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Trigger Finger



Trigger finger limits finger movement. When you try to straighten your finger, it will lock or catch before popping out straight.


Trigger finger is a condition that affects the tendons in your fingers or thumb.


In trigger finger, also known as stenosing tenosynovitis (stuh-NO-sing ten-o-sin-o-VIE-tis), one of your fingers or your thumb gets stuck in a bent position and then straightens with a snap — like a trigger being pulled and released. If trigger finger is severe, your finger may become locked in a bent position.


Often painful, trigger finger is caused by a narrowing of the sheath that surrounds the tendon in the affected finger. People whose work or hobbies require repetitive gripping actions are more susceptible. Trigger finger is also more common in women and in anyone with diabetes.


A
natomy


The tendon sheath attaches to the finger bones and keeps the flexor tendon in place as it moves.


Tendons are tissues that connect muscles to bone. When muscles contract, tendons pull on bones. This is what causes some parts of the body to move.


The muscles that move the fingers and thumb are located in the forearm, above the wrist. Long tendons — called the flexor tendons — extend from the muscles through the wrist and attach to the small bones of the fingers and thumb.


These flexor tendons control the movements of the fingers and thumb. When you bend or straighten your finger, the flexor tendon slides through a snug tunnel, called the tendon sheath, that keeps the tendon in place next to the bones


D
escription


The flexor tendon can become irritated as it slides through the tendon sheath tunnel. As it becomes more and more irritated, the tendon may thicken and nodules may form, making its passage through the tunnel more difficult.


The tendon sheath may also thicken, causing the opening of the tunnel to become smaller.

If you have trigger finger, the tendon becomes momentarily stuck at the mouth of the tendon sheath tunnel when you try to straighten your finger. You might feel a pop as the tendon slips through the tight area and your finger will suddenly shoot straight out.


The thickened nodule on the flexor tendon strikes the sheath tunnel, making it difficult to straighten the finger.


The cause of trigger finger is usually unknown. There are factors that put people at greater risk for developing it.


-Trigger fingers are more common in women than men.


-They occur most frequently in people who are between the ages of 40 and 60 years of age.


-Trigger fingers are more common in people with certain medical problems, such as diabetes and rheumatoid arthritis.


-Trigger fingers may occur after activities that strain the hand.


S
ymptoms


Symptoms of trigger finger usually start without any injury, although they may follow a period of heavy hand use. Symptoms may include:


-Finger stiffness, particularly in the morning


-A popping or clicking sensation as you move your finger


-Tenderness or a bump (nodule) at the base of the affected finger


-Finger catching or locking in a bent position, which suddenly pops straight


-Finger locked in a bent position, which you are unable to straighten
Stiffness and catching tend to be worse after inactivity, such as when you wake in the morning. Your fingers will often loosen up as you move them.


Sometimes, when the tendon breaks free, it may feel like your finger joint is dislocating. In severe cases of trigger finger, the finger cannot be straightened, even with help. Sometimes, one or more fingers are affected.


C
auses


The cause of trigger finger is a narrowing of the sheath that surrounds the tendon in the affected finger. Tendons are fibrous cords that attach muscle to bone. Each tendon is surrounded by a protective sheath — which, in turn, is lined with a substance called tenosynovium. The tenosynovium releases lubricating fluid that allows the tendon to glide smoothly within its protective sheath as you bend and straighten your finger — like a cord through a lubricated pipe.


But if the tenosynovium becomes inflamed frequently or for long periods, the space within the tendon sheath can become narrow and constricting. The tendon can't glide through the sheath easily, at times catching the finger in a bent position before popping straight. With each catch, the tendon itself becomes more irritated and inflamed, worsening the problem. With prolonged inflammation, scarring and thickening (fibrosis) can occur and bumps (nodules) can form .


R
isk factors


Factors that put you at risk of developing trigger finger include:


· Repeated gripping. If you routinely grip an item — such as a power tool or musical instrument — for extended periods of time, you may be more prone to developing a trigger finger.


· Certain health problems. You're also at greater risk if you have certain medical conditions, including rheumatoid arthritis, diabetes, hypothyroidism, amyloidosis and certain infections, such as tuberculosis.


-Your sex. Trigger finger is more common in women.


E
xamination


Diagnosis of trigger finger doesn't require any elaborate testing.

