Pull the Trigger!

Among the many conditions affecting the upper extremity that we treat here at Ascend Hand Therapy, trigger finger is one of more common diagnoses we see on a regular basis. People sometimes get trigger finger and Dupuytren’s contracture confused (see our previous blog from September 2018 for more on Dupuytren’s). In everyday life, people know that they have a trigger finger when their finger catches or gets stuck in a bent position requiring the use of the other hand to get it back straight again. The middle joint (or PIP-proximal interphalangeal joint) gets caught in a flexed position resembling the motion of pulling a trigger. Clinically speaking, trigger finger is what we call stenosing tenosynovitis. The fluid around the tendon gets inflamed causing it to become thick and viscous. As the tendon tries to pass through a pulley in the palm, it gets caught resulting in the triggering effect. So, the middle joint in the finger is affected, but the actual source of the problem is in the palm of the hand. Great. I have a trigger finger, so what now???

Glad you asked! Conservative treatment has a few different options. Your hand surgeon may prescribe some anti-inflammatory medication, or he may give you a steroid injection into the inflamed area. Your doctor may also prescribe occupational therapy. In therapy, we can use custom or prefabricated orthoses which restrict the motion of the finger allowing it to heal. Specific exercises are also performed that promote tendon gliding through the pulley without triggering. Soft tissue mobilization and therapeutic massage are effective in promoting good circulation. Other modalities like ultrasound and phototherapy (i.e., cold light laser or infrared lights) may be used as well. Many times, therapy is effective in preventing the need for surgical intervention.
If surgical intervention is required, the surgery itself is not as involved as other procedures. The surgery consists of the hand surgeon cutting the inflamed pulley (the A1 pulley as we call it) in order to allow the tendon to move without getting caught. Occupational therapy is also prescribed following the surgery to maximize the benefit of the procedure.
Typically, trigger finger is caused by overuse. They can also occur when your hands are swollen for a long time requiring the tendon to work harder as it passes through the pulley. When people are treated at our clinic, we always watch out for developing trigger fingers as patients normally have increased swelling following their surgery or injury. Do you have a trigger finger and want to stop the pain and prevent surgery? Then, pull the trigger and come see us at Ascend Hand Therapy! We are here to lend a helping hand.

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