Triggering is a very common condition that affects the tendons that bend (flex) the fingers and the thumb. The tendons get stuck as they try to pull, causing a clicking or catching sensation with bending of the joints. In more advanced cases, the affected digit will actually get stuck in a flexed position.
All of the finger and thumb flexor tendons travel down tunnels (tendon sheaths) that guide them down the digits into the palm. Normally, just the right amount of room exists in the tunnel to allow the tendons the to glide smoothly. If the tendon becomes swollen, in reaction to overuse for example, it sticks or catches in the tunnel as it tries to glide. This catch often makes the joint of the affected digit feel as if it were popping or clicking. If the tunnel is really tight, the tendon will get trapped, and cause the digit to get stuck in a flexed (or occasionally extended) position. People often have their worst triggering first thing in the morning, but symptoms can occur at any time. The irritated area can become quite painful and tender, especially on the palm side of the digit near its base.
Triggering is often caused by overactivity, such as repetitive gripping. Individuals with certain diseases such as diabetes have a predisposition for triggering.
For a mild case of triggering, simply decreasing activity (avoiding repetitive gripping, for example) may be all that is required. Anti-inflammatory medications may also be helpful to ease the discomfort. Temporary splinting of the affected digit may help if reduction of activity for the hand overall is not possible.
Steroid (cortisone) injections are a very effective treatment, especially when given 3-6 months from the start of symptoms. One or two injections can often cure the triggering and get people back to normal. Injections are often used in diabetics as well, but statistically the cure rate is lower.
If conservative measures are not working, surgery may be recommended. The goal of surgery is to open the tight portion of the tendon sheath to allow smooth gliding of the tendon. The tight section is usually the near end of the tunnel, close to where the finger or thumb attaches to the hand. The surgery is a safe, outpatient procedure that does not require general anesthesia and is often done in an office operating room setting. The beneficial results of the surgery are usually permanent.