Putting a Stop to Trigger Finger Injury Pain By Jeff Anliker, LMT

Trigger Finger is becoming a common, yet quite serious problem among many individuals, just as Carpal Tunnel Syndrome has been the past decade, and still is. Although Carpal Tunnel has received all the media hype in the past, Trigger Finger is currently affecting millions of Americans each year, causing suffers to experience lost time from work, expensive rehabilitation and often long-term disability, resulting in millions of man-hours and billions of dollars lost to the business, government and healthcare sectors.

So the question arises; what is Trigger Finger and how can it be eliminated without taking medications that may not be necessary, undergoing painful cortisone injections or even worse, being subjected to surgery, which has very poor results? The past few years have seen physicians prescribing ever-increasing numbers of invasive treatment methods that are often not the solution to treating either disease or injury, and completely avoiding the application of sound conservative therapy. 

The reason is simply money. Don’t be surprised as this is what the healthcare industry is inundated with. So, it is up to the patient to either find a physician that will implement conservative therapy first and try invasive treatments if all other measures fail, or address their injury themselves via conservative therapeutic alternatives. So let’s learn about Trigger finger and what can be done to help address this serious injury. 

What are the Telltale Signs and Symptoms of Trigger Finger?
Trigger Finger can effect any and all fingers as well as any of the MP, PIP and DIP joints of the fingers although it usually comes in a couple of basic forms: The first is where the distal joint of the finger is bowed into a flexed position. This form of tenosynovitis does not cause the finger to lock into the palm of the hand, and although it can be manually straightened with force, it goes right back to the bowed position. 

The second type of Trigger Finger is the most common, and that is the locking of a finger or fingers into the palm of the hand. The affected finger can be flexed downward but as the finger is straightened, it either stays in the locked-down position or quickly snaps and jerks back into the extended position. This snapping or jerking can be painless or painful, depending upon the severity of the condition. If the finger locks in the flexed position and cannot extend on its own, it can be extended with force, generally using the opposing hand.

What is Trigger Finger and Why Do I have it?
The finger’s flexor tendons are secured in place by a series of ligaments called "pulleys". These “pulleys” form a tunnel so that when the flexor muscles are contracted, the tendons can move along the bone in a straight line. In order to make sure these tendons travel in a smooth manner, the body produces and coats the flexor tendons with synovial fluid, allowing the tendons to glide through the tunnel without difficulty. The problem occurs when a flexor tendon becomes damaged via direct trauma or repetitive stress, creating micro-tears in the tendon that result in swelling and accumulation of scar tissue as it heals. 

When the damaged area is continually stressed, it keeps accumulating scar tissue to repair itself, creating a nodule or fibrotic adhesion. As this area continues to generate scar tissue, it becomes larger, causing increased friction as it attempts to pass through the pulley system each time the fingers are moved. Even if the area of injury on the tendon has completely healed, but has a nodule / adhesion on it, each time the finger is flexed and extended, it is re-irritated and the swelling increases causing the nodule / adhesion to enlarge and lock the finger into the palm of the hand. The reason the nodule / adhesion will pass through the pulley system as the finger is flexed but not when it is extended is that the nodule / adhesion is smaller on the front and larger on the back. This causes it to move through the pulley, but become stuck as the finger is brought back to a straight position.

NOTE: Trigger Finger can also be caused by the following medical conditions: Rheumatoid Arthritis, gout and partial tendon lacerations. 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.

Treating Trigger Finger Injuries:
Trigger finger can sometimes be treated with rest, activity modification and oral anti-inflammatory medications, or in more extreme instances, invasive procedures such as steroid injections and surgery are utilized. The most optimal measure in cases where the disorder is caused by direct trauma or repetitive overuse is the use of conservative therapy utilizing stretches and exercises to address the actual cause of the disorder, allowing the tendon sheath to return to its normal, pain-free condition. By allowing the area to heal, then initiating stretches and exercises to break down the nodule / adhesion on the tendon as well as stretch and thin it, the tendon will glide freely through the pulley system without causing irritation to the synovial sheath, thereby eliminating the cyclic irritation, swelling and scar tissue build-up that occurs.

Steps for Successful Treatment of Trigger Finger:
Reduce Inflammation - Be sure that the acute phase of injury is over and no visible swelling is present.
Stretch - Use passive and active stretches on the affected finger to help lengthen and thin the affected tendon.
Implement Flextend / Restore exercises - Perform simultaneous strengthening and stretching exercises.