The finger is used for a lot of things. We use them to point, describe things, type on our phones and computers, pick things up and other activities that are included in our day to day activities. This also places the finger in a vulnerable position to be injured.
Trigger finger is a condition that affects the tendons in the fingers and causes fingers to “lock and catch” while we bend and straighten our fingers. The similarity to the trigger on a gun that has a locking and catching mechanism and is also rigid is what gave this condition the name ‘trigger finger’.
This article will bring more light into this condition, how it can be treated and what may happen if not treated well and on time.
What Is Trigger Finger?
The fingers that are commonly affected are the ring finger and the thumb. Our fingers are made up of bones joined together by ligaments and supported by muscles that attach to the bones. The soft tissues that attach muscles to the bones are called tendons. Tendons act as a network provider between muscles and bones. If we want to bend our fingers, the muscles will contract and the tendons we allow us to bend our fingers.
Like joints have cartilages and bursae that supply synovial fluid for easy movement, tendons have a soft tissue that covers them to allow for easy movement. This soft tissue is known as the tendon sheath.
When these tendons get irritated or inflamed in the sheath, the tendons do not move about easily and this causes the catching and locking sensation that is known as trigger finger.
Exercises For Trigger Finger
Exercises will involve stretching the tendons that have been affected. Some of these exercises are:
1. Finger To Thumb Circle Stretch
- Take your index finger to the pad of the thumb to form a circle
- Apply a little pressure on the finger using your thumb to stretch the finger
- Repeat this on the other fingers
- Do this up to ten times
2. Grip Strength
- Using a softball or a rolled up towel, squeeze the ball and towel 10 times
- Hold each squeeze for 10 seconds
3. Rubber Band Stretch
- Place a rubber band or a hair grip around your fingers
- Open up your fingers to stretch out the band
- Hold for 5 seconds
- Relax your fingers
4. Finger Extensor Stretch
- Place your palm flat on a table
- Use your other hand to slowly lift the affected finger off the table
- Pull the finger as high as it can go without straining it
- Hold the pull for 5 seconds
- If other fingers are affected, do the same as well
- Place your palm with the affected finger flat on the table
- Spread your fingers out wide
- Hold for 5 seconds
- Then squeeze your fingers together for a few seconds
- Use your other hand to bend your fingers backward and forward
- This can be done 2 – 4 times in a day
6. “V” Stretch
- Move the affected finger away from its neighbor finger
- To go deeper into the stretch use your index finger and thumb finger, on the other hand, to stretch them further
- Hold this stretch for 5 seconds
- Press the affected finger and its neighbor close to themselves
- Repeat this 5 times
7. Finger Lifts
- Place your palm on the table
- Actively lift each finger off the table for 5 seconds
- Repeat 5 times with more time on the injured finger
- This increases the strength in the muscles of the fingers
8. Tendon Gliding
- This is very necessary to avoid adhesions in the tendon as it heals. This form of exercise helps to relieve pain and reduce swelling.
- Spread out your fingers wide
- Bend your fingers towards the end of the palm except for the thumb
- Take them back to their original position then bend them to the middle of the palm
- Take each fingertip to the tip of the thumb
- Take the tip of the thumb to the base of the fingers
What Causes Trigger Finger?
- Overuse of the fingers especially if you have a job that involves using your fingers all the time.
- Rheumatoid arthritis is a condition that causes inflammation at some joints of the body. A swollen joint at the fingers can affect the tendon or compress the tendon in the sheath thereby irritating and causing tendon inflammation.
- An injury to the palm or finger.
- People with diabetes tend to have trigger finger but the link is still not clear.
- It is said to occur more in women than in men probably because of the lifestyle of women such as going for a manicure or nail extension and the finger is kept in an awkward position for a long while.
- Carpal tunnel syndrome involves the median nerve which supplies the fingers. This can lead to the fingers not moving well and can cause irritation in the tendon sheath.
How Do You Know You Have It?
