Trigger Finger: What you can DO


Trigger finger, often experienced by the elderly or by people diagnosed with conditions like rheumatoid arthritis, causes the fingers to pop or get stuck when you try to extend them. Diagnosis is often made by a physical examination & manipulation of the finger by your doctor. Exercises & physical therapy treatments for a trigger finger are suggested before more serious treatment options such as surgery are recommended. 

Definition

Trigger finger is a bone & joint condition caused by a contraction of the flexor tendons lining the inside of the finger. The flexor tendons are secured to the ligaments and bones of your fingers with sheaths. If your finger flexor tendons become thickened or develop small nodules due to age, wear or tear, you’re often unable to extend a finger or a thumb. This causes your finger to bend into a fixed position as you try to extend, much the way you’d hold your finger to pull a trigger, hence its name.

As with all disorders of the upper extremity, proximal segments must be screened.  Also, because posture can contribute to distal problems, it should be addressed to provide the patient with optimal outcomes. It is important to commence Physiotherapy soon after diagnosis to prevent the condition from getting worse & to get back to your normal level of functioning.

Physiotherapy treatment will help to reduce swelling, relieve pain and stiffness & regain functional movement of the finger. Physiotherapy treatment may include:

  • Ultrasound: Reduce swelling & accelerate healing
  • Soft tissue massage
  • Joint mobilisation
  • Passive stretching
  • Supervised hand & finger exercise program to regain strength, dexterity & flexibility
  • Splinting or Taping

Patient Education

Since trigger finger is observed as an overuse injury, education is very important. Education should be given on:

  • Rest
  • Modifications of activities
  • Specialized tools
  • Splinting
  • Modalities
  • Posture

Modalities such as heat/ice, ultrasound, electric stimulation, massage, stretching, & joint motion (active & passive) can have some positive effects on trigger finger. Following heat with stretching can provide more extensibility with plastic deformation. Joint movement & mobilizations increase joint & soft tissue mobility via a slow, passive therapeutic traction & translational gliding.

Exercises

Tendon Exercises

  • Perform a series of tendon gliding exercises.
  • Start with your fingers extended outward and your thumb pointing away from and perpendicular to the palm. Flex your fingers toward your thumb, as if you’re making the shape of a duck’s beak. Your finger and thumb should be approximately 1/2 inch apart. From this position, curl your fingers into your palm, placing your thumb along the outside of the index finger. Curl your fingers more and make a fist; this time, curl your thumb over the outside of your knuckles.
  • Slowly open your hand and lift the fingers, knuckles bent, into a upright position, your thumb again extended away from your palm. Repeat the sequence several times.

Soft Tissue Mobilization

  • Massage or soft tissue mobilization may help reduce the severity of your trigger finger or thumb constriction.
  • Massage manipulates muscle, tendon & ligament tissues & floods the affected area with blood & nutrients.
  • Massage also helps relax tightened muscles, which may facilitate other trigger finger exercises for greater efficacy and benefits.
  • One method of massaging a sore trigger finger is friction massage, which a physical therapist can do or you can do yourself. Stroke the affected finger in a downward motion toward the palm or upward toward the tip of the finger. This may help relieve pain and stiffness caused by nodules & lengthen the finger muscles and tendons.

Palm Presses

  • Hand & finger exercises that contract & extend the muscles & tendons of the fingers may provide relief & greater range of motion of the finger & thumb.
  • Pick up small items & place them in your palm, squeezing tightly for several seconds. Release, opening your fingers wide, & then repeat as instructed by your physical therapist.
  • Regular exercise and movement may help lengthen the flexor tendons, relieving symptoms of trigger finger.
  • Avoid activities which involve a sustained grip. Hold off on the use of grip strengthening devices or exercises involving repetitive squeezing – these put stress on the irritated tendon.

If fingers bend & lock during the night and are painful to straighten in the morning, it may be helpful to wear a splint to keep them straight while sleeping.

Splinting
A first step in treatment is to stop doing activities that aggravate the condition. Splinting is one of the best ways to limit motion. There are various ways to splint a patient but, ultimately, it will depend on what provides the patient with the most relief. Splints are usually worn for 6-10 weeks. It should be noted that splinting yields lower success rates in patients with severe triggering or longstanding duration of symptoms.Two major types of splinting most recently studied:

  • Splinting at the DIP joint.  This showed to have resolution in 50% of the patient’s symptoms.
  • Splinting at the MCP joint with 15 degrees of flexion.  This showed to have resolution of the patient’s symptoms at both 65% and 92.9%, which is consistent with current literature.

 

 

 

Taping Technique (Click for video on Taping)

DISCLAIMER: Please consult your medical professional before beginning exercises.

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4 thoughts on “Trigger Finger: What you can DO

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