Key Points
- Trigger finger is a common overuse injury that affects hand function and common misconceptions of this condition often result in individuals engaging in activities or hand exercises that tend to aggravate symptoms.
- Most cases of trigger finger can be resolved with non-surgical treatment options such as Hand Therapy.
- It is important to seek early treatment for trigger finger so that the condition can be resolved as quickly as possible without need for surgery.
Causes of trigger finger
Trigger finger – a condition which is often not life threatening in nature, but debilitating enough to affect your daily life. Widely recognised to be an overuse injury, sufferers of this condition often do not understand the cause behind it and are unsure of what they should do to help symptoms improve. In this article, we debunk the myths of trigger finger and explore what can be done to set you on the road to recovery.
Myth #1: Can trigger finger “spread to the other fingers?”
Fact:
Trigger finger is an overuse injury that affects the muscle tendon which bends your finger (flexor tendon) and its surrounding structures. Inflammation of the finger flexor tendon causes pain and swelling over the tendon and/or surrounding structures such as the finger pulleys (soft tissues which the tendons pass through) and the tendon synovial sheath (a lining covering the tendon). This makes it difficult for the tendon to move back and forth through the pulleys smoothly, resulting in a catch (“trigger”) when straightening a finger from a bent position.
Although relatively rare, it is possible to develop trigger finger over multiple fingers at the same time. However, this is usually due to frequent and prolonged overuse of the fingers and not because the condition is “spreading” to other fingers. Trigger finger is not a virus that spreads. -_-
Myth #2: Cause of trigger finger
Fact:
As Singaporeans, we don’t like to take no for an answer. I don’t know. Not sure. Are not acceptable. As sufferers of this condition often try to pinpoint its exact cause, but more often than not are unable to attribute the onset of symptoms to a particular incident or injury.
In fact, the causes of trigger finger are not well known, though research studies have suggested that it often occurs over time from frequent, repetitive and/or forceful use of your hands in daily activities (e.g. frequent wringing dry of cleaning cloth/mop when doing housework, cooking/baking, assembly line work, technical work that requires frequent use of hand tools, as well as events such as moving house or spring cleaning).
The cumulative strain on the finger tendons over time may result in inflammation of the tendon and/or pulley. Medical conditions such as diabetes, rheumatoid arthritis, gout, carpal tunnel syndrome, De Quervain’s disease and hypothyroidism also appear to be risk factors for this condition.
Myth #3: Trigger finger only occurs in women.
Fact:
Although women have been found to be diagnosed with trigger finger 2 – 6 times more frequently than men, this condition can affect anyone. Trigger finger is the fourth most common reason for a referral to a specialist clinic, with a lifetime risk of 2.6% among the general population. The onset of trigger finger is also most commonly observed in persons between 40 to 60 years of age.
Myth #4: My fingers are stiff, especially in the morning. Must be trigger finger!
Fact:
Finger stiffness (especially in the mornings) is a common symptom among various hand conditions, such as carpal tunnel syndrome, upper limb fractures, arthritis and traumatic upper limb injuries. Thus, trigger finger cannot be diagnosed based on this symptom alone.
Trigger finger symptoms tend to occur and worsen gradually after a period of heavy or extensive hand use in activities that require forceful and often repetitive gripping/pinching of the fingers/thumb. These symptoms include:
● A lump or swelling at the base of the finger/thumb on the palm side of the hand which may be painful or tender when there is pressure on it.
● During finger/thumb movements, the finger/thumb becomes stuck in a bent position and force is required to straighten it out. This may result in a “clicking” or “popping” sensation when opening up your finger/thumb, which may also be accompanied by pain.
● Feelings of stiffness and loss of mobility over the affected finger/thumb.
Myth #5: Trigger finger will get better on its own without treatment.
Fact:
Will trigger fingers get better on its own? Although it is possible for some mild cases of trigger finger to resolve on its own through a period of resting, many cases are likely to require some form of treatment. Hand therapy is a common first-line treatment for trigger finger and is non-invasive in nature.
Your Doctor may also suggest other non-surgical interventions such as short-term oral medications (e.g. non-steroidal anti-inflammatory drugs), or corticosteroid injections over the site of inflammation which can also help reduce inflammation, pain and over the involved finger/thumb because of the trigger finger.
If your trigger finger symptoms are severe or do not improve over time with non-surgical interventions, your Doctor may recommend a trigger finger surgery which involves the release of the tendon synovial sheath. Hand therapy is often required after surgery as well to help regain the movement, strength and function of the affected finger/thumb.
Myth #6: Surgery or corticosteroid injections are the only options for treatment of trigger finger.
Fact:
Trigger finger treatment is not limited only to surgery and corticosteroid injections. Treatment for trigger finger also includes Hand Therapy which is a great option where symptoms are mild to moderate in severity. It is important to seek early Hand Therapy treatment for trigger finger as non-surgical treatment success rates tend to decrease with time.
Hand therapy for trigger finger may include the following interventions:
● Providing advice on lifestyle and activity modifications so as to eliminate or minimise daily activities or finger/thumb movements which may further aggravate the condition.
● A trigger finger splint can be worn over the affected finger/thumb when you are using your hands to perform daily activities so as to provide support and encourage further rest of the finger/thumb. Resting will help reduce inflammation and its associated symptoms (i.e. pain and triggering over the finger/thumb).
● Exercises for trigger finger includes teaching appropriate range of motion and stretching exercises that can help reduce finger stiffness while avoiding aggravation of trigger finger symptoms.
● Use of therapeutic modalities such as heat treatment and ultrasound therapy, which may provide symptomatic relief of trigger finger symptoms.
Myth #7: I need to do more finger exercises to cure my trigger finger.
Fact:
As mentioned previously, trigger finger is largely an overuse injury. As such, it is important to rest your fingers and avoid active, repetitive and/or forceful gripping movements of the finger. Strengthening exercises of the fingers (e.g. squeezing a stress ball) should be avoided until the pain and triggering symptoms subside completely. Resting of the finger is often aided by wearing a customised splint, which can be provided by a hand therapist.
If you experience any finger stiffness, it is best to consult your Hand Therapist or Doctor before commencing any finger exercises so that you can learn mobility exercises which will not aggravate your trigger finger symptoms.
If you are experiencing any pain or problems in your hand, wrist or elbow, don’t suffer alone. We are always here to help you at The Rehab Centre. Contact us or book an appointment to see our Hand Therapist who will be able to partner you to recovery!
Ref:
Brozovich, N., Agrawal, D., & Reddy, G. (2019). A Critical Appraisal of Adult Trigger Finger. Plastic and Reconstructive Surgery – Global Open, 7(8), e2360. https://doi.org/10.1097/gox.0000000000002360
Langer, D., Maeir, A., Michailevich, M., & Luria, S. (2017). Evaluating Hand Function in Clients with Trigger Finger. Occupational Therapy International, 2017. https://doi.org/10.1155/2017/9539206
Lunsford, D., Valdes, K., & Hengy, S. (2019). Conservative management of trigger finger: A systematic review. Journal of Hand Therapy, 32(2), 212–221. https://doi.org/10.1016/j.jht.2017.10.016
