Trigger finger and massage
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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Information, in part, from the American Physical Therapy Association and the Arthritis Foundation
Trigger finger is also known as stenosing tenosynovitis. It is a condition in which a finger or thumb catches and is held in a bent position.
The finger may straighten with a snap — like a trigger being pulled and released. If the condition is severe, the finger may become locked in a bent position.
An often painful condition, trigger finger is caused by a narrowing of the sheath that surrounds the tendon in the affected finger. Musicians, writers, gardeners and others whose work or hobbies require repetitive gripping actions are most susceptible to this condition. Trigger finger is also more common in women than in men. It also happens in older individuals.
Treatment varies depending on the severity of the condition, and ranges from rest to medications to surgery.
Initially, the affected finger may seem stiff and may click when moved. A bump (nodule) or tenderness in the palm at the base of the finger may be felt. This is the spot where the tendon is probably catching.
As trigger finger worsens, the finger may catch at times in a bent position and then suddenly pop straight out. Eventually, the finger may not fully straighten.
Trigger finger most often affects the middle or ring finger or thumb. More than one finger may be affected at a time, and both hands might be involved. Triggering is usually worse in the morning.
The cause of trigger finger is a narrowing of the sheath that surrounds the tendon in the affected finger. Tendons are fibrous cords that attach muscle to bone. Each tendon is surrounded by a protective sheath — which in turn is lined with a substance called tenosynovium. The tenosynovium releases lubricating fluid, which allows the tendon to glide smoothly within its protective sheath as you bend and straighten your finger.
But if the tenosynovium becomes inflamed from repetitive strain injury or overuse or due to inflammatory conditions such as rheumatoid arthritis, the space within the tendon sheath can become narrow and constricting. The tendon can't glide through the sheath easily, at times catching the finger in a bent position before popping straight. With each catch, the tendon becomes more irritated and inflamed, worsening the problem.
Repetitive gripping for extended periods of time is a risk factor. Certain medical conditions, including rheumatoid arthritis, diabetes, hypothyroidism, amyloidosis and certain infections — including tuberculosis and sporotrichosis, a fungal infection are also risk factors.
Treatment for trigger finger varies depending on its severity and duration. For mild symptoms, these approaches may be effective:
Splinting to keep the affected finger in an extended position for several weeks. The splint helps to rest the joint.
Ice helps control inflammation that is causing pain and can easily be done as part of a home program. Ice massage is done by rubbing an ice cube or ice cup on a sore spot or tender point.
Placing the affected hand in warm water for five to 10 minutes, especially in the morning, may reduce the severity of the catching sensation during the day. If this helps, it can be repeated throughout the day.
Paraffin is a form of heat where your hand and forearm is dipped in a small tank with a mixture of paraffin wax and mineral oil.
Soft tissue mobilization/massage has been shown to relieve pain and spasm by helping muscles relax, by bringing in a fresh supply of oxygen and nutrient-rich blood. Soft tissue treatments can help tight muscles relax. Deep transverse friction massage, is done by rubbing across the sore nodule to take away soreness and irritation. Your therapist may direct you where and in which direction to rub.
Your doctor may also suggest that you perform gentle exercises with the affected finger. This can help you to maintain mobility in your finger.
Ultrasound treatments are a way for your therapist to reach deep tissues.
Phonophoresis uses the high frequency sound waves of ultrasound to "push" a steroid medication (cortisone) through the skin. Iontophoresis uses a small machine that produces a mild electrical charge, which is used to carry medicine, usually a steroid, through the skin. Either type of phoresis may be used in place of a cortisone injection.
When movement of a joint is limited, the problems of trigger finger/thumb may worsen. If you don't have full range of motion, your therapist can use graded joint mobilization, manual stretching, and select exercises to improve your movement. Active movement and range of motion exercises as part of a home program can also help restore forearm and wrist motion.
Careful stretching is important during the healing process. As the pain and irritation begin to ease, stretching may be used to help the sore area begin to heal. The muscles and other soft tissue can be gently stretched to allow the finger or thumb to bend without clicking or catching.
As healing continues different types of exercises are used. Early on, isometrics help maintain muscle strength without over-stressing tissue. Isometrics are exercises where the muscles are tightened but no movement occurs. These exercises allow the muscles to stay fit, but they don't stress the soft tissues like other types of exercises. As your problem begins to heal, more vigorous exercises will be used to increase endurance and strength.
Medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) — ibuprofen (Advil, Motrin, others), for example — may relieve the inflammation and swelling that led to the constriction of the tendon sheath and trapping of the tendon.
An injection of a steroid medication such as cortisone near or into the tendon sheath can also be used to reduce inflammation of the sheath.
Although most people with more serious symptoms of trigger finger are successfully treated with NSAIDs or injections, surgical release of the tendon may be necessary for troublesome locking that doesn't respond to other treatments.
A more recent technique is percutaneous hydrodissection of the tendon sheath. With this technique, ultrasound guidance is used to introduce a small needle into the tendon sheath and a large volume of fluid (approximately 10 cc's) is injected to open the sheath... very similar to how an angioplasty is done for a coronary artery. This often prevent the the need for surgery.
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