Trigger Finger

If you have recently developed a trigger finger, you may first feel painless clicking when you move the affected finger. As the condition increases in progression, you may experience pain at the base of the affected finger when it moves or if you press on it. For example, a patient might notice that his or her index finger hurts from knitting or beginning to perform in another hobby activity. Trigger finger pain and stiffness often appear in the morning, whilst firmly holding an object or whilst extending the affected finger. If the trigger finger pain grows more severely, the affected finger can stick when you bend it, leading the finger to suddenly snap into a straight position. As the condition progresses, you may not be able to fully bend or straighten the affected finger. Generally, common symptoms of trigger finger include the following below:

• Pain is located inside the palm at the base of the finger.
• A sudden “popping” or “clicking” feeling when moving the affected finger.
• A finger is not able to straighten from a locked position.
• Finger stiffness, especially in the morning.
• Finger being locked into a bent position then popping straight.
• A lump around the base of the affected finger near the palm.

The cause of the trigger finger is quite unclear; however, it is much more common in individuals whose work or hobbies involve repetitive gripping actions (such as musicians, industrial workers, and farmers), which can irritate the tendon sheath over time. Additionally, other risk factors that increase the risk of developing trigger finger affect more women than men, aged 40-60, and for those developing certain health problems in the midst of trigger finger (such as diabetes or rheumatoid arthritis), or having complications following carpal tunnel syndrome surgical treatment.

Many doctors are not sure what causes the tendon or sheath inflammation that may lead to trigger finger. However, a wide variety of different conditions and risk factors can increase the likelihood of experiencing trigger, including the following:

• Diabetes – The risk of developing a trigger finger is approximately 5-10 times higher for people living with diabetes than the general population, and 25% of patients with trigger finger have diabetes. In addition, approximately half of patients with diabetes and trigger finger will experience the condition in multiple fingers.

• Rheumatoid arthritis – This is an inflammatory disorder that can affect the joints of the human body, as well as tendons in the hands. Since rheumatoid arthritis can cause inflammation of the tendons in the hands, it can also lead to developing a trigger finger.

• Gout – Gout is a painful type of arthritis resulting from uric acid buildup in the human body. Gout often occurs in finger joints, and when it is left untreated, it can even damage the tendons. Patients with gout are more likely to experience a trigger finger than the general population.

• Osteoarthritis – Osteoarthritis is one of the most common types of arthritis located in the hands. This condition causes cartilage deterioration in the joints, and eventually tendon-related pain. Trigger fingers can be associated with osteoarthritis.

Other conditions that can cause inflammation in the hands and lead to trigger finger include kidney disease and hypothyroidism.

Generally, the diagnosis of trigger finger is clinical; therefore it is presumed in a patient whose finger locks during flexion, clicks painfully, and catches upon extension. It is also presumed whenever an inflamed nodule at the base of the affected finger is currently presented. Ultrasound can be obtained in assessing this type of condition. Ultrasound may demonstrate thickening of the pulley as well as inflammation and irregularity of the underlying flexor tendon. However, it may not reliably predict the site. Ultrasound can be used dynamically in order to demonstrate the catching and clicking during the tendon sliding. Certain plain radiographs are useful to rule out other conditions, such as an occult fracture. Before initiating any surgical procedure regarding trigger finger, physiotherapy is a great option to alleviate any symptoms linked to this condition. Physiotherapy for trigger finger would include either icing or heating the tissue, stretching exercises, and searching for different ways to decrease unnecessary stress to the hand, such as:

• Manual therapy – The use of various techniques, including soft tissue massage, can help to decrease pain and the catching of the finger.

• Stretching exercises – These types of exercises can strongly help maintain the motion in your fingers.

• Pain relief – Ice or heat can be applied to the hand to help decrease pain. Heat prior to exercises and stretching may also help loosen the tissues safely.

• Patient education – It is important to ensure that you still use your hand with the trigger finger. Sometimes the more that the fingers move, the better they feel and heal. Initially, it can be advantageous to avoid any repetitive gripping or grasping.

Other treatment of trigger finger normally is non-operative – these types of treatment include the following:

Steroid injection – Injection of steroids is often successful and a most recommended treatment strategy for patients with trigger fingers. It is inexpensive, easily performed, as less invasive than surgery. The delivery of steroids into the tendon sheath is important for its effectiveness. Steroid injections may be helpful in many patients, although, recurrence of side effects can occur. Steroid injections can cause tissue atrophy, skin discoloration, hypopigmentation, or even infection. Patients with prolonged symptoms are less likely to have a resolution.

