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TRIGGER FINGER

Trigger finger is a condition that causes the finger or thumb to ‘click’ or ‘lock’ when it is bent. The finger can start off by catching a little bit, which you notice when you go to open the hand, or first thing in the morning. Trigger finger progresses to actually getting locked in a bent position, requiring the other hand to pull it out straight again. In the most severe cases, the finger is stuck in a bent position, and medical assistance is required to straighten the finger.

Tell me more about trigger finger

If you have trigger finger, you may notice a tender spot in the palm of the hand or on the front of the thumb under the webbing. This tenderness indicates the position of a nodule, or a thickening of the tendons to the fingers, as this is the cause of the triggering.

Tendons glide smoothly up and down to bend and straighten the fingers. The tendons pass underneath pulleys, or little roofs, which hold them in place under the skin. In trigger finger, a nodule forms that catches as the tendon moves in and out through the sheath.

What causes trigger finger?

Trigger finger can be naturally occurring with age, and it can be caused by repetitive finger movement or gripping. Trigger finger occurs more often in people with other inflammatory conditions, such as arthritisdiabetes or gout.

Repetitive bending or gripping of the fingers can cause irritation of the tendon and the sheath around it, which results in thickening and nodule formation. The nodule catches on the edges of the sheath as the tendon moves the finger open and closed. The trigger is caused when enough tension is put on the finger to force the nodule back under the pulley.

How do I know if I have trigger finger?

You will feel a clicking sensation in the palm of your hand when you bend and straighten your finger, or in more severe cases, you will be unable to straighten your finger from a bent position without the help of your other hand. Often you will be able to feel a small lump in the palm of your hand at the base of your finger or thumb—this is usually quite painful. Trigger finger is diagnosed in a clinical setting with a hand assessment and further testing is rarely required.

How can physiotherapy help with trigger finger?

A physiotherapist with experience in treating hand injuries can make a special splint for you to wear, which limits the amount you can bend your trigger finger. This stops the tendon from ‘clicking’ or ‘locking’, and so stops the irritation from occurring. This splint will be small and minimally intrusive. There are various designs that will be suitable depending on your job and hand activities during the day. Most people are able to go about their normal activities with minimal disruption while wearing a splint for trigger finger.

This splint needs to be worn full time for 4–10 weeks until the clicking has resolved. Your physiotherapist will guide you as to when you can wean out of your splint. Other physiotherapy techniques that can be helpful include massage, stretches and tendon gliding exercises to enhance the recovery, although the mainstay of treatment is the splint.

It’s important to note that not all physiotherapists are specialised in the area of hand therapy. For the best treatment outcome, find a physio who specialises in this area.

How effective is physiotherapy for trigger finger?

Physiotherapy is usually very effective in treating trigger finger. Splinting for up to 10 weeks has been known to show a 90 per cent success rate in resolving trigger finger. A corticosteroid injection can be helpful when combined with splinting, if the splint alone is not enough to settle your symptoms. In some severe cases that do not respond to splinting, a small surgery to open up the pulley may be needed.

 

What can I do at home?

Wearing your splint full time is the most important thing you can do for your trigger finger. Your physiotherapist will give you special tendon gliding exercises as part of your treatment, which you need to complete daily. It is also important that you avoid repetitive gripping, especially if it causes firm pressure in the palm of your hand over the affected area.

How long until I feel better?

Pain should resolve as soon as the finger is appropriately splinted, as this should stop any clicking or locking. Trigger finger can take up to 10 weeks of splinting before it gets better. The painful nodule in the palm of your hand can take even longer to get better—it may take up to several months even after the trigger finger has resolved.

 

Source – Choose.physio