Snap, Crackle, Pop - Trigger Fingers!
In today’s culture, each finger has its own meaning:
- You can give someone a Thumbs-up
- The Index finger is most commonly used for pointing
- The Middle finger can be used to make rude gestures
- You can put a ring on that special someone’s Ring finger as a promise of marriage and fidelity
- Or you can make the recess-famous pinky promise by hooking Pinky or Little fingers together with a friend
But the trigger finger isn’t just for activating the trigger of a gun. It’s also a common hand condition that can affect not just the index, but all 5 fingers (most commonly the thumb, middle, and ring fingers). However in the thumb digit, this condition is called “Trigger Thumb”.
HOW DO YOU KNOW IF YOU HAVE TRIGGER FINGER?
You may have trigger finger if 1 (or more) of your fingers ever gets stuck or catches when you try to open your hand or make a full fist, and may make a “snap” or “pop” sound. Over time, this “catching” may also result in pain and swelling.
Unfortunately, once you have it in 1 digit, it’s common for this to spread to other digits. This is why it’s best to catch this early and seek treatment with physiotherapy.
Other risk factors include being: female (2-3x more likely than males), middle age (50-60’s), and diabetic.
WHAT’S GOING ON?
There are two tendons (Flexor Digitorum Profundus & Flexor Digitorum Superficialis) that bend your fingers and are kept close to the bone thanks to special sheaths called pulleys. These pulleys help prevent “bowstringing” and improve mechanical advantage. These pulleys are similar to the eyelets on a fishing rod – keeping the line close to the rod.
With heavy and repetitive gripping, the body does what it usually does to help heal and protect tissues – it swells and thickens – and may also eventually form a nodule in this tendon. (In the inflammatory process, bigger usually means better). Unfortunately, this thickening makes it harder for the tendon (+/- nodule) to slide smoothly into and through these pulleys = resulting in the catching or “popping” sensation. Over time, the fibers of the tendon continue to bunch up, making it harder and harder to push through, like trying to push a fraying thread through the eye of a needle.
1) Catch it early! Early diagnosis DOES make a difference – so you can get back to normal hand activity that much sooner.
2) Activity Modification – such as carrying grocery bags with your forearm rather than holding them in your hand, can help decrease the local inflammation.
3) Daily continuous wearing of an Orthosis – such as Oval 8’s or other finger braces (that block bending at the 1st (MCP) or 2nd (PIP) knuckle) – helps decrease friction and improves tendon gliding at the pulleys.
4) Gentle tendon gliding exercises may also be beneficial for breaking up any adhesions that occur between the 2 tendons within the sheath itself.
5) Consider talking to your general physician regarding getting a local corticosteroid or cortisone injection to help decrease inflammation.
If your symptoms still have not improved after 8 weeks of conservative management, talk to your doctor about a surgical release of the pulley.
If you have more questions about trigger finger or any other upper extremity condition, feel free to book a Telehealth appointment with me at InReach Physiotherapy!
By: Susan Herdman, Registered Physiotherapist – Specializing in Upper Extremity and Hand Rehabilitation
Lee, Marilyn P; Biafora, Sam J; & Zelouf, David S. (2021) 7th Edition Rehabilitation of the Hand and Upper Extremity – Chapter 35: Tendinopathies of the Upper Extremity. Elsevier.
McQueen, Kathryn S & Pemberton, Tim. (2020) 3rd Edition Cooper’s Fundamentals of Hand Therapy: Clinical Reasoning and Treatment Guidelines for Common Diagnoses of the Upper Extremity – Chapter 24: Elbow, Wrist, and Hand Tendinopathies. Elsevier.