Trigger Finger or Trigger Thumb: Otherwise Known as Stenosing Tenosynovitis

What is Trigger Finger or Trigger Thumb?

Trigger finger is an inflammatory condition that is most common in the ring finger but can affect any of the fingers. Triggering of a finger occurs because the tendon that helps move the finger up and down becomes inflamed and no longer moves smoothly through the pulley that supports this tendon. Thus, when the muscle pulls the tendon to make a fist, the swollen tendon, which normally glides through the pulley without any problem, is now too large; thus, it “pops” or “triggers” as it tries to go through the narrow pulley. This pulley is found at the base of each of the fingers, in the distal crease in the palm of the hand, and this area can be quite tender when this area is pressed.

Our hands are much stronger when we bend our fingers into a fist than when we straighten our fingers, and thus at times, the finger gets “locked” into a fist with this diagnosis. The lack of strength to pull this swollen tendon back through the pulley to straighten our fingers may require the use of the opposite hand to straighten the finger.

What is Trigger Thumb

Trigger thumb is the same as trigger finger; however it affects the long tendon to the thumb. The pulley involved can be found at the bottom crease of the thumb in the palm of the hand. Like trigger finger, the muscle bending the tip of the thumb is stronger than the muscle straightening it; thus, at times, the tip of the thumb can be seen as “popping” or “triggering” as it is bent. And at times, the opposite hand is required to straighten the tip of the thumb
fully.

Symptoms

  • The first symptom of this diagnosis is pain in the palm of the hand over the area of the crease line of the finger or thumb. (It is surprisingly a quite
    painful condition!)
  • When this inflammation becomes worse, “triggering” can be noted. In extreme cases, making a fist becomes impossible, which can lead to secondary joint stiffness and limited motion.
  • If left untreated, limited motion and joint stiffness become more apparent, making performing daily tasks very difficult.
  • A finger becomes stuck in a bent position and cannot be extended due to extreme pain.
  • In extreme conditions, it may be impossible to even bend a finger to make a fist.

Causes

  • Repetitive gripping as when using a tool such as scissors, a hammer, vice grip, etc. Sustained gripping of an object.
  • Rheumatoid arthritis, gout, and diabetes are conditions that can make people more susceptible to Trigger Finger/Thumb.
  • Sleeping with the fingers in a fisted position is known to make this condition worse.
  • Exercising the fingers (including squeezing a ball) after this condition starts can make this condition worse.
  • The condition is more common in women than men.
  • Recent studies suggest that trigger finger may be a complication associated with surgery for carpal tunnel syndrome surgery, especially during the first six months after surgery.
  • Many times, the causes are unknown. Conservative treatment (this means treating it without surgery):
  • Heat: Heat can help increase circulation to the involved structures and help promote healing.
  • Ice: Decreasing the inflammation with ice after heat will help to decrease the pain and inflammation.
  • Modalities: At Premier Physical Therapy, we use several different types of modalities to help increase circulation to help promote healing. Please call Premier Physical Therapy to see if this would benefit you.
  • Orthotic: An orthotic to help protect and rest the structures involved is imperative for treating this condition. Orthotics at Premier Physical Therapy are custom-made and are usually covered by your insurance.
  • Education: Patient education is the key to help each person fully understand their condition and how to prevent this condition from returning. At Premier Physical Therapy, we make sure you have the necessary information to fully understanding your condition.
  • Massage/Transverse Friction Massage: Transverse Friction massage is found to be helpful in treating this condition. Let us show you the correct
    techniques.

Surgery

Early treatment of Trigger Finger/Thumb can make a huge difference in the outcome of Trigger Finger or Trigger Thumb. Trigger finger can be treated
without surgery in most cases, and surgery is recommended only after conservative treatment has failed.’

For more information: Go to ASHT Patient Education at https://www.asht.org/sites/default/files/docs/2018/Trigger%20Finger%202018.pdf

Call Premier Physical Therapy at 573.335.7868 for more information concerning this diagnosis.