Having a trigger finger or thumb can be very frustrating for a child or teen – not to mention worrisome for a parent. The good news is, Cook Children's orthopedic team has the know-how to diagnose your child and create a treatment plan to help them regain full use of their finger or thumb.
Trigger finger occurs when a finger or thumb gets stuck in a bent position, as if you were squeezing a trigger. Once it gets unstuck, the finger pops straight out, like a trigger being released. Straightening, or trying to straighten, a trigger finger or thumb can also be quite painful. In severe cases, the finger cannot be straightened. Surgery is needed to correct it.
Tendons connect muscles to bones. When you tighten a muscle, it pulls on the tendon, and this causes the bone to move.
The tendons that move your finger slide through a tendon sheath (tunnel) as you bend your finger.
- If the tunnel swells and becomes smaller, or the tendon has a bump on it, the tendon cannot slide smoothly through the tunnel.
- When it cannot slide smoothly, the tendon may become stuck when you try to straighten your finger.
Trigger finger can occur in both children and adults, though it's more common in adults. Children are more likely to develop trigger thumb. Trigger thumb occurs in about 3 in 1,000 children after the age of 1.
Trigger finger can occur in infancy, but is more common in kids between the ages of 1 and 4.
Some of the most common signs that your child may have a trigger finger include:
- The finger is stiff or it locks in a bent position.
- A finger or thumb gets stuck in a bent or straight position.
- Your child has painful snapping or popping when bending and straighten the finger.
- The symptoms are worse in the morning.
- There's a tender bump on the palm side of your child's hand or at the base of the finger or thumb.
Trigger finger is diagnosed by medical history and a physical exam. Trigger finger usually does not require x-rays or lab tests. Your child can have more than one trigger finger and it can develop in both hands.
In mild cases of trigger finger/thumb, the goal is to decrease swelling in the tunnel. Care may include:
- Allowing the tendon to rest. Your child's doctor recommend a splint, or tape the trigger finger to another finger (called buddy taping).
- Applying heat and ice and stretching may also be helpful.
Your child may also be given a shot of a medicine called cortisone. The shot goes into the tunnel that the tendon goes through. This can help reduce swelling. A second shot if the first one does not work.
In cases where the finger is locked in a bent position or does not get better with other treatment surgery may be necessary. The surgery is done under local anesthesia or a nerve block. This prevents pain. It's a minimally invasive surgery and your child may be awake during surgery.
During the surgery the orthopedic surgeon will:
- Make a small cut in the skin just below the tunnel (sheath covering the tendon) of the trigger finger.
- Then a small cut is made in the tunnel. If your child is awake during surgery, they may be asked to move the finger.
- Close the skin with stitches and put compression or tight bandage on the hand.
- Your child will need to keep the bandage on for 48 hours. After that, you can use a simple bandage, like a Band-Aid.
- The stitches will be removed after about 2 weeks.
- Once it has healed, your child can use the finger normally.
When to Call the Doctor
If you notice any signs of infection, call your child's surgeon right away. Signs of infection include:
- Redness in the incision or hand
- Swelling or warmth in the incision or hand
- Yellow or green drainage from the incision
- Hand pain or discomfort
- If the trigger finger returns