Trigger and Mallet Finger

How Does Trigger Finger Impact Your Anatomy and Health?

A trigger finger can make it difficult to perform daily activities such as gripping objects, typing on a keyboard, or holding a pen. It can also cause pain and stiffness in the affected finger, making it hard to move or use the finger. 

Risk Factors and Causes of Trigger Finger

The exact cause of trigger finger is unknown, but it is believed to be caused by a combination of factors, including:

• Age: People over 40 are more likely to develop trigger finger.
• Gender: Women are more likely than men to develop trigger finger.
• Medical Conditions: Certain conditions, such as diabetes, rheumatoid arthritis, and hypothyroidism, can increase your risk of developing a trigger finger.
• Repetitive Hand Movements: Activities that require repetitive hand movements, such as typing or playing an instrument, can increase your risk of developing a trigger finger.
• Injury: An injury to the hand or finger can cause inflammation in the tendons, leading to a trigger finger.
• Congenital Abnormalities: Some people may be born with a small or narrow tendon sheath, which can increase their risk of developing a trigger finger.

Symptoms of Trigger Finger

The symptoms of trigger finger can vary depending on the severity of the condition, but they typically include the following:

• Pain or discomfort in the affected finger or thumb
• Stiffness or tenderness in the affected finger or thumb
• A popping or clicking sensation when you move your finger or thumb
• Difficulty bending or straightening your finger or thumb
• A bump or nodule on the affected finger or thumb

Diagnosis of Trigger Finger

A trigger finger is diagnosed through medical history, physical examination, and imaging tests.

Medical History

Your orthopaedic surgeon will ask you about your symptoms, medical history, and any underlying medical conditions you may have that could contribute to a trigger finger. This may include questions about your occupation, hobbies, and other activities that may put you at risk of developing the condition.

Physical Examination

During a physical examination, your orthopaedic surgeon will evaluate the affected finger, looking for signs of inflammation, tenderness, and other abnormalities. They may also ask you to move your finger to assess its range of motion and to see if there is any clicking or popping when the finger is bent or straightened.

Imaging Tests

Imaging tests are not usually necessary to diagnose a trigger finger, as the condition can typically be diagnosed based on a physical examination and medical history. However, imaging tests may sometimes be ordered to rule out other conditions or assess the severity.

Here are some imaging tests that may be used for trigger finger:

• X-rays: X-rays can be used to rule out other conditions, such as arthritis, or to evaluate the joint for any abnormalities.
• Ultrasound: Ultrasound can be used to visualise the affected tendon and the surrounding structures, allowing for a more accurate diagnosis and assessment of the severity of the condition.
• Magnetic Resonance Imaging (MRI): An MRI can provide detailed images of the soft tissues of the hand, including the tendons and tendon sheaths, and can help identify any underlying conditions or complications.
• Computed Tomography (CT) Scan: A CT scan can provide detailed images of the bones and joints of the hand and can be useful in identifying any structural abnormalities or injuries contributing to the trigger finger.

Once your orthopaedic surgeon has confirmed the diagnosis of a trigger finger, they will develop a treatment plan tailored to your specific needs and the severity of your condition. Early diagnosis and treatment are crucial to managing trigger finger effectively and preventing complications such as chronic pain and disability.

Treatment Options for Trigger Finger

Treatment for trigger finger depends on the severity of the condition and its impact on your daily activities. Some treatment options include:

• Splinting: Wearing a splint or brace on the affected finger or thumb can help keep it in a neutral position and reduce inflammation. This can be especially helpful at night when you are more likely to bend your finger unconsciously.
• Nonsteroidal anti-inflammatory drugs (NSAIDs): Medications such as ibuprofen or naproxen can help reduce pain and swelling.
• Steroid injections: Injecting corticosteroid medication into the affected tendon sheath can help reduce inflammation and relieve symptoms. This is often an effective treatment for mild to moderate cases of trigger fingers.
• Hand therapy: Stretching and strengthening exercises can help improve the range of motion and reduce symptoms over time.
• Surgery: In severe cases where other treatments have not been effective, surgery may be necessary to release the affected tendon and restore normal finger function. This is typically a day procedure and has a high success rate.

