Monday, November 13, 2017

Trigger Finger or Thumb

Trigger finger limits finger movement. When you try to straighten your finger, it will lock or catch before popping out straight.

Trigger finger is a condition that affects the tendons in your fingers or thumb.



⇧ This patient's finger sticks in the bent position as she tries to straighten it. 


Anatomy
The tendon sheath attaches to the finger bones and keeps the flexor tendon in place as it moves.














Tendons are tissues that connect muscles to bone. When muscles contract, tendons pull on bones. This is what causes some parts of the body to move.
The muscles that move the fingers and thumb are located in the forearm, above the wrist. Long tendons — called the flexor tendons — extend from the muscles through the wrist and attach to the small bones of the fingers and thumb.
These flexor tendons control the movements of the fingers and thumb. When you bend or straighten your finger, the flexor tendon slides through a snug tunnel, called the tendon sheath, that keeps the tendon in place next to the bones.

Description
The flexor tendon can become irritated as it slides through the tendon sheath tunnel. As it becomes more and more irritated, the tendon may thicken and nodules may form, making its passage through the tunnel more difficult.
The tendon sheath may also thicken, causing the opening of the tunnel to become smaller.
If you have trigger finger, the tendon becomes momentarily stuck at the mouth of the tendon sheath tunnel when you try to straighten your finger. You might feel a pop as the tendon slips through the tight area and your finger will suddenly shoot straight out.
The thickened nodule on the flexor tendon strikes the sheath tunnel, making it difficult to straighten the finger.
Reproduced and adapted from Griffin LY (ed): Essentials of Musculoskeletal Care. 3rd Ed. Rosemont, IL. American Academy of Orthopaedic Surgeons, 2005
Cause
The cause of trigger finger is usually unknown. There are factors that put people at greater risk for developing it.
  • Trigger fingers are more common in women than men.
  • They occur most frequently in people who are between the ages of 40 and 60 years of age.
  • Trigger fingers are more common in people with certain medical problems, such as diabetes and rheumatoid arthritis.
  • Trigger fingers may occur after activities that strain the hand.
Symptoms
Symptoms of trigger finger usually start without any injury, although they may follow a period of heavy hand use. Symptoms may include:
  • A tender lump in your palm
  • Swelling
  • Catching or popping sensation in your finger or thumb joints
  • Pain when bending or straightening your finger
Stiffness and catching tend to be worse after inactivity, such as when you wake in the morning. Your fingers will often loosen up as you move them.
Sometimes, when the tendon breaks free, it may feel like your finger joint is dislocating. In severe cases of trigger finger, the finger cannot be straightened, even with help. Sometimes, one or more fingers are affected.

Doctor Examination
Your doctor can diagnose the problem by talking with you and examining your hand. No other testing or x-rays are usually needed to diagnose trigger finger.

Nonsurgical Treatment

Rest

If symptoms are mild, resting the finger may be enough to resolve the problem. Your doctor may recommend a splint to keep your finger in a neutral, resting position.

Medications

Over-the-counter pain medications, such as non-steroidal anti-inflammatory medicines (NSAIDS) or acetaminophen can be used to relieve the pain.

Steroid Injections

Your doctor may choose to inject a corticosteroid — a powerful anti-inflammatory medication — into the tendon sheath. In some cases, this improves the problem only temporarily,and another injection is needed. If two injections fail to resolve the problem, surgery should be considered.
Injections are less likely to provide permanent relief if you have had the triggering for a long time, or if you have an associated medical problem, like diabetes.

Surgical Treatment
Trigger finger is not a dangerous condition. The decision to have surgery is a personal one, based on how severe your symptoms are and whether nonsurgical options have failed. In addition, if your finger is stuck in a bent position, your doctor may recommend surgery to prevent permanent stiffness.

Surgical Procedure

The goal of surgery is to widen the opening of the tunnel so that the tendon can slide through it more easily. This is usually done on an outpatient basis, meaning you will not need to stay overnight at the hospital.
Most people are given an injection of local anesthesia to numb the hand for the procedure.
The surgery is performed through a small incision in the palm or sometimes with the tip of a needle. The tendon sheath tunnel is cut. When it heals back together, the sheath is looser and the tendon has more room to move through it.
During surgery, the tendon sheath is cut.
Reproduced and adapted from Griffin LY (ed): Essentials of Musculoskeletal Care. 3rd Ed. Rosemont, IL. American Academy of Orthopaedic Surgeons, 2005

Complications

  • Incomplete extension — due to persistent tightness of the tendon sheath beyond the part that was released
  • Persistent triggering — due to incomplete release of the first part of the sheath
  • Bowstringing — due to excessive release of the sheath
  • Infection

Recovery

Most people are able to move their fingers immediately after surgery.
It is common to have some soreness in your palm. Frequently raising your hand above your heart can help reduce swelling and pain.
Recovery is usually complete within a few weeks, but it may take up to 6 months for all swelling and stiffness to go away.
If your finger was quite stiff before surgery, physical therapy and finger exercises may help loosen it up.

