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Article Summary:
Sinchew Daily – 17th November 2022

Question: I am a housewife. I noticed something strange with my fingers such as not being able to straighten them in the morning, or I have to use the other hand to pull them apart. It felt like it was stuck. When I opened it, I heard a snapping sound, and its very painful.

 I thought its due to blood circulation problem, so I tried soaking my palms in hot water and even treated them with acupuncture, but nothing worked. I went to the doctor after that and was given anti-inflammatory drugs and painkillers, but it still didn’t improve much.

 Q1: What is the problem?

 Q2: What should I do?

 Q3: What treatments are there?

Doctor’s Answer:

“Based on your letter, the condition is likely the sign of trigger finger. The scientific term is stenosing tenosynovitis of the flexor tendons. The symptom is that the finger is stuck and can be painful and tight, and once you try to straighten your fingers, you will hear sound of a snap, and feel a sharp pain.

It is important to note that trigger finger is not a disease but rather it an aggravation due to repetitive actions, such as twisting, squeezing and grasping, etc. In short, the patient developed trigger fingers due to daily habits or sporting activities.

The human hand is a very complex and precise structure, including flexor tendons, tendon sheaths, etc. We can bend our palms and finger because of flexor tendon. However, if overworked and the fingers are frequently stretched and flexed, it will cause the flexor tendon to repeatedly rub and squeeze on the tendon sheath, and local congestion will appear over time causing edema and may lead to inflammation.

This condition can occur in all five fingers, but the most common ones are the ring finger, thumb, and middle finger. Dr. Lim added that the trigger finger is not due to age, therefore it is not limited to the elderly. Even young people in their 10s to 20s are seen in outpatient clinics.

“Trigger fingers can be divided into 3 stages, namely, in the acute attack, it will feel very painful, but you can still bend and straighten your fingers, but there will be local pain, but in the second stage, your fingers will bend and get stuck. The first time you push it hard, there will be a snapping sound and pain, and as you mentioned in your letter, in the final stage, it remains stuck and you can’t even correct it”.

Is the trigger finger condition linked to rheumatoid arthritis? 

In most cases, they are two distinct conditions, and only a small percentage of the inflammation of the nerve endings is caused by rheumatoid arthritis which causes symptoms similar to trigger fingers.

Are there cases of congenital trigger finger?

Yes, congenital trigger finger (thumb) can be seen in some cases involving the baby after birth, because when parents try to pull the baby’s thumb, the baby with a congenital trigger thumb will feel a painful sensation and cry. Fortunately, it is a rare occurrence and, in most cases, non-surgical treatment is available.

How to treat “Trigger Finger”

Doctor will diagnose and recommend treatment based on the stages of the condition as mentioned above. Diagnosis can be made from clinical symptoms without using scans, X-rays, etc.

In terms of treatment options, there is either non-surgical or surgical treatment. The former refers to changing daily routine, by avoiding twisting, squeezing, and grasping, combined with anti-inflammatory drugs including oral or external application, and some hand stretching exercises.

When surgical intervention is required, there are 2 types: (1) percutaneous release and (2) open surgery.

Percutaneous release is a type of minimally invasive surgery where after anaesthesia, a needle is used instead of a scalpel.

The latter is the open surgery option which involves administering local anaesthesia before a small incision of 2 cm in size is made on the palm of the hand to separate the nerves and blood vessels.

Dr. Lee added that 99% of cases will not recur after surgery, and the entire operation process takes about 10 minutes, after which the patient can be discharged from the hospital and go home to rest.

The last method is to inject steroids into the problem area to reduce inflammation. Once the inflammation is reduced, the tendon can pass through the tendon sheath. However, Dr Lee does express caution against this method due to atrophy of tendons or cartilage, and if continuous injections do not improve, open surgery is necessary.

How to prevent trigger fingers in daily life?

Dr Lee emphasized that the trigger fingers are caused by the action of the patient such as twisting, squeezing or grasping movements, and if possible, try to avoid such actions. When you experience tightness or pain, you can consider buying anti-inflammatory drugs, which can provide temporary relief. However, if the symptoms persist, please consult your doctor.

The following are summarized answers to your questions:

A1: The condition indicates signs of trigger fingers.

A2: Reduce twisting, squeezing, and grasping movements, and then seek medical advice.

A3: There are 2 types of interventions for trigger fingers: non-surgical and surgical treatment.

Read the full article here

Featured Doctor :

Dato Dr Lee Joon Kiong

Consultant Orthopaedic Surgeon

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