In 2010 when I first came out of Chiropractic college I had an understanding that I would see back pain, neck pain, shoulder pain fairly often. On the contrary, I never thought that trigger finger would arise as often as I have seen it. As a matter of fact, my very first patient in clinic came in with trigger thumb and she previously underwent surgery for trigger finger several months earlier and was hoping to avoid another surgery. Eventually, after several weeks we were able to get her back to work and functioning properly without any surgery!
What is trigger finger/trigger thumb?
Trigger finger in the medical world is called stenosing tenosynovitis. Essentially this is when the tendon no longer has as much room to glide and slide properly throughout its path. As a result, the tendon can often get stuck or locked into a position. As the tendon continues to have difficulty gliding through its path, it often gets irritated and inflamed causing pain and tenderness. While this often happens to the index finger (like pulling a trigger, hence trigger finger), I have seen this fairly often with the thumb.
What is the cause of trigger finger?
It is said that those who have a job or work with their hands frequently can increase their risk of this condition, but who doesn’t work with their hands these days? It appears that trigger finger is can become more prevalent in repetitive strain type of work and those that grip often as well as aggressively because it often uses the tendons and muscles. The overuse of the tendons can create irritation to the joint causing this condition. In addition, you can likely develop this issue after an injury to the area.
What are the symptoms of trigger finger?
Trigger finger starts off benign; meaning you likely won’t think much of it other than soreness into the hand or finger. As the condition progresses, you will likely notice some more stiffness, soreness, clicking or locking of the joint at the fingertips. In most cases you will also notice that is hard to open boxes, bottles, pick up or grasp things effectively.
Interestingly, often times a bump or nodule within the joint begins to develop and I have even seen patients have this surgically removed by a doctor.
As the condition continues on you will likely notice soreness, stiffness, and pain that is worse after sleeping. This is due to us sleeping in the fetal or flexed posture position and the tendon often becomes contracted in this position.
Often times, patients begin to compensate and avoid using the affected hand. This then leads to the elbow staying in a chronically shortened position. Many times we will have to go in and treat the arm and the shoulder to make sure further injuries do not develop.
What are the risk factors for this condition?
- Repetitive strain on the joint
- Forceful or prolonged gripping
- Female (for some reason this is more prevalent in females)
- Chronic illness like diabetes, and rhemutoid arthritis
Why do you think the thumb is often involved?
Often times I see the thumb is involved in because the thumb is unique to humans and their anatomy. Apes and other types of mammals do not have opposable thumbs and they help provide us with a grip strength that aids us uniquely to bend, twist, hold, and manipulate objects. For this reason, we require the thumb to be a strong stabilizer for grip control and it often gets used for powerful gripping motions like opening a can of pickles, golf, baseball, opening, closing packages, etc.
How can you diagnose trigger finger?
Just like all doctor visits, you will need a relevant health history as this dives into what you may or may not be doing at your job, sport, or activity to see if this is a condition. Often times you will not need an x-ray or MRI but rather the doctor should be able to touch, see, and feel the condition to make the diagnosis. This is fairly straightforward and should take a few minutes and can include range of motion of the joint, observance of the joint locking, and grip strength testing.
Phases of trigger finger and trigger thumb.
Although there is no formal classification of phases, I have personally seen this condition from the beginning phases all the way to patients presenting in my office without care for a year plus before getting any help.
Essentially, the longer that this condition continues on, the more inflammation occurs. This results in more pain within the hand and fingers and of course results in reduced strength, mobility, and activity of the whole joint.
What does the treatment look like for trigger finger?
Treatment of this condition ranges all the way from massage to the hand all the way to surgery. Of course I would always recommend that patients undergo an evaluation first and try their best for conservative measures first!
What are some ways to treat this condition without medication or surgery?
It really depends on your phase of care and how inflamed you are that determines how aggressive the treatment can be. If you are very inflamed, the treatment will likely have to start of much lighter and you will have to take more of an anti-inflammatory approach to care.
Treatment in the Chiropractic office includes joint manipulation and mobilization. This does not mean aggressive adjustments to the spine or to the hand but rather gently guiding the joint through passive motions to help the capsule, joint, and tendon move better.
In addition, there needs to be a heavy emphasis of soft tissue mobilization to help the tendon glide and slide better. I often use Active Release Technique and Graston Technique for these conditions. In addition, the tendons run all the way from the arm and elbow to the hands so we will have to work up the chain NOT just the hand! Remember, this a tendon that has lost that ability to move properly so you will need to get the muscle and tendon to move more again!
What are some things I should avoid to help improve this condition?
Glad you asked!
- Avoid aggressive stretching as this can inflame the tendon. Stretching can be beneficial but if you are tugging on the inflamed tendon, its just going to make things a bit worse.
- Pushing directly on the nodule or bump can compress the tendon at the irritated area. Again, this can cause a flare-up and more pain.
- Excessive grasping for obvious reasons
What are some things I can do on my own to help my condition?
- Ice massage to the area using an ice cube
- Avoid repetitive tasks and strong grasping (stated before)
- Self myofascial release and joint mobilization
- GET A BRACE – I know this is the last thing you want to do but if you keep the joint in a contracted state (like when you sleep), you will not be able to get the proper lengthening. In addition, the brace helps to protect it if you bang it into walls, pets, desks, etc.
- GET TREATMENT – Self-treatment is great and you should do it but treatment with a professional is more passive and more thorough.
- Strengthening – it may take some time to get to this phase but once you can, you need to make sure the hand, forearm, and arm are stronger to prevent injuries again.
How long does it take to heal trigger finger?
This type of condition tends to linger around (likely due to the use of the hand) for several weeks. In my experience, most patients come in with a bit more of a moderate case as they wait a few weeks before starting to seek cares. On average, you can likely estimate that this condition may take around 8-10 weeks before you can start really gaining some significant mobility and strength back. Professionally, I have seen this clear up in about 6 weeks and I have even done a treatment plan with someone that had lasted about 16-18 weeks. The sooner you get treatment, the faster you will recover!
Trigger finger and trigger thumb is not fun and it can really impact your life in your job, sports, and daily activities around the house. Make sure you find someone who can help you. If you like the person to be me, please contact us!
In your health,
Dr. Josh Jagoda – Chiropractor