Your doctor or health care provider makes the diagnosis based on your medical history and a physical exam. During the physical exam, your doctor will ask you to open and close your hand, checking for areas of pain, smoothness of motion and evidence of locking. Rarely, your doctor may inject a numbing medication (local anesthetic) to reduce pain so that he or she can proceed with the physical exam of your fingers and hand.


T
reatment


Nonsurgical Treatment


Rest


If symptoms are mild, resting the finger may be enough to resolve the problem. Your doctor may recommend a splint to keep your finger in a neutral, resting position.


Splinting.


Your doctor may have you wear a splint to keep the affected finger in an extended position for up to six weeks. The splint helps to rest the joint.

Splinting also helps prevent you from curling your fingers into a fist while sleeping, which can make it painful to move your fingers in the morning.


Physical therapy


Because the mobility is locked as a result of specific tendon tightening, releasing the tension and then exercising the opposite action will help to elongate the finger. A transverse friction massage helps to break down the sheath and allows the finger to extend.

This should be immediately followed by stretching the finger, either actively or passively to lengthen the tendon. Exercises should be specific to the motion opposite of gripping--extending the finger.

This builds muscles to compensate for the gripping imbalance.

S
elf-Massage


Massaging the affected knuckle will facilitate blood flow to the area, which will lubricate the joint and prepare it for movement. With your affected finger in a comfortable position, begin to gently rub across the knuckle then rub in a circular motion. Continue the self-massage for two to three minutes and follow with range-of-motion exercises.

Assisted Movement


Assisted movement exercises will help maintain and even improve range of motion in your affected finger. Use your other hand to slowly and gently bend and straighten your affected finger, moving it through the largest range of motion possible. Bend and straighten your finger 10 to 15 times.

Stretching


Stretching your finger is important not only for your muscles but also for the tendons and ligaments in your affected finger. Keeping the connective tissue as flexible as possible is important in the treatment of trigger finger. Use your other hand to pull your affected finger beyond extension until you feel a stretch in the bottom of your finger. Hold the stretch for five to 10 seconds then stretch your finger in the other direction. Repeat each stretch three to five times.


Finger Extensor Stretch


This routine will make the affected finger moving after surgery. Lay flat the hand of your injured finger on a solid surface. Let your opposite hand hold the injured finger. Gently raise the injured finger up leaving the rest of your fingers flat on the surface. Continue the lift until the finger is slightly stretched. Let it stay for few seconds and allow to rest. Repeat when needed.


Tendon Gliding


Tendon gliding exercises will improve the ailment by making the tendons gently run through the surrounding sheaths to enhance lubrication. Spread your fingers widely while you can, and slowly bend them to let it touch the palm of your hands. You can begin by touching the top of the palm; spread again and move down to the middle; spread again then move to the bottom. When you have done this exercise, you can have your thumb touch all your fingertips, then down to your palm. Repeat the exercise when needed and perform slowly, pausing if you feel pain. You can also have your hands immersed in warm water to relieve the stiffness once the exercise is repeated.

Strengthening Exercises


Unlike a strengthening exercise of a healthy joint, exercising trigger finger requires a tender touch. This injury is not a result of lack of strength in the finger; it is a tendon issue that stops mobility. Placing the finger in warm water and rotating it is a great way to warm up the tendons and help stretch the finger, regaining some of the range of motion. Massage will also help. Until the problem is resolved, repetitive gripping of objects may only worsen the problem. Between exercises, splint the finger, give it lots of rest and take anti-inflammatory medicine to ease pain.


Trigger finger is common among individuals who repetitively grip objects. Gripping is performed by your flexor muscles, which means your extensor muscles may be weak causing a muscle imbalance. Strengthening these muscles may help in the treatment of trigger finger. Keeping your fingers straight, bend your knuckles so that your hand forms a 90-degree angle. Press your thumb close to your fingers then wrap a thick rubber band around your fingers and thumb.

Working against the resistance of the rubber band, open your hand by extending your fingers as much as possible. Slowly return to the starting position. Repeat the exercise 10 to 15 times.


Finger Abduction 1


This routine enhances blood circulation to the injured finger. It also strengthens its smaller ligaments. Have the injured finger placed side by side with a normal finger. Let the thumb and index finger of your other hand press slightly the two fingers placed together. Then apply slight resistance to the two fingers as you move them apart using your index finger and thumb. Have the resistance adequate for the two fingers to separate.