- Pain when bending and straightening the affected finger
- The stiffness of the fingers especially in the morning
- Locking and catching sensation
How Is It Treated?
1. See Your Doctor First
Seeing a doctor will help to pinpoint the major cause of the symptoms and if it is associated with other conditions. Sometimes, the doctor may advise running some diagnostic tests. Based on the results, the doctor will then manage the condition by prescribing medications and referring to a physiotherapist or a rheumatologist.
Medications with active ingredients like ibuprofen, naproxen, and diclofenac may be prescribed by the doctor to help relieve pain and reduce any form of swelling at the tendons. Topical gels with the same active ingredients may be recommended as well that can be used to massage the affected finger.
Resting from activities involving the finger will help to speed up healing to avoid further irritation of the already irritated tendon.
Ice is usually recommended to relieve pain and also to reduce swelling. Depending on the course of the injury, a physiotherapist may change this modality to heating modalities to reduce joint stiffness. Ice immersion, which involves placing the entire hand in a bowl of crushed ice and water, is usually advised for trigger finger. This should not be done for more than 30 minutes.
A finger splint is recommended for a trigger finger to avoid unnecessary movement of the finger or forming a habit of “looking” for the locking and catching of the joint.
Physiotherapy’s main goal is to relieve pain, increase joint movement and prevent deformities that may arise from the condition. A physiotherapist will have gotten some information from the referring doctor and will carry out an assessment on the affected finger and other associated joints like the wrist.
The physiotherapist may notice some muscle weakness or a nerve involvement that may be adding to the condition. Questions concerning your social and occupational lifestyle will be asked too, in case there may be a need to modify them to avoid reinjury and complications.
After carrying out the assessment, the physiotherapist will:
- Relieve pain using heating modalities like infrared, paraffin wax bath or ice. Using heating modalities can increase blood flow around the affected finger or the synovial fluid in the sheath to allow for easy movement of the tendon and the finger.
- Massage can also be used to relieve pain. Frictional massage can help to reduce and prevent adhesions at the tendon while kneading massage can help reduce the swelling and improve range of motion.
- Increase the range of movement at the joint by reducing joint stiffness. This can be done by using the heating modalities mentioned earlier and passively stretching the affected finger to the client’s limit.
- Strengthening exercises to the hand and fingers. strong muscles support injured tendons and ligaments and help to relieve the pressure on the injured soft tissues as well. The physiotherapist will prescribe the exercises based on the assessment findings.
- Modify a daily lifestyle. For instance, if your job expects a lot of typing, rets or stretch breaks can be suggested.
7. Steroid Injections
Unlike other pain medications that are basically non-steroidal, corticosteroids are stronger and faster pain-relieving medications. They are injected into the affected finger to reduce inflammation and swelling thereby relieving pain. However, they have side effects such as pain or discomfort for some days at the injection site and may also cause an infection at the painful joint.
A trigger finger release surgery is done as a last resort if other forms of treatment do not alleviate the symptoms. The two major forms of surgery that are usually done are:
Open Surgery – In this type of surgery, the tendon sheath is cut to allow for easy movement of the tendon. This is done under local anesthesia given in the affected hand. A cut is done in the palm under the affected finger. The surgeon moves the affected finger while gradually cutting the tendon sheath until the movement is free.
Percutaneous Release – Unlike open surgery where there is an incision, percutaneous release involves injecting a needle into the sheath and moving it within the sheath and moving the finger at the same time to try and reduce any restriction the tendon may have in the sheath.
If a trigger finger is not well treated, it may lead to the finger being in a permanently bent or straightened position. This often requires surgery. However, complications may arise from performing surgery such as:
- Tendon position might have been changed
- Damage to blood vessels in the sheath
- Nerve injury
- Reoccuring swelling in the palm
Trigger finger is a painful condition that can affect the fingers especially the ring finger and thumb. If treatment is started immediately, the condition takes 2 – 3 weeks to heal completely. However, if the different forms of treatment do not work, surgery is always done as the last resort.