Preview
of Trigger Finger:
Trigger Finger is a form of overuse injury
with symptoms ranging from a painless annoyance
with occasional snapping/jerking of the finger(s),
to severe dysfunction and pain with continuous
locking of the finger(s) in a flexed downward
position into the palm of the hand.
Anatomy of Trigger Finger: The tendons that
move the fingers are held in place on the bones
by a series of ligaments called "pulleys".
These ligaments form an arch on top of the
bone that creates a tunnel so that when the
flexor muscles are contracted, the tendons
can move along the bone in a straight path.
In order to make sure these tendons travel
in a smooth manner and reduce friction of the
tendon and its sheath, the body produces and
coats the flexor tendons with a slippery coating
called "tenosynovium" which allows
the tendons to glide through the tunnel formed
by the pulleys when the fingers/hands are used
to grasp objects.
Symptoms of Trigger Finger:
Trigger Finger may affect any of the fingers
(1-5) as well as any one of the finger joints
(MP, PIP, DIP Joints). The occurrence of this
injury usually results from overuse of the
flexor muscles/tendons and the formation of
an adhesion or fibrotic nodule on the tendon.
If left untreated, the adhesion/nodule becomes
larger, therefore creating a conflicting ratio
between the size of the tendon and the size
of the entrance of the tendon sheath.
There may also be thickening of the pulley
ligament as well, due to the friction of the
adhesion/nodule against the pulley ligament.
In most cases, if the adhesion/nodule is not
treated, it will continue to increase in size
(Depending on activity/use of affected finger)
to the point where it still has the ability
to pass into and through the tendon sheath
when flexing the finger, but becomes stuck
and cannot move back through the tendon sheath
and/or pulley when trying to extend/straighten
the finger, thus causing the finger to lock
in the flexed downward position (Palm of hand).
At first, this is experienced as a snapping
of the affected finger when relaxing a fist.
If the condition worsens, the finger may need
active force from the opposing hand/fingers
to straighten, or the affected finger(s) may
not straighten at all.
Cause(s) of Trigger Finger:
Most clinicians believe that the disorder
is caused by the tendon sheath because it becomes
thickened or swollen and pinches the tendon
and prevents it from gliding smoothly. But
common sense reveals that the history of patients
suffering with Trigger Finger have one common
denominator, overuse, excessive use and/or
abuse of the hands from work and recreational
activities.
Trigger
Finger is usually (not always) the
result of direct injury to the tendon via micro-tears
resulting from direct and sudden trauma or
tasks that required repetitive use of the hands
over long periods of time. And as the body
attempts to heal itself causes the formation
of scar tissue / fibrotic adhesion, and the
swelling of the tendon sheath is a secondary
injury caused by friction between the adhesion
and the tendon sheath as the finger is flexed
and extended. This friction causes irritation,
swelling, and inflammation to both the adhesion
on the tendon and to the tendon sheath, thus
resulting in a cyclic injury, starting with
the adhesion on the tendon, then the adhesion
irritates the sheath, then the sheath swells
and pinches down more so it irritates the adhesion
even more, and continuing to go back and forth
again and again with both the tendon and its
sheath contributing to the cause-effect of
Trigger Finger.
NOTE: Other contributors/factors of Trigger
Finger are Rheumatoid Arthritis, partial tendon
lacerations, repeated trauma from pistol gripped
power tools, or long hours grasping a steering
wheel.
Trigger Finger may also be caused by an infection
of the synovium, resulting in the scarring
and formation of a nodule on the tendon. Trigger
Finger can also be caused by a congenital defect
that forms a nodule inside of the tendon. The
condition is not usually noticeable until the
infant begins to use its hands.
Treatment(s)
for Trigger Finger:
Sometimes
the swelling
can be treated with rest, activity
modification, oral anti-inflammatory medications,
or steroid injections. The tendon sheath will
usually return to its normal, pain-free condition.
More severe cases may require surgery to release
the tendon, but is suggested as a last resort
after all other conservative methods have been
attempted. Often times, Trigger Finger will be persistent
because either no rehabilitation efforts were
attempted or improper forms of rehabilitation
were utilized pre- or post-surgery. In most
cases of Trigger Finger, injections and surgery
both attempt to cure the disorder by treating
the symptoms instead of treating the "Actual
Injury". In the case of Trigger Finger,
the actual injury is the adhesion, nodule,
and scar tissue buildup on the tendon due to
excess strain, overuse, or direct trauma to
that specific location on the tendon. Because
Trigger Finger and those afflicted with Repetitive
Strain Injuries, Cumulative Trauma Disorders,
Including Carpal Tunnel Syndrome HAVE THE SAME
TYPE OF HISTORY this Trigger Finger would be
treated in the same manner, through the implementation
of a variety of stretching and strengthening
exercises to break down adhesions, thin the
tendon and create stability around the affected
joint.
Successful
Treatment for Trigger Finger: (Perform
in the sequence listed)
Transverse
Friction Massage - Perform across the nodule/adhesion
on the affected finger to help break it down,
reducing its size. Stretches
- Immediately follow Transverse
Friction Massage with passive and active stretches
to the affected finger to help thin the tendon.
Exercises
- Immediately follow the stretches
with active strengthening exercises for the
OPPOSING MUSCLE GROUP, in this case the extensor
muscles that extend the fingers and wrist,
in order to hold and maintain the length to
the tendon that you just stretched
Hydrotherapy
- Ice the affected tendon in
a stretched position to maintain the length
of the tendon that was just created through
the stretches and exercises. Icing the tendon
also removes swelling and toxins created through
the use of massage, stretches and exercises.
Ice the tendon no longer than 1-2 minutes.
Take a break for 3-minutes and repeat the ice
cycle two more times.
Always consult a physician to make sure that
you have had a proper diagnosis of your condition
before beginning any form of treatment program.
Mr. Anliker is a Therapist and Inventor of Therapeutic
Exercise Products that are utilized by Corporations,
Consumers and Medical Facilities around the world
for the prevention and rehabilitation of repetitive
strain injuries.
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