Below are a few common trigger finger treatment exercises as well as some trigger finger stretches.

7 EXERCISES FOR TRIGGER FINGER

Image result for trigger thumb

1. One of the main factors of trigger finger is thought to be repetitive gripping motions from hobbies or jobs such as driving, playing tennis, etc. One exercise for trigger finger that can help to strengthen your tendons is to lay the hand palm-down on a flat surface and then to lift each finger one by one (focusing on even strength) with special emphasis on the injured digit. You should raise each finger slowly and deliberately then hold each finger/thumb in the lifted position for a second or two before resting it.


⇧Finger Roll Trigger Finger Exercise


2.Another extensor trigger finger exercise involves drawing the thumb and fingers together, wrapping a rubber band around them and then opening and closing the hand against this resistance. 

Rubberband Stretch For Trigger Finger Exercise

⇧Rubberband Stretch For Trigger Finger Exercise


3. The next exercise involves placing your finger that is affected to your thumb, essentially created a circle shape with your fingers. Hold this for about five seconds then repeat around 10 times. 

Finger Flick For Trigger Finger Exercise

⇧Finger Flick For Trigger Finger Exercise


4. This exercise incorporates grabbing a tennis ball or a stress ball. Hold it in the palm of your hand and squeeze the ball for about five seconds then release. Repeat around 5-10 times a day. 

Tennis Ball Grip For Trigger Finger Exercise

⇧Tennis Ball Grip For Trigger Finger Exercise

5. Trigger finger exercises that work on the abduction muscles can also be helpful for trigger finger treatment. One simple exercise involves spreading the fingers wide, then drawing them together in a fist and repeating the process. 

Grip Stretch For Trigger Finger Exercise

⇧Grip Stretch For Trigger Finger Exercise


6. For another such exercise, begin with the fingers extended straight, lower them to touch the top of the palm, and then extend them again to the upright position. Bend them again to touch the middle of the palm, unbend and extend, and finally lower them to touch the bottom part off the palm and wrap up by straightening the fingers. This is one of the most useful exercises to help relieve your pain. 

Ball Fist Stretch For Trigger Finger Exercise

⇧Ball Fist Stretch For Trigger Finger Exercise


7. The final exercise has you hold the injured finger and the one next to it spread apart from one another so they form a “V.” Place your thumb and index finger of the other hand inside of the split fingers and apply pressure as you split the fingers apart.

Scissor Stretch For Trigger Finger Exercise

⇧Scissor Stretch For Trigger Finger Exercise.



In addition to these exercises, it’s recommended to massage the joint or area that is affected by trigger finger. Massaging will help to circulate the blood flow around your fingers and help ease inflammation. Try massaging your hand for a couple minutes everyday before and even after you do the exercises above.

What Could Be Causing My Trigger Finger or Thumb Pain?

The cause of trigger finger at times is still a mystery, but there are some underlying factors connecting to the arise of trigger finger. There are different elements that may put you at a higher risk to developing this condition. Answer the questions below to determine which factor may have contributed to your trigger finger or thumb pain:

Q: Are you a female?
Females are more likely to develop trigger finger compared to men.

Q: Are you between the ages of 40-60?
Trigger finger is related to overtime use of your joints, tendons, and muscles. The aging process may weaken your tendons, making you more prone to developing this condition.

Q: Have you injured your hand before?
You are more likely to develop trigger finger if you’ve already had a previous injury to that area.

Q: Do you have diabetes?
Individuals that have diabetes tend to have joint issues relating to the stiffening or thickening of connective tissues.

Q: Do you have rheumatoid arthritis?
Rheumatoid arthritis directly relates to the joints in your fingers and is a disease that causes inflammation in these areas. Your chances increase greatly if you’re susceptible to inflammation.

