“One morning, I woke up and my finger was stuck in a bent position,” says Risa Pulver, who’s lived with type 1 diabetes for 35 years. “I had to physically unbend it.”
This was just a few years ago, and soon New York-based Pulver found that several of her fingers began locking up on her every day.
When she finally told her healthcare team, she received a quick and easy diagnosis of what’s commonly referred to as “trigger finger,” but known to the medical world as “stenosing tenosynovitis.”
Let’s take a closer look at this common yet challenging condition, and what to do if you also live with diabetes, and are noticing symptoms of it in your own fingers.
Trigger finger is the result of inflammation in the tendons that enable you to flex and bend your fingers and your thumb. It not only limits your ability to move, straighten, and use your fingers for even the simplest of daily tasks, but it can also be painful.
“It’s very common in people with and without diabetes. I see anywhere from 5 to 10 patients with trigger fingers in my office every day,” Dr. Daniel B. Polatsch told DiabetesMine. Polatsch is one of New York’s most recognized hand surgeons.
“The tendons are basically ropes that move and pull your fingers down into a fist,” Polatsch explains. “Those tendons enter a very narrow tunnel at the base of each finger and this tunnel functions much like a pulley system.”
Without this tunnel-like system, Polatsch says the tendons on your fingers would actually pull away and bow from your fingers instead of tightening against them.
“What’s happening is that as the tendon is rubbing, it curves into that tunnel. And over time, the tunnel narrows and thickens, like a callus that’s been forming over the course of many, many years.”
Polatsch adds, however, that there’s quite a range in the severity of this condition.
“As it develops, the symptoms can be as simple as pain at the base of your finger, or a bit of stiffness, or the inability to fully straighten a finger, or the inability to make a tight fist. The most severe is when it gets stuck and catches. It’s locked in that position and you cannot manually straighten that finger or fully open your hand.”
Not all cases develop slowly through that sequence of events, he adds. Some people simply wake up one morning and suddenly have a finger that is locked.
A condition that’s not discussed often, trigger finger is actually very common in people with type 1 and type 2 diabetes. Research published in 2008 by
- People with diabetes are up to 10 percent more likely to develop trigger finger.
- The risk is correlated with the number of years you’ve lived with diabetes, not your blood sugar levels.
- Women are 6 times more likely than men to develop trigger finger.
- Trigger finger develops most commonly in your 40s and 50s but can develop earlier.
- People with carpal tunnel syndrome, de Quervain’s tenosynovitis, hypothyroidism, rheumatoid arthritis, renal disease, and amyloidosis have a higher risk of developing trigger finger.
- The order of fingers most commonly affected are: ring finger, thumb, middle finger, pointer (or index), and then your pinky finger.
So yes, having diabetes substantially increases your risk of developing one or several trigger fingers.
In short: no and yes.
As noted, research points to the length of time you’ve lived with diabetes as the main risk indicator of developing trigger finger, rather than your blood sugar levels.
But research has not yet pinpointed the exact relationship between diabetes and this condition, and there is
However, remember that healthy blood sugar levels still have a tremendous impact on the overall health and function of your fingers.
Preventing peripheral neuropathy in your fingers through healthy blood sugar management is still critical.
Even if you’re only experiencing mild stiffness in your fingers or thumb in the morning, it’s important to see a hand specialist, rather than dismiss its significance because the stiffness dissipates as the day goes on.
“People with diabetes often think it’s normal to have stiffness in their fingers,” says Polatsch. “They assume it’s just part of diabetes without realizing it’s the early stages of trigger finger.”
Catching signs of a trigger finger in one or many of your fingers is critical in preventing it from worsening and requiring surgery.
Early signs and symptoms include:
- consistent soreness or ache at the base of your finger or thumb
- a clicking noise when you move that finger
- a small lump or bump at the base of your finger or thumb
- any degree of stiffness
“Some patients let it develop for a long time before doing anything about it,” says Polatsch. “But you want to treat it as early as possible.”
Despite the discomfort, it is also important to try and straighten your affected fingers daily — even if you eventually plan on having it corrected with surgery.
“If you don’t try to straighten it regularly, then you’re not moving it fully, so it gets stiffer and loses motion,” explains Polatsch. Much like walking every day to keep your knees lubricated, forcing your affected fingers to move every day increases the success rate of surgery or other treatment options.
We reached out to our social media community, and heard back from a number of people who’ve experienced this condition.
Risa, age 55, living with type 1 diabetes (T1D) for 35 years, trigger finger developed at age 53: “One morning I woke up and my finger was stuck in a bent position. I had to physically unbend. This started happening almost daily.”
Anita, age 36, T1D for 25 years, trigger finger developed at age 30: “My finger knuckles stiffened and it started with the middle finger and happened mostly in the morning. When I tried to bend my fingers, all the fingers bent together except the middle finger. It would bend later in the day but with a snap sound. Sometimes I need to put my fingers underneath a pillow so they don’t curl and stiffen while I’m sleeping, because it’s hard to release the stiffness in the morning. When the fingers stiffen, sometimes I am unable to do anything as simple as opening a door or lifting a spoon. Daily activities can be hard because my fingers can’t be used.”
Chris, age 33, T1D for 20 years, trigger finger developed at age 30 : “It almost came out of the blue for me. I had a pretty standard weekend doing housework, shopping, etc., when I woke up the Monday morning of that week with a very stiff and swollen index finger. My index finger just felt very stiff, like the muscles and tendons were very tight. Specifically the middle joint felt very tight, and the ability to bend my finger in half was very painful, but not a problem on any other finger. The cold seems to trigger the lack of mobility in that particular joint and finger but it’s nothing I can’t work around.”
