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Trigger Finger and Hand Therapy

Trigger finger has a classic tell-tale sign: clicking and pain at the base of the finger especially with flexing / gripping. Even my dad, father-in-law and myself have had it before, so it’s really common.

The medical name of it is called stenosing tenosynovitis and it is actuallly the top 5 causes of disability in the human hand! That’s a scary thought, because most of the time, it’s a fairly straightforward condition to treat and for it to heal.

Symptoms of trigger finger

Patients typically report experiencing at the base of the finger

  • aches and pains
  • swelling
  • sometimes feeling “itchy”
  • clicking
  • locking / jamming

Trigger fingers tends to affect more adults 40 and above, but we’d seen younger and younger individuals (even children!) who develop it too.

What it looks or presents as

The most classic sign of trigger finger are a combination of or all of the following:

  1. aches, pains and tenderness at base of affect finger, on the palm side
  2. stiffness in the morning or after rest
  3. gradually starts to develop mild clicking
  4. eventually clicking worsens to become jamming and eventually may even lock

Some patients may develop multiple finger trigger fingers on the same hand or even other hand too.

Who’s more at risk

  • individuals who perform a lot of manual work or labour which includes lifting and administrative duties
  • people who play a lot of games or hobbies involving grip such as tennis, soldering, knitting / sewing
  • pregnant ladies
  • people who are diabetic
  • people who have history of rheumatoid arthritis
  • repeated gripping. Occupations and hobbies that involve repetitive hand use and prolonged gripping may increase your risk of trigger finger.
  • more common in women.
  • complication from carpal tunnel syndrome surgery

Pathophysiology

To understand trigger finger, we must first see how it’s connected to our movements, muscles and tendons:

  • muscles move bones / joints by shortening (flexing), which will pull the tendon
  • these tendons are like ropes, which are secured with special tunnels called pulleys
  • the tendons are protected from fraying by a tendon sheath that’s called the tenosynovium

What happens is that with

  • excessive and repetitive flexing
  • direct damage
  • other factors

the tendon sheathe starts to thicken (the tendon itself may thicken too) and that causes more friction and sometimes “locking” of tendon-tendon sheathe at the pulley (typically at the pulley at the base of the finger, in the palm). In many cases, a nodule (ball-like structure) can develop in the tendon sheath which then will block movement.

4 stages of trigger finger

It’s this nodule that causes the finger to be locked in flexed position, and there are 4 stages of trigger finger:

  • Stage 1: Tenderness and pain at base of finger. Patients may report itching and swelling too.
  • Stage 2: Patient starts to experiencing very mild clicking at the base of the affected finger. The clicking doesnt involve being jammed or locked, and they’re able to close and open their fingers without using the other hand.
  • Stage 3: At this stage, the clicking is more painful, and patient starts to experience “jamming” of the finger ie they need to use the other hand to “unclick” or unlock the jammed finger.
  • Stage 4: Very advanced stage, and possibly unable to extend unless with lots of help/rest; lots of stiffness

Normally by stage 2, we recommend a direct cortisone injection to release and decrease the swelling. If at stage 3, patient can consider surgery (stage 4 definitely require release surgery)

Causes of Trigger Finger

The most common causes of trigger finger revolves around repetitive force-generating activities such as:

  • house work: wringing cloth/mop repeatedly, holding tightly onto tools and using them such as hammering, screwdriver
  • lots of gripping activities such as pulling, climbing (including sports and weight lifting)
  • sports activity that includes racquet games or holding onto a stick

Of course, it can be caused or aggravated by:

  • direct trauma such as blows or fall to the ground
  • tendon laceration
  • contributing medical conditions such as gout, diabetes, rheumatoid arthritis
  • can be present alongside with other repetitive strain injuries such as carpal tunnel syndrome, De Quervain’s tenosynovitis (mummy’s/Blackberry thumb)

Hand Therapy Management

1) Conservative (non surgery)

  • Anti-trigger splinting for trigger finger
  • Protected range of motion exercises to maintain joint and tendon range, which also provides nutrition to affected tendon and tendon sheathe (in the earlier stage)
  • Gentle progressive to resistive and strengthening activities
  • Ultrasound therapy to accelerate soft tissue healing (tendon sheath and tendon pulley)

2) Post Trigger Finger Surgical Release

  • Anti-trigger splinting for trigger finger
  • Wound care and wound management to prevent joint and tendon glide stiffness, and prevent infections
  • Protected range of motion exercises to maintain joint and tendon range, which also provides nutrition to affected tendon and tendon sheathe (in the earlier stage)
  • Progressive to resistive and strengthening activities
  • Ultrasound therapy to accelerate soft tissue healing (tendon sheath and tendon pulley)

Where To Next?

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