Trigger Finger

By Robert Grech

Trigger finger (TF) is a pathologic change in hypertrophy at the intersection of the tendon with the tendon pulley, resulting in difficult gliding of the tendon under the pulley and causing triggering, snapping, or locking upon flexion of the involved metacarpophalangeal joint of the fingers. It is classified into 4 grades: grade 1, uneven movement; grade 2, actively correctable; grade 3, passively correctable; and grade 4, fixed deformity (Chen, Lin, Kuo and Lee, 2021; Huisstede, Gladdines, Randsdorp and Koes, 2018).

Symptoms

The most common early symptoms include:

Persistent pain;
A bump or lump around the base of the finger;
Tenderness around the base of the finger;
A clicking or snapping noise during movement;
Stiffness in one finger;
Morning stiffness;
Non-functional hand
Incapacity to extend the uncurl the finger (Ferrara et al., 2020; Huisstede, Gladdines, Randsdorp and Koes, 2018).

Causes and Risk Factors

TF is usually classified as an idiopathic condition, but some other etiologic hypothesis was proposed. Other possible causes are discrepancy between the diameter of the flexor tendon and its sheath at the metacarpal head, and hand overuse and repetitive blunt trauma (Ferrara et al., 2020).

Risk factors associated with the trigger finger include:
Being a woman (women have 2-6 higher risk to develop than men)
Having diabetes
Hypothyroidism
rheumatoid arthritis
Carpal tunnel syndrome
Dupuytren’s disease
Amyloidosis
Mucopolysaccharide storage disorders
Genetic predisposition
Performing repetitive activities that can strain the hand, such as playing musical instruments (Brozovich, Agrawal and Reddy, 2019); Ferrara et al., 2020).

Diagnosis

A doctor can normally diagnose trigger fingers with a physical exam (tenderness on the tendon pulling), morning stiffness and a few simple medical history questions. They will look for a bent finger and watch the patient opening and closing their hand (Ferrara et al., 2020).

Treatment

Treatments depend on the severity of the symptoms, they include:

Taking a break from repetitive activities for 4 or 6 weeks;
Wearing a brace or splint to restrict movement and rest the hand;
Applying heat or ice to reduce swelling;
Stretching exercises
Manual therapy
Shock-wave therapy
Gently extending the fingers to improve range of motion (Chen, Lin, Kuo and Lee, 2021; Ferrara et al., 2020).

Medicines also can help relieve inflammation. Anti-inflammatory drugs are ibuprofen, naproxen, and steroid injections. If medications and home treatments don’t work, the doctor may recommend surgery. Surgeons perform trigger finger surgery on an outpatient basis. After getting an anesthetic shot, the surgeon makes a small cut in the palm and then cuts the tight tendon sheath (Chen, Lin, Kuo and Lee, 2021).

The doctor may recommend physiotherapy exercises to relieve postoperative stiffness. The physiotherapy cycle for this pathology consists of the integration of manual therapy techniques and specific exercises. Manual therapy techniques such as traction mobilizations, and massage aim to reduce tissue tension and stiffness, recovering the movement dysfunction as much as possible. Specific exercises can improve muscle strength balance, through stretching of the tissues and the strengthening of some muscle groups. The physiotherapist may also advise the patient about specific positions to be adopted at home and behaviors to be avoided. Three months following the start of Physiotherapy treatment, 68.6% of patients found their symptoms to improve with no symptom recurrence at a 6 month follow-up (Brozovich, Agrawal and Reddy, 2019)

REFERENCES

Brozovich, N., Agrawal, D. and Reddy, G., 2019. A Critical Appraisal of Adult Trigger Finger: Pathophysiology, Treatment, and Future Outlook. Plastic and Reconstructive Surgery – Global Open, 7(8), p.e2360.

Chen, Y., Lin, C., Kuo, Y. and Lee, O., 2021. Extracorporeal Shockwave Therapy in the Treatment of Trigger Finger: A Randomized Controlled Study. Archives of Physical Medicine and Rehabilitation, 102(11), pp.2083-2090.e1.

Coady-Fariborzian, L. and McGreane, A., 2015. Risk Factors for Postoperative Complications in Trigger Finger Release. Federal Practitioner, February, pp.21-23.

Ferrara, P., Codazza, S., Maccauro, G., Zirio, G., Ferriero, G. and Ronconi, G., 2020. Physical therapies for the conservative treatment of the trigger finger: a narrative review. Orthopedic Reviews, 12, pp.90-94.

Huisstede, B., Gladdines, S., Randsdorp, M. and Koes, B., 2018. Effectiveness of Conservative, Surgical, and Postsurgical Interventions for Trigger Finger, Dupuytren Disease, and De Quervain Disease: A Systematic Review. Archives of Physical Medicine and Rehabilitation, 99(8), pp.1635-1649.e21.