Donna, age 52, T1D for 33 years, trigger finger developed at age 35: “I first noticed that I was getting a sore little finger on my right hand, which then got quite stiff. The joint started to ‘click’ and the finger would get stuck in a curled position, so I would actually need to force it to straighten with my other hand. This did resolve itself over a matter of months. A few years later the same thing happened in the left little finger, again resolving itself. Another few years and the first and second fingers of my left hand started to click and stick.”
Moe, age 76, T1D for 55 years, trigger finger developed at age 56: “It started on the pinky of my left and my right hands. I can curl them but I can’t straighten them. It does hurt, especially if I try to straighten too much. Throughout the day I would say it’s uncomfortable. I can still go to the gym every day but certain exercises I avoid — like pushups — because I can’t put my hand flat on the mat. I play piano and I can’t reach quite as far as I used to reach. If the piece requires reaching more than an octave, I just leave one note out.”
“Treat it early,” emphasizes Polatsch, who’s seen far too many patients endure the discomfort and inconveniences of trigger fingers for years or decades before seeking treatment.
Typical trigger finger treatment options include:
- Regular physical therapy to stretch and exercise the affected finger or thumb.
- Wearing a splint on the affected finger or thumb to essentially keep it straightened for a prolonged period of time, along with over-the-counter anti-inflammatory drugs.
Steroid injection(s) into the site of the affected finger or thumb. (Steroids are known to temporarily raise blood sugar levelswhich means you’ll need to discuss adjusting your insulin dosing with your healthcare team at the time of injection and the weeks that follow.)
- Surgery to manually release the affected finger or thumb. Surgery is stated to have as high as a
99 percent success rate, but it does require postsurgical physical therapy.
“Splints and steroid injections are the first options. Research on steroids in the early treatment of trigger finger has a 50 to 60 percent chance of
However, he adds that if you have multiple fingers affected and you have diabetes, the
“I’ve never operated on someone who didn’t let me first try treating it with an injection,” explains Polatsch. “It’s safe and it can delay more severe symptoms for a long time.”
Keep in mind that steroid injections will likely impact your blood sugars if you don’t make adjustments in your background/basal insulin doses with guidance from your healthcare team. This stems from steroids’ impact on your sensitivity to insulin.
You may need an increase of anywhere from 10 to 50 percent for a few days to a couple of weeks after the injection. To determine its impact on your insulin needs, check your blood sugar often and keep in close contact with your healthcare team to make necessary adjustments.
The most effective treatment method is surgery — also referred to as “trigger finger release” — and is one of the most common surgeries a hand surgeon performs, says Polatsch.
“I’ve probably done at least 3,000 surgeries on trigger fingers in my career. The results are quite good for most patients. The sooner you treat it, the better. There’s no reason to suffer,” he says.
The people who shared their earliest symptoms, above, were also forthcoming about the treatments they received.
Risa, age 55, T1D for 35 years, trigger finger developed at age 53: “I decided to go for a steroid injection. The injection was done by a radiologist with a guided ultrasound. At one point it was so uncomfortable because it is such a tiny space to inject into the right spot that I almost stopped the procedure. Finally, the doctor hit the right spot. It was not a pleasant experience and I have had many steroid injections [for other conditions].
It helped for several months with the pain and locking but then several months later it started acting up again. My rheumatologist then recommended I see a hand surgeon for a consult. The hand surgeon said she could give me another steroid shot and see if that helps for longer, or I could proceed with surgery. I decided to have surgery. I had the surgery in May 2019. I started physical therapy and did exercise for several months. It’s now a year and a half later and my finger leans backward slightly but it’s significantly better than it was before the surgery.”
Anita, age 36, T1D for 25 years, trigger finger developed at age 30: “There are moments I want a surgery to fix my trigger fingers — especially when the fingers are curled longer and are painful to release — but due to this pandemic I postponed surgery.”
Chris, age 33, T1D for 20 years, trigger finger developed at age 30: “I was told at first to manage it with light flexing and painkillers. At the start, it was particularly painful, and I noticed it a lot, however over time it has become slightly more mobile and less sore. [Author’s note: Chris has not had his trigger fingers treated with injections or surgery.] I just accept it as one of the many issues diabetes can chuck at us.”
Donna, age 52, T1D for 33 years, trigger finger developed at age 35: “I tried joint creams, but they didn’t work. After an unsuccessful steroid injection at my primary care, I was referred to the hospital where I had my carpal tunnel release and the two trigger fingers released at the same time. A couple of years passed and the ring finger on the left hand started to click and stick. It was also quite painful. My primary care skipped the injection as it hadn’t worked before, and I had the finger released in January this year. Now the middle finger and the thumb joint of my right hand have started to click. And it only interferes with my craft hobbies, especially knitting. The fingers I have had released are absolutely fine now.”
Moe, age 76, T1D for 55 years, trigger finger developed at age 56: “At first, it was progressing and then it stopped getting worse — I don’t know why. For the last 10 years, it hasn’t gotten worse. At one point, my doctors were anxious to operate and I went to a hand specialist who wanted to do surgery, because of course he wants the work. But I decided it wasn’t worth the aggravation. It doesn’t bug me that much — I have worse problems than trigger finger.”
At the end of the day, “trigger finger” is a very treatable condition. If you experience it, you’re encouraged to seek treatment ASAP. Remember Polatsch’s words: “There’s no reason to suffer.”