Trigger Finger – What Is It?

Trigger Finger is becoming a common, yet quite serious problem among many individuals, just as Carpal Tunnel Syndrome has been in the past and still is. Although Carpal Tunnel has received all the media hype, Trigger Finger is affecting millions of Americans each year, causing lost time from work, 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; is Trigger Finger a disease or is it a result of repetitive use or direct trauma to the affected finger or fingers?  Many physicians would like people to think it is a disease so they can prescribe medications and perform surgery. But invasive methods are often not the solution to disease or injury, but instead, the application of sound conservative therapy.

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 and not 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 extended.

Trigger Finger can also be caused by the following medical conditions: Rheumatoid Arthritis 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 on the inside of the tendon.

Treatment(s) for Trigger Finger:
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, selling and scar tissue build-up that occurs.

Successful Treatment for Trigger Finger:

Reduce Inflammation - Be sure that the acute phase of injury is over and no visible swelling is present.
Stretches - Use passive and active stretches on the affected finger to help thin the tendon.
Flextend / Restore Exercises and Stretches  - Immediately follow the stretches with active strengthening exercises and stretches.

AUTHOR: Jeff P. Anliker, LMT, is a Therapist, Inventor of Therapeutic Exercise Products that are utilized by Corporations, Consumers and Medical Facilities around the world for treating muscle imbalances affecting the upper extremity. Balance Systems, Inc.