• Robin R Varghese, PT.

Triggered??? Are you a victim of Trigger finger or of Trigger thumb? We are here to help you.

What is a trigger finger?

Tendons are strong cords of connective tissue that connect muscle to bone which help to support powerful movements. Some tendons are protected in a layer called synovial sheath and when one of the tendons in the hand becomes stuck in the sheath, this is known as trigger finger. When it happens to the tendon of the thumb, it is called as Trigger thumb.

What can cause a trigger finger?

inflammation of the sheath and/or tendon is partly responsible. Trigger finger can be caused by overuse of your palm. A difference in size between the flexor tendon sheath and the flexor tendons may lead to abnormalities of the gliding mechanism by causing actual abrasion between the two surfaces, resulting in the development of progressive inflammation between the tendons and the sheath. Trigger finger can manifest from any activity requiring prolonged forceful finger flexion like carrying shopping bags or a briefcase, prolonged writing, rock climbing, or the strenuous grasping of small tools or objects with sharp edges. The condition could develop idiopathically or secondary to other pathologies.



Who is prone to be affected by Trigger finger?

Trigger finger is more likely to develop in the fifth or sixth decade of life and women are up to six times more likely to develop trigger finger than men. The average age is 58 years. The chance of developing trigger finger is 2-3%, but in the diabetic population, it rises to 10%. Also common in people with Carpal Tunnel Syndrome, DeQuervain’s disease, Hypothyroidism, Rheumatoid arthritis, Renal disease and Amyloidosis.

What are the symptoms of Trigger finger?

Painless clicking during movement of the digit. This can progress to painful catching or popping, typically at the MCP or PIP joints.

Treatment

This includes non-operative and operative management

Non operative management includes corticosteroid injections and physical therapy

Operative treatment is opted when conservative methods fail.

Physical therapy management

1. Education of the patient on the following:

· Rest

· Modifications of activities

· Specialized tools

· Splinting

· Modalities

· Posture

2.

Splinting

Two major types of splinting most recently studied:

1. Splinting at the Distal Inter Phalangeal (DIP) joint. This showed to have a resolution in 50% of the patient’s symptoms.


2. Splinting at the Meta Carpo Phalangeal (MCP) joint with 15 degrees of flexion. This showed to have a resolution of the patient’s symptoms of 92.9%.

3. Exercises

Three exercises are recommended in the management of trigger fingers particularly following surgical release:

Digit blocking: patient to block the MCP joint, and allow the PIP joints to bend. This exercise could be done with all fingers at the same time or individually. The same exercise could be repeated at the DIP joint. Repetition and frequency are advised according to the level of stiffness and pain

Tendon gliding has been found to be beneficial. Your therapist will guide you through this.

Active range of motion: Finger abduction and adduction are recommended to strengthen the interossei and the lumbricals

4. Modalities such as heat / ice, ultrasound, electric stimulation, massage, stretching, and joint motion (active and passive) can have some positive effects on the trigger finger.


5. Extracorporeal Shockwave Therapy

Recently, extracorporeal shock wave therapy (ESWT) has been advanced as a possible alternative to surgery for the treatment of musculoskeletal disorders in patients recalcitrant to traditional conservative treatment. It is believed that ESWT induces the repair of the inflamed tissues by tissue regeneration and stimulates nitric oxide synthase, leading to suppression of ongoing inflammation and have a beneficial effect on the thickening of the flexor tendon and its sheath. This may enable the obstruction in the trigger finger to be overcome

At Valley Healing Hands Brownsville, Texas, we provide the best Physical therapy and Occupational therapy for Trigger Finger and Trigger Thumb; and our therapists will be always ready to assist you and see you through your discomfort.




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