HAND/WRIST
Trigger finger, also referred to as “stenosing tenosynovitis”, is a condition that involves “locking” or “catching” of a finger when you attempt to bend or straighten it. This sensation with finger movement, also described as “clicking” or “popping”, leads to stiffness, pain, and difficulty with hand-use. It is common for individuals with trigger finger to feel a tender lump, called a “nodule” at the base of their finger towards their palm. Trigger finger most often develops without a specific injury. It can be the result of over-using the hand, particularly with activities that involve heavy, repetitive, or prolonged grasping or pinching. There are also certain medical conditions that are associated with developing trigger finger, including diabetes, osteoarthritis, and rheumatoid arthritis.
A little background in anatomy can make it easier to understand why trigger finger occurs. To bend your finger, you must contract or pull on, a tendon that attaches the bones in your finger to the muscles in your forearm. The tendon glides through the finger and palm through a lubricated tunnel called a “sheath”. There are also bands of tissue called “pulleys” that hold the tendons close to the bones in the fingers. When you bend your finger, the tendons pass through the lubricated tunnel or sheath and through the pulleys. In trigger finger, the pulley becomes inflamed or thickened, making it difficult for the tendon to glide through it. The tendon can also become inflamed and develop a nodule or a lump that “catches” or gets stuck trying to pass through the pulley. A severe trigger can get “locked” in a bent position, requiring use of the other hand to straighten the finger.
Treatment for trigger finger depends on a doctor’s assessment and the severity of the symptoms
• Initial treatments usually involve resting the hand. It is important to avoid triggering as it may increase the symptoms and prolong the healing process.
• Splinting at night involves keeping the finger straight while you sleep, this rests the tendon in a non-aggravating position.
• Gentle stretching exercises may be prescribed to decrease pain and stiffness and improve flexibility.
• Over-the-counter medications such as acetaminophen and other anti-inflammatory drugs can help reduce pain and inflammation.
• Corticosteroid injections are anti-inflammatory and are injected into the tendon sheath at the base of the finger towards the palm.
• Surgery commonly known as a “trigger finger release” is sometimes indicated. This procedure involves a small incision to release the affected pulley, allowing the tendon to glide freely.
• Hand therapy may be recommended for conservative treatment or post-operatively. Hand therapy can assist patients with splinting, regaining their movement with exercises, and managing their swelling, pain and scar formation.
References:
Lee, M.P., Biafora, S.J., & Zelouf, D.S. (2011). Management of hand and wrist tendinopathies. In Skirven, T. M.,
Lee Osterman, A., Fedorczyk, J. M., & Amadio, P. C. (Eds.), Rehabilitation of the hand and upper extremity (6th ed., Vol. 1, pp. 575-579). Philadelphia, PA: Elsevier Mosby.