Finger Abduction 2


This routine works similarly to the abduction exercise where blood circulation is enhanced and the smaller ligaments are strengthened. Separate the injured finger as far away from the closest normal finger. Allow the two fingers to form a V position. Have the index finger and thumb of your other hand push the two fingers against the other fingers. Then press slightly the two fingers bringing them closer together.


Finger Spread


You can start by pinching the fingertips and your thumb. Place an elastic band around them. Separate your fingers from your thumb, making the band fairly tight. Allow it to stay in place on your fingers and thumb. Make a repetitive pumping motion to extend the fingers and thumb away and close to each other again and again. You should apply tension on the elastic during the whole exercise. Repeat the routine as necessary. Have your fingers and thumb bent towards your palm and hook the elastic band in the middle. Let your other hand pull the end of the band and allow slight tension. Straighten your fingers against the tension.


Palm Presses


Hand and finger exercises that contract and extend the muscles and tendons of the fingers may provide relief and greater range of motion of the finger and thumb. Pick up small items and place them in your palm, squeezing tightly for several seconds. Release, opening your fingers wide, and then repeat as instructed by your physical therapist. Regular exercise and movement may help lengthen the flexor tendons, relieving symptoms of trigger finger.


Object Pick-ups



Placing a large variety of small objects on a table -- including safety pins, coins, marbles, pens, pencils, buttons and tissues -- can help you to regain function in your finger. Grasp the items between your affected finger and your thumb. Place the objects on the other side of the table and repeat. Complete this exercise for five minutes at a time, twice a day.


Paper Grasp



This exercise can help increase flexibility and strength in your hand following surgery. Take a sheet of paper and place it in the palm of your hand.

Crumble the paper into as small of a ball as you can possibly create by using your fingers. Use your fingers to straighten the sheet of paper out and repeat. Complete one set of 10 repetitions twice a day.


"O" Exercise



This exercise will help with your ability to bend and straighten your finger. Place your affected finger to your thumb so that you are making an "O" shape.

Hold this position for five seconds. Straighten your finger back out and return to the starting position. Complete one set of 10 repetitions twice a day.


Avoiding repetitive gripping.


For at least three to four weeks, avoid activities that require repetitive gripping, repeated grasping or the prolonged use of vibrating hand-held machinery.


Medications


Over-the-counter pain medications, such as non-steroidal anti-inflammatory medicines (NSAIDS) can be used to relieve the pain.


Steroid Injections


Your doctor may choose to inject a corticosteroid — a powerful anti-inflammatory medication — into the tendon sheath. In some cases, this improves the problem only temporarily,and another injection is needed. If two injections fail to resolve the problem, surgery should be considered.


Injections are less likely to provide permanent relief if you have had the triggering for a long time, or if you have an associated medical problem, like diabetes.


Surgical Treatment


Trigger finger is not a dangerous condition. The decision to have surgery is a personal one, based on how severe your symptoms are and whether nonsurgical options have failed. In addition, if your finger is stuck in a bent position, your doctor may recommend surgery to prevent permanent stiffness.


Surgical Procedure


The goal of surgery is to widen the opening of the tunnel so that the tendon can slide through it more easily. This is usually done on an outpatient basis, meaning you will not need to stay overnight at the hospital.


Most people are given an injection of local anesthesia to numb the hand for the procedure.


The surgery is performed through a small incision in the palm or sometimes with the tip of a needle. The tendon sheath tunnel is cut. When it heals back together, the sheath is looser and the tendon has more room to move through it.


During surgery, the tendon sheath is cut.


Complications


· Incomplete extension — due to persistent tightness of the tendon sheath beyond the part that was released


· Persistent triggering — due to incomplete release of the first part of the sheath


-Bowstringing — due to excessive release of the sheath


-Infection


Recovery


Most people are able to move their fingers immediately after surgery.


It is common to have some soreness in your palm. Frequently raising your hand above your heart can help reduce swelling and pain.


Recovery is usually complete within a few weeks, but it may take up to 6 months for all swelling and stiffness to go away.


If your finger was quite stiff before surgery, physical therapy and finger exercises may help loosen it up.