Trigger Finger Treatment at a Glance

• Mild or early trigger finger may respond to a cortisone injection.
• Continued snapping after injections may require release of the A1 pulley.
• Dr. Ichtertz often performs this release with a needle placed through the skin.
• In his 26 years of using this technique, he has needed to perform an open release on very few patients.
• Treatment is chosen after discussing the available options with each patient.

Why Does a Trigger Finger Snap or Lock?

The tendons in your hand connect the muscles of your forearm to the bones in your fingers and thumb. When you bend or straighten a finger, its tendon slides through a narrow tunnel called a tendon sheath. Small structures called pulleys hold the tendon close to the bone and help guide its movement.

Trigger finger develops when the tendon becomes thickened and no longer glides smoothly beneath the A1 pulley at the base of the finger. As the tendon moves through this tight space, it can catch and then suddenly release. This produces the snapping or popping sensation many patients notice.

As the condition progresses, the finger may become painful or lock in a bent position. Trigger finger can affect any digit. When it affects the thumb, it is often called trigger thumb.

Although patients sometimes associate the problem with frequent hand use, repetitive finger activity has not been proven to be the cause.

When Should You Have a Trigger Finger Checked?

Trigger finger often begins with mild discomfort near the base of the finger, around the crease where the finger meets the palm. Symptoms may be more noticeable in the morning and improve somewhat as you begin using your hand.

Consider having your hand evaluated if you notice:

• Tenderness or a small lump in the palm
• A feeling of swelling or stiffness in the finger
• Catching, popping, or snapping during movement
• Pain when bending or straightening the finger
• A finger that becomes stuck in a bent position
• The need to use your other hand to straighten the affected finger

It is helpful to seek an evaluation before the finger becomes severely painful or regularly locks. When trigger finger is identified while symptoms are still mild, simpler treatment options may be more likely to help.

Can Mild Trigger Finger Be Treated With a Cortisone Injection?

When a patient comes in early and the trigger finger is still mild, treatment may be as minor as a cortisone injection. The medication is placed near the affected tendon sheath and A1 pulley to reduce irritation and help the tendon move more freely.

For some patients, one injection provides lasting relief. Others improve for a time but later notice that the catching or snapping has returned. A cortisone injection is not guaranteed to resolve every trigger finger, particularly when the symptoms have been present for several months or the finger is already locking severely.

Injections may also be less effective for some patients with diabetes. Cortisone can temporarily affect blood sugar, so patients with diabetes should discuss that consideration with their doctor before treatment.

Dr. Ichtertz looks at the severity of the triggering, how long it has been happening, and the patient’s health history before recommending an injection.

What Happens When Trigger Finger Injections Do Not Work?

If an injection does not provide enough relief, or the snapping returns, the next step depends on the individual patient. Dr. Ichtertz considers whether the patient has completed a course of injections for the same finger or previously experienced an injection that failed to resolve another trigger digit.

When the finger continues to snap despite injection treatment, repeatedly trying the same approach may not provide a lasting solution. At that point, our specialist may offer a more definitive treatment that releases the A1 pulley.

For many of his patients, this does not require opening the palm through a traditional surgical incision. Instead, our orthopedist may perform a percutaneous trigger finger release using a needle placed through the skin of the palm.

How Does Percutaneous Trigger Finger Release Work?

“Percutaneous” simply means that the procedure is performed through the skin. After the area is numbed, our specialist places a needle through the skin of the palm and uses it to release the tight A1 pulley.

The A1 pulley normally helps hold the flexor tendon close to the bone. With trigger finger, the space beneath that pulley can become too tight for the thickened tendon to pass through smoothly. Releasing the pulley creates more room, allowing the tendon to glide with less catching or snapping.

Percutaneous trigger finger release is an established technique that has been described and used by hand surgeons for many years.  Our hand specialist has performed this procedure for more than 26 years and uses his experience to determine whether it is appropriate for a particular patient.

The procedure addresses the source of the triggering without the larger incision used for a traditional open release. However, it is not suitable for every patient or every affected digit. The appropriate approach depends on the examination, the location and severity of the triggering, previous treatment, and the patient’s individual circumstances. Dr. Ichtertz discusses these factors before recommending a release.

When Is Open Trigger Finger Surgery Necessary?

Percutaneous release is not appropriate in every situation. When our hand specialist determines that the A1 pulley cannot be safely or effectively released with a needle, an open trigger finger release may be considered.

During an open release, a small incision is made in the palm so the surgeon can see and release the A1 pulley directly. This gives the flexor tendon more room to move without catching.

In more than 26 years of performing percutaneous releases, our orthopedist has needed to take very few patients to the operating room for an open procedure. The recommendation depends on the affected digit, the examination, and the patient’s individual needs.

Why Choose Nebraska Hand & Shoulder Institute?

Trigger finger treatment should not follow a one-size-fits-all plan. At Nebraska Hand & Shoulder Institute, Dr. Ichtertz evaluates how the finger moves, the severity of the triggering, and any treatment the patient has already tried before making a recommendation.

The goal is to address the catching or locking while avoiding a more involved procedure when a less invasive option is appropriate.

Trigger Finger Treatment FAQs

Find the Right Trigger Finger Treatment in Nebraska

If a painful, snapping, or locking finger is making everyday activities more difficult, Nebraska Hand & Shoulder Institute can help you understand your treatment options. Dr. Ichtertz will examine your hand, review any treatment you have already tried, and discuss whether an injection or trigger finger release may be appropriate.

Schedule an appointment to receive a personalized trigger finger evaluation at our Omaha, Lincoln, or Grand Island location.