It sounds like something right out of a Western, but trigger finger is actually a painful condition which commonly affects patients between 55 and 60 years old - with women outnumbering men three to one.

'It is a condition in which one of your fingers or your thumb catches in a bent position. When you attempt to straighten it, it goes 'snap' - like a trigger being pulled and released,' says Associate Professor Aymeric Lim, chief of the department of hand and reconstructive microsurgery at National University Hospital. He estimates that there are about 2,500 patients in Singapore seeking treatment for this condition every year.

At first, the affected finger may feel stiff and a little painful. There is a bump (nodule) or tenderness at the base of the affected finger, in the palm. This is the spot where the tendon is catching.

As trigger finger worsens, the finger may catch at times in a bent position and then suddenly pop straight. Eventually, the finger may not fully straighten. In some cases, it may affect more than one finger at a time. Triggering is usually more pronounced in the morning, while firmly grasping an object or when straightening the finger.

'People whose work or hobbies require repetitive gripping actions are most susceptible to this condition. Many of them are golfers. The grip on the golf club is smaller and the ball is hard. This puts their hands at greater risk of injury,' Prof Lim explains.

Symptoms: Pain and stiffness

The tendons in the fingers are like ropes that attach to the ends of the fingers. These tendons run through a sheath. Should these tendons become inflamed from injury or overuse, or from inflammatory conditions like rheumatoid arthritis, the space within the sheath becomes constricted.

When this happens, the tendon can't glide along as smoothly, at times 'catching' the finger in a bent position before popping straight. And most times it occurs in the middle finger and sometimes in the thumb.

In some cases, the cause of trigger finger is unclear, and can seemingly appear from nowhere. It can occur in one or more fingers, and at different times in different locations.

'You should seek medical advice if you have been feeling any stiffness and pain in your finger for a few days. In the early stages, it can be easily treated with medication or injections. If steroid injections don't work, surgery may be required,' says Prof Lim.

Treatment

Anti-inflammatory drugs may ease the swelling that led to the constriction of the tendon sheath and the trapping of the tendon, and can relieve the pain. If this doesn't work, a steroid injection near or into the tendon sheath may be necessary. If it's effective, the patient should feel better by the end of the week.

'This treatment is most effective if given soon after signs and symptoms begin. In some cases, the patient may require a second injection,' says Prof Lim.

The more severe cases will require surgery which involves making a small incision in the palm to release the locking tendon and 'open' up the tunnel.

'This simple surgery takes about 10 minutes and is done under local anaesthesia. And the finger should get better in two or three days.'

Untreated, the thumb or finger will remain in a permanently bent position.

E-mail: glo.chan@gmail.com

Get a grip on the pain early

It all started with a slight pain at the base of my left thumb. When I bent the affected thumb, I had to use the other hand to 'unbend' it. Only then would it 'snap' back into place. I did not think much of it and put it down to all the household chores that I had been doing.

Over the next few days, the pain got worse. When I lay down, I would put my left hand under my butt, hoping that the added weight on the hand would ease the pain. Every night when I went to bed, I hoped the pain would go away by the next morning.

It did not. In fact, worse was to come.

I had increasingly more trouble with daily activities especially those that needed some dexterity of the thumb. Although I am right-handed, I was surprised at how much I relied on my left hand.

It was painful and frustrating trying to fasten a bra. I could not even squeeze the toothpaste tube with my left hand while holding the toothbrush in my right. And I needed both hands to manoeuvre the handbrake while driving.

If I was deshelling a prawn, I would be stunned by a sudden sharp pain in the thumb, which took a good five minutes to subside.

During those few weeks, the motto was 'Mum's not cooking' as I could not get a good grip on the wok handle with my left thumb.

I put up with the pain for some weeks until I casually mentioned it to a doctor friend. He said something about how it was a trigger finger. It was the first time I had ever heard of it.

That night, I looked it up on the Internet. I found out that it was not going to go away by itself. I had visions of my left thumb becoming permanently bent if I did not get it treated, so I saw a general practitioner the next day.

He gave me some medication to ease the pain and bring down the inflammation. When this did not work, I was referred to a hand surgeon at the National University Hospital.

Dr Aymeric Lim, who is chief of the department of hand and reconstructive surgery, said that I must have injured my thumb. I recalled then I had hurt it, forcing down a stiff handbrake.

He added that my condition was in the early stages and gave me a steroid injection into my thumb to reduce the inflammation. There was some soreness for a few days and by the end of the week, the pain was gone completely.

- GLORIA CHAN

Gloria is a freelance writer who's glad to have the use of both hands again so she can go back to her favourite past-time, cooking!