Splinting – There are many finger splints available, with the best option being a splint that helps prevent the finger from bending to the point where it triggers, but still allows you to use your hand. By limiting how far the finger bends, the tendon is less likely to get caught and has the chance to rest and heal. Oval-8 finger splints are a great solution as they can be worn to prevent the finger from bending all the way, although, still allows your hand to move.

If your symptoms do not improve with rest, anti-inflammatory medications, or ice application, your doctor might consider corticosteroid injections. You might also consider corticosteroid treatment if you are experiencing severe trigger finger symptoms. Corticosteroids are a type of synthetic drug to your body’s hormones that suppress inflammation. Doctors often prescribe them to treat inflammatory conditions, such as rheumatoid arthritis and allergies. During this specific procedure, the doctor will inject the corticosteroid into the tendon sheath at the base of the affected thumb or finger with a small needle. Corticosteroid shots typically contain a local anesthetic to numb the affected area, however, you may feel a little pressure when receiving the injection. Corticosteroid injections are normally effective for a single year, although sometimes longer. However, this type of trigger finger treatment may be less successful in patients living with diabetes. Generally, this is a quick, straightforward procedure that can help you avoid surgical treatment.

There are many simple exercise methods that be performed either at home or elsewhere, including the following:

Finger extensor stretch – First you lay your hand out flat on a table or on a solid surface. Secondly, you use your other hand to hold the affected finger. Then slowly lift up the finger and keep the rest of your fingers flat. Finally, lift and stretch the finger as high as it will go without straining. Hold the stretch for a few seconds before releasing it back down softly. You can perform this stretch on all your fingers and your thumb. Repeat this exercise for 1 full set of 5 reps. It is recommended to use this method 3 times a day.

Finger spread – Begin by pinching the tips of your fingers and thumbs. Afterward, insert an elastic band around your fingers. Move your fingers away from your thumb so that the band tightens. Extend your fingers and thumb away and close to each other 10 consecutive times. You should then be able to feel the slight tension of the elastic band while you are performing this method. After 10 times, bend your fingers and thumb towards your palm. Hook the elastic band in the middle, then finally, use your opposite hand to pull the end of the band to create a slight tension. Keep the tension as you straighten and bend your fingers 10 more times. Repeat this exercise 3 times throughout the day.

Palm pressing – You can start this method off by picking up a small item and placing it in your palm. Squeeze the object tightly for a few seconds, then release it by opening your fingers wide. It is recommended to repeat this minor exercise method a few more times. Perform this at least two more times during the day.

Towel grasps – Place a sheet of paper or small towel in the palm of your hand. Then use your fingers to squeeze the paper or towel into a tiny ball (as small as possible). Apply pressure to your fist whilst you are squeezing, and hold this position for a few more seconds. Finally, slowly straighten your fingers and release the paper or towel. Repeat this exercise 10 more times, performing it twice a day.

Tendon glides – Begin by spreading your fingers as wide as possible. Bend your fingers so that your fingertips touch the top of your palm. Then straighten your fingers again and spread them wide. Afterwards, open your fingers wide so you can bring your fingertips to touch the bottom of your palm. Bring your thumb to touch each fingertip, finalizing the exercise by bringing your thumb to touch different places on your palm. Perform this method 3 sets twice a day.

One of the greatest ways to treat a trigger finger at home is to try non-invasive options. Essentially, you’ll want to care for trigger finger as you would for sore muscles – with rest and over-the-counter medications (where approved by your doctor). Wearing a splint may also help heal and prevent a trigger finger in mild cases. Some at-home trigger finger treatment includes:

• Rest – If you have a trigger finger due to overusing your fingers at work or home, you may find relief by resting your hand. Try to avoid activities that require repetitive gripping or the extended use of handheld tools for three to four weeks until your symptoms improve.

• Non-steroidal Anti-inflammatory Medications – Non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, or naproxen can strongly help relieve pain and inflammation relating to trigger fingers (consult your doctor pior).

• Ice application – Cold treatment can decrease pain and swelling by reducing blood flow to the affected area. However, it is essential to use this method in moderation – too much cold can cause stiff, sore joints. It is recommended to use an ice pack every hour or two over the first three days or until the swelling decreases.