Image result for trigger thumb

Q: What kind of job do you have?
It is believed that occupations or hobbies are one of the main causes to having trigger finger or thumb. If you’re job requires repeated and constant gripping, your chance of trigger finger increases. Such jobs or hobbies may include farmers, industrial workers, musicians, and playing tennis or racquetball. Gripping induced trigger fingers or thumb. 

causes-of-trigger-finger-include-gripping

Q: Do you have gout?
Gout is a type of arthritis which causes your joints to become inflamed or swollen. Trigger finger basically is a result of your tendon becoming inflamed, similar in gout arthritis.

Q: Do you have dupuytren’s contracture or carpal tunnel syndrome?

These other conditions tend to go hand-in-hand with trigger finger. If you have one of these conditions, the chances of developing one of the other conditions increases. Sometimes these conditions may occur at the same time or after one another.

Trigger Thumb in Children, Also Known As Congenital Trigger Thumb

Image result for trigger thumb

Image result for trigger thumb
Image result for trigger thumb

Image result for trigger thumb

Trigger thumb in children is characterized by the same clicking, popping and sticking of the thumb in the bent position that adults with the condition experience. Often this is due to a nodultrigger-thumb-pain-in-childrene on the tendon that is unable to pass easily through the tendon sheath. Essentially, your fingers are made up of tendons that enable them to move and bend. In your fingers your tendons are covered in a tunnel like structure of tissues, called a sheath. Normally, your fingers should easily glide without any issues. However, it’s not uncommon for your tendon to become inflamed for whatever reason. This inflammation makes the tendons too swollen to properly glide throughout your sheath.

What Causes Trigger Finger of Thumb in Children?


While in adults there is generally thought to be some causal activity for tendon irritation, there is some evidence that it is a congenital (present from birth) condition for kids. For this reason, it is sometimes called congenital trigger thumb. But some dispute that trigger finger in children is congenital; thus, the term “pediatric trigger thumb” is used as well.

Regardless of the cause or what it is called, trigger thumb in toddlers rarely goes away without treatment. In fact, the odds of this going away on its own decrease the older the child—especially after the age of 3. Thus, it is important to seek treatment for trigger thumb.

How do I know if my Child has Trigger Finger or Thumb?


If you’re curious whether or not your child is suffering from trigger finger you’ve most likely noticed something strange happening with their fingers. If you observed that your child is struggling to open up their fingers and they are staying in a bent position, it is likely trigger finger. Attempt to straighten your child’s finger yourself, if you feel any type of resistance or pop this is a strong indicator of the condition. Trigger finger is the most common with the thumb for kids. Don’t be afraid to visit with a doctor or physical therapist to confirm your suspicions.


Is There A Natural Cure or Remedy for Trigger Finger/Thumb?


Thankfully, trigger finger is treatable and has a wide variety of different natural treatment options, some more conservative than others. We highly recommend using conservative treatment options first when it comes to your child.

trigger-finger-thumb-splint-for-children-buy-nowTrigger Finger Splinting: Wearing a brace made specifically for trigger finger is a great way to alleviate and heal pain right away. Most people recommend wearing the brace at night to avoid any issues during the day, this may be especially helpful if your child is very young. In order to have the most support you will want a finger brace with a rigid splint, like the one pictured on the right. Splinting post surgery is often highly recommend to keep your finger isolated and protected. If you visit with a doctor and they think surgery is the best option, ask them about post surgery protocol. The other conservative options are great and help to relieve pain but may be harder in practice with a young child.

Trigger Finger Exercise: Gentle exercises to help maintain mobility in your child’s fingers will go a long way with trigger finger. Here are a few examples of the most useful and realistic exercises for a child:


grip-stretch-for-trigger-finger

Depending on the age of your child, with a little assistance this exercise should be realistic. Trigger finger exercises that work on the abduction muscles are very helpful for treatment. One simple exercise involves spreading the fingers wide, then drawing them together in a fist and repeating the process.

tennis-ball-stretch-trigger-finger

This exercise may easier than you think to get your child to do. This exercise incorporates grabbing a tennis ball or a stress ball. Have your child hold it in the palm of their hand and squeeze the ball for a few seconds. For more exercise ideas to treat trigger finger read here.

Trigger Finger Physical Therapy: Because the issue with trigger finger is limited mobility of the finger, using physical trigger finger therapy exercises is a great way to work it out. Physical therapist will use a variety of trigger finger exercises to help stretch and work out your child’s fingers. Often times strengthening exercises are also used to help control the movement of the hand. Highly recommended is a transverse friction massage that helps to break down the sheath.


These conservative and natural treatment options are great for mild cases of trigger finger, or after you initially discover that your child has trigger finger. If you are finding no relief in conservative remedies consulting with your doctor may be the next best option.


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