Surgical Treatment for Trigger Finger

Surgical treatment for the trigger finger is called a trigger finger release. 

It is usually considered when other treatments, such as rest, immobilisation, steroid injections, and hand therapy, have not effectively relieved symptoms.

During the procedure, the surgeon makes an incision in the affected finger or thumb and cuts the pulley where the tendon has been getting stuck. This allows the tendon to move freely without catching or triggering. Other pulleys keep the tendon in place.

After the surgery, the hand will be wrapped in a bandage for a short period to protect the area and promote healing. You may also be advised to do certain exercises or hand therapy to help restore range of motion and strength to the affected finger.

Most people experience significant relief of symptoms after surgical treatment of a trigger finger. However, as with any surgery, there are risks and potential complications, such as infection, nerve damage, or stiffness in the finger. Your surgeon can discuss these risks with you and help determine if surgery is the best option for your case.

What if Trigger Finger is Untreated?

If left untreated, the trigger finger can worsen, leading to chronic pain and stiffness in the affected finger. Sometimes, the finger may become permanently locked in a bent or straightened position, making it difficult to perform daily activities. 

What is Mallet Finger?

Mallet Finger, also known as "baseball finger," is an injury to the outermost joint of the finger. This typically occurs when an object strikes the tip of the finger or thumb and forces it to bend further than it is capable of, which can damage the extensor tendon (the tendon that straightens the outermost joint of the finger or thumb). 

How Does Mallet Finger Impact Your Anatomy and Health?

The extensor tendon on the back of the finger (near the tip) gets damaged in a mallet finger. This tendon damage results in an inability to extend the distal joint of the finger, and the joint droops. This can impact your ability to perform tasks that require fine motor skills, like typing or gripping objects.

Causes and Risk Factors for Mallet Finger

Mallet finger can occur in anyone but is most commonly seen in athletes or those who play netball, basketball, or any sport involving a ball. This is because these activities increase the risk of a ball or other object striking the tip of the finger. However, even everyday activities can cause a mallet finger if the finger gets forcibly bent.

Symptoms of Mallet Finger

The symptoms of a mallet finger include:

• Inability to extend the distal joint of the finger (but the finger can be straightened with assistance).
• Pain, tenderness, and swelling at the outermost joint immediately after the injury.
• Sometimes, bruising or blood beneath the nail.
• The finger may appear deformed, with the tip drooping downwards.

What are the Types of Mallet Finger?

Mallet finger injuries can be classified into two types:

• Tendinous Mallet Finger: This type occurs when the force applied to the finger causes the extensor tendon to tear. This is the most common type of mallet finger.
• Bony (or osseous) Mallet Finger: This occurs when the force applied to the finger causes the tendon to pull away a small piece of bone along with the tendon. This is a type of avulsion fracture.

Diagnosis of Mallet Finger

Mallet finger is usually diagnosed through a combination of medical history, physical examination and imaging tests:

• During a medical history, your doctor will ask questions about how your injury occurred, your general health and your activity levels.
• During the physical examination, your doctor will examine your finger for signs of mallet finger, like pain, swelling, and deformity.
• Imaging tests, such as X-rays, determine whether there is a fracture and if the joint is properly aligned.

Treatment Options for Mallet Finger

Treatment for mallet finger depends on the severity of the injury:

• Non-surgical treatment: For most mallet finger injuries, non-surgical treatment is recommended. This often involves using a splint to keep the finger straight for 6 to 8 weeks to allow the tendon to heal.
• Surgical treatment: Surgery is usually reserved for more severe cases, such as when a large fracture is present, or the joint is misaligned. The surgery might involve pinning the joint or repairing the fractured bone and tendon with small screws and wires.

What if Mallet Finger is Untreated?

If left untreated, a mallet finger can lead to permanent deformity where the tip of the finger or thumb remains bent towards the palm. This can affect the function of the hand and may lead to difficulties with tasks that require fine motor skills.