What is Trigger Finger?
Vision a finger pulling a pistol trigger; this is what a trigger finger looks like, it is stuck in this bent (flexed) position. The medical term for trigger finger is stenosing tenosynovitis. Stenosing means narrowing, and tenosynovitis means swelling or inflammation of the tendon.
Stenosing tenosynovitis means a narrowed pathway due to swelling or inflammation of a tendon. So, what does this mean and how serious is this? Well, let’s start with some basic anatomy of the hand. We have 29 bones, 29 joints, 23 ligaments, and many more tendons, nerves, and arteries within the hand.
Bones provide a solid structure, and when two bones meet up, they form a joint. Ligaments attach bone to bone; tendons attached muscle to bone. Nerves assist with communication from the brain and travel throughout the body, in particular, we have three main nerves that supply communication to the hand. Arteries provide blood supply to the hand.
Movement of our hands is a coordinated effort between bones, joints, ligaments, muscles, tendons, and nerves. Hand movements originate from muscles within our forearms. They travel down the forearm and attach to bones within the hand by way of tendons. Think of tendons as a pulley system for the muscles and bones. When muscle contracts, it pulls on the tendon which in turn pulls on the bone to cause movement.
Each tendon has an outer protective shell, called a sheath. The tendon glides through the sheath with movement. So, when a tendon is irritated or inflamed, the space between it and the sheath is narrowed causing the tendon to stick or even get stuck within the sheath. When this occurs, the tendon’s pulley system is “frozen” causing the finger to stay in a flexed, or bent, position.
So why would a tendon swell? The most common reasons are overuse, trauma, or a secondary cause of another medical condition like rheumatoid arthritis (RA) or diabetes. With repetitive movements, which by the way can be repetitive exposure to sustained gripping, the tendon may be irritated causing inflammation.
With an autoimmune disease like rheumatoid arthritis or a metabolic disease like diabetes, these disease processes can cause stress to the balance of our systems. For reasons not always known, our body can “attack” itself causing irritation, inflammation, and in some cases like RA, deformity. Those who suffer from such conditions are at higher risk of developing trigger finger.
What causes trigger finger?
Not every trigger finger case has a known cause, in fact, the cause is usually unknown. There are a few common risk factors for developing trigger finger, and they are:
- Age, between 40-60 years’ old
- Carpal tunnel syndrome
- Exposure to repetitive grip (e.g. musicians, farmers, industrial workers, etc.)
- Kidney disease with dialysis treatment
- Rheumatoid arthritis
- Women are at higher risk than men
Symptoms of Trigger Finger
Commonly there are precursor warning signs to the onset of a trigger finger. Typically, on the palm side of your hand, you may experience pain at the base of your finger or thumb. You may also experience a clicking sound, or it may feel like your finger is “catching” during movement.
As the tendon becomes more irritated and inflamed, the symptoms of pain and the sensation of the finger getting stuck are pronounced. In the more advanced stage, the finger may “lock” into the flexed position.
How is a trigger finger diagnosed?
Trigger finger is diagnosed through a physical exam of the finger and hand. Your health care provider will check for a lump in the palm, swelling, and if there is the ability to straighten the finger. Imaging is not used to diagnosis this condition.
Treatment of Trigger Finger
Approximately 1 in every 5 cases heal on their own within a few weeks. The initial cause is inflammation of the tendon which doesn’t allow for the tendon to properly glide within the sheath, if caught early enough, sometimes rest is all the tendon needs.
Most who suffer from trigger finger will need medical intervention. Early intervention is key to conservative care. Your physical or occupational therapist (PT or OT) will work with you on reducing the inflammation and irritation of the tendon. Usually, a custom finger splint is made to help keep the finger in an extended, or neutral, position. Immobilizing the tendon allows for rest and provides time for the tendon to heal fully. The typical healing time is about 6-weeks.
In rare cases when the finger is “locked” into place, a steroid injection or surgery may be needed. The goal of the steroid injection is to jump start the healing process by reducing inflammation and irritation of the tendon. Coupled with the injection, you will wear a finger splint to all for the tendon to rest and heal.
Conservative care or injections typically do not work for those who have suffered from the trigger finger for quite some time. Without early treatment, surgical intervention may be indicated. Surgery is performed on an out-patient basis, and local anesthesia is used.
Through a small incision, your surgeon will enter with a needle and cut the tendon sheath to allow for more space for the tendon. Once healed, the sheath grows back in a more lose state so the tendon can continue to glide within the sheath.
Early intervention of a trigger finger is proven to respond to conservative care by a PT or OT successfully. As a consumer of health care, you have a choice in finding the right provider for you. Do your homework and search for a health care provider, like a physical therapist, with excellent outcomes, great customer reviews, and can provide you the care you need for a reasonable cost.
In most states, you can be seen by a PT first, without a physician’s order. To determine if your state has direct access, please visit the American Physical Therapy Association’s website Physical Therapy Direct Access By State.
To get started with conservative care today, you can find a highly qualified PT in your area. There are many qualified PTs, so to find one near you, please click on the following link (FOTO PT database link). This link will help you find a PT that has top national rankings for treating knee pain.