HAND/WRIST
Trigger finger, or stenosing tenosynovitis, causes fingers to “catch” while bending. This condition can affect more than one finger at a time. It is commonly seen in people who have rheumatoid or osteoarthritis, diabetes, gout, or chronic smokers. The most frequent place in the hand for trigger finger to develop is the ring finger.
Symptoms:
People with trigger finger may experience any of the following:
• Popping feeling during finger bending
• Tenderness in palm at the base of the affected finger
• Pain and stiffness during repetitive gripping
• Finger locking
Anatomy:
Tendons are elastic bands of tissue that connect bone to muscles. Muscles contract to pull on the bones to cause the joints of the body to move. Flexor tendons, or the tendons that bend the wrist and the fingers, slide through tunnels of tissue that hold tendons close to the bone, called the tendon sheath. Your finger muscles are the FDP, or the flexor digitorum profundis, and the FDS, flexor digitorum superficialis. Trigger finger occurs when a nodule forms on inflamed tendons and can no longer freely pass through these tunnels. The tendon sheath might also become inflamed, which causes the tunnel opening to become smaller and more difficult for the tendon to pass through.
Treatment:
Non-Surgical Treatment:
• Splinting: Achieved through
immobilizing the finger in a neutral, resting position to limit painful tendon catching.
• Medication: Over-the-counter anti inflammatory medications could be used to relieve painful symptoms.
• Steroid Injections: corticosteroid, or a powerful anti-inflammatory medication, is injected into the inflamed tendon sheath.
• Therapy
Surgical Treatment:
If non-surgical treatment is unsuccessful, and the affected finger is frequently stuck in a bent position, surgery might be recommended.
• Procedure: a small incision is made in the palm, sometimes with the tip of a needle, cutting into the tendon sheath. The inflamed tissue is broken up and is allowed to heal back together. When it heals, the tendon has more room to move, which greatly reduces or eliminates the catching.
Therapy could reduce trigger finger symptoms, post-operative stiffness, and restore prior level of function. Therapy might include any of the following:
• Soft tissue mobilization
• Hot or cold therapies
• Range of motion exercises
• Electrical Stimulation
• Splint fabrication
• Ice massage
• Tendon gliding exercises
• Ultrasound
• Ergonomic training
• Dexterity retraining
Pictured below is a custom orthotic that was fabricated for trigger finger!
Ice Massage Instructions
1. Use a paper, plastic, or Styrofoam cup, fill it with water and freeze it.
2. Once frozen tear off about half of the cup to expose the ice leaving the other half of the cup as a handle for yourself.
3. Use the bare ice to massage the area of injury/pain directly on your skin for 5-10 mins. During this time you should experience these phases:
-The first stage is cold
-The second is burning/pricking
-The third stage is, aching, which can sometimes hurt worse than the pain.
-The fourth and most important stage is numbness. As soon as this stage is achieved, remove the ice.
4. It is VERY IMPORTANT to continually move the ice on your skin not overlapping any spot continually to avoid the ice from burning you. Ice burn is a lasting red spot that aches/burns just like a burn from a hot object lasting for several days.
Feel free to complete ice massage for 2-3x a day with several hours in between each session. If you experience lasting redness/aching/burning reduce use until the area of skin is back to normal.
Below are examples of ice massage cups you can make at home (left image), or buy an ice massage cup (right image).
