenerative pathologies, tendinopathies, nerve compressions at the upper limb level, nerve lesions and their outcomes, hand and wrist traumatology, Dupuytren’s disease, post-traumatic outcomes, capsuloligamentous lesions of the wrist and hand.
Over time he developed a particular interest in the use of hand prosthesisbut also in the minimally invasive techniquessuch as the techniques eco-guided and the approach arthroscopic.
He is a member of Italian Society of Hand Surgery (SICM) and of American Society of Surgeons of the Hand (ASSH). He collaborated in writing some chapters of Orthopedic textbooks and presented the results of our clinical and surgical activity with communications at national conferences.
