Trigger Finger and Thumb

Trigger FingerWhat Is Trigger Finger and Thumb? This condition affects the movement of the tendons as you bend your fingers and thumb towards your palm. This movement is known as flexion. In simple terms trigger finger is a common disorder of the hand which causes painful snapping or locking of the fingers or thumb.

 

 

The Facts of Trigger Finger and Thumb:

Anatomy

Where does the condition develop?

A series of ligaments act like pulleys and hold the tendons that move the fingers in place on the bones. These ligaments result in an arch on the surface of the bone that forms a sort of tunnel for the tendon to run in along the bone. The tendons are wrapped in a slippery coating called tenosynovium in order to keep the tendons moving smoothly under the ligaments. The tenosynovium reduces friction and allows the flexor tendons to glide through the tunnel formed by the pulleys as the hand is used to grasp objects.

 

Causes of trigger finger and thumb

Triggering is the result of thickening in the tendon that forms a knob or nodule. Usually the pulley ligament may thicken as well. The frequent irritation from the tendon repeatedly sliding through the pulley causes the tendon to swell in this area and form nodule. Partial tendon lacerations, rheumatoid arthritis, repeated trauma from pistol-gripped power tools, or long hours grasping a steering wheel can cause triggering. Damaged or infection to the synovium causes a rounded swelling (nodule) to form in the tendon.

Another cause of triggering might be due to a congenital defect that forms a nodule in the tendon. The condition is not usually noticeable until infants begin to use their hands.

 

Signs and Symptoms

When the fingers are bent, pain and a funny clicking sensation is the symptom of trigger finger or thumb. Pain usually occurs when the finger or thumb is bent and straightened. Tenderness also occurs at the bottom of the finger or thumb over the area of the nodule. The clicking sensation occurs when the nodule moves through the tunnel formed by the pulley ligaments. When the finger is straight, the nodule is at the far edge of the surrounding ligament. When the finger is flexed, the nodule passes under the ligament and causes the clicking sensation. When the nodule becomes too large it may pass under the ligament, but it gets stuck at the near edge. The finger is locked in the flexed trigger position because the nodule cannot move back through the tunnel.

 

Diagnosis

Physical examination alone can determine if you have trigger finger and thumb. Usually a palpable click can be felt as the nodule snaps under the first finger pulley. If the condition is allowed to progress, the nodule may swell to the point where it gets caught and the finger is locked in a bent, or flexed position. X-rays or special test are not required.

 

Treatment Options:

  • If you had this condition for less than four months, it is usually effective to have physical therapy by an occupational therapist. The inflamed area is normally splinted and allowed to rest. Special exercises are used to allow normal gliding of the tendon. Therapist might show you ways to change your activities to prevent triggering and to give the inflamed area a chance to heal.
  • Therapy sessions sometimes include iontophoresis, which uses a mild electrical current to push anti-inflammatory medicine to the sore area. This treatment is especially helpful for patients who can’t tolerate injections.
  • A cortisone injection into the tendon sheath may be required to reduce the inflammation and shrink the nodule. This will help relieve the triggering, though the results may not last long. A splint may be used after the injection to rest the tendon and help decrease the inflammation and shrink the nodule.

 

Surgery

The purpose of surgery is to open the pulley that’s obstructing the nodule and allow the tendon from sliding smoothly. This surgery procedure is usually done as an outpatient, meaning you can leave the hospital the same day.

Surgery can be done using a general or regional anesthetic. The skin and fascia are separated so the doctor can see the tendon pulley. Special care is taken not to damage the nearby nerves and blood vessels. Next, your surgeon will divide the tendon pulley carefully. Once the tendon pulley has been separated, the skin is sewn together with fine stitches.

 

Rehabilitation

If triggering has been present for more than four months, nonsurgical treatment is usually short-lived. You may get some relief of symptoms with a cortisone injection. If you wear a splint, the nodule may shrink temporarily, but patients often end up needing surgery for this problem.

 

After Surgery

You’ll need to wear a bandage and padding over the area after surgery until the stitches are removed. The purpose is to provide gentle compression and reduce the bleeding and swelling that occurs immediately after surgery. However, you remove it fairly quickly, and usually only a bandage is required after the first 24 to 48 hours. A few days after surgery, you need to begin gentle range-of-motion exercises.

Unless the finger or thumb was locked for a while before surgery, most patients won’t need to participate in a formal rehabilitation program. In such cases, the finger or thumb may not straighten out right away after the surgery. A therapist may apply a special brace to get the finger or thumb to straighten. Heat treatments, soft-tissue massage, and hands-on stretching may be applied to help with the range of motion.

To help straighten and stabilize the muscles and joints, you’ll need to do some exercises specified by the therapist. Other exercises are used to improve fine motor control and dexterity. Tips will be given on ways to do your activities while avoiding extra strain on the healing tendon. You may need to return to therapy two to three sessions each week for up to six weeks.

 

What’s the cure?

Conservative non-surgical treatment to avoid or modify activities that have caused the inflammation. Oral anti-inflammatory medications to reduce the inflammation or discomfort. Steroid injection administered directly into the tendon sheath to reduce the soft tissue swelling. Our doctor will advise on the best option and get you well fast. Give us a call and make an appointment with our doctor now and recover fast from trigger finger and thumb.

 

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