| | | |  | | © Reed Group | | |
Trigger finger refers to a sensation when the fingers or thumb feel stuck or temporarily snagged during efforts to straighten (extend) or bend (flex) the digits. In early stages, there may simply be diminished range of motion, particularly a lack of full flexion of the finger or thumb.
Trigger finger is caused by thickening of the tendon and is sometimes accompanied by inflammation that narrows the tunnel (flexor sheath) where the tendon glides back and forth to allow movement of the fingers. The tendon itself may develop a knot (nodule) caused by irritation from rubbing against the narrowed tunnel walls of the sheath. With initial attempts at finger motion, the tendon tries to move the finger but encounters resistance to movement as the swollen part of the tendon tries to move through the narrowed part of the tunnel. With further attempts at digit motion, the tendon nodule pulls through the short tunnel, and a snapping sensation (triggering) accompanied by pain may then be felt. The snapping movement likely will create more irritation to the affected area, resulting in even more inflammation and swelling that creates additional narrowing and interference with finger movement. This cycle of damage can result in the finger or thumb becoming stuck or locked, with movement becoming increasingly painful and difficult.
The cause of most cases of trigger finger is unknown (idiopathic). In some cases, the condition is associated with repetitive grip activity. Stenosing tenosynovitis has synovial proliferation and is associated with diseases such as rheumatoid arthritis, gout, diabetes, and kidney (renal) failure.
Risk: Studies indicate that trigger finger may be related to certain occupational risk factors, including highly repetitive hand activity, especially with grip, vibration, and a combination of excessive manual force, repetition and awkward or restrictive hand posture. Incidence and Prevalence: Trigger finger or thumb is a relatively common condition. It has a higher incidence (75%) in women than in men. Most cases occur in individuals between 52 and 62 years of age (Foye). It often occurs in both hands (bilateral). |
Source: Medical Disability Advisor
| History: A sensation of discomfort or pain may begin in the base of the thumb or finger. Individuals may report a snapping or locking of the finger or thumb during grasping and releasing of the hand, and report that passive assistance or forceful voluntary effort are required to correct it. Pain and swelling over the palm of the hand near the metacarpal head may be noted. Swelling or stiffness in the fingers, particularly in the morning, may be reported. Pain with motion is more common with trigger thumb; reduced range of motion more common with trigger finger (Silver). Individuals may report a history of repetitive or sustained activities such as gripping. Physical exam: A mobile nodule in the affected tendon may be detected through touch (palpation) at the palmar aspect of the metacarpal head; it is usually tender. Finger and thumb movements may be observed through bending and straightening each joint (flexion/extension). Snapping and locking in the affected area may be noted with range of motion movements. Tests: Diagnosis of trigger finger or thumb typically is based on the individual’s history and results of physical examination (clinical diagnosis). X-rays may be used to rule out bone or joint abnormalities, especially if the individual has a history of arthritis or injury (trauma) to the affected area. MRI may be used to confirm tenosynovitis of the flexor sheath (Silver). |
Source: Medical Disability Advisor
| The individual may need to wear a splint on affected fingers for up to 6 weeks to reduce swelling and allow hand and finger movement to return to normal. This can be very difficult for the thumb as it is quite limiting for hand use. Splinting has been shown to resolve early trigger finger in 55% of a manual labor population (Rodgers). Anti-inflammatory medications to reduce swelling also may be prescribed. In the absence of vascular disease, application of ice packs to the palm of the hand for 20 minutes 2 or 3 times a day may be recommended. The individual may be advised to avoid activities, particularly repetitive ones, that irritate the affected area. Treatment plans generally include corticosteroid injections into the tendon sheath. These are reported to be from 64% to 93% successful (Murphy; Rhoades); however, individuals with diabetes do not respond as well to corticosteroid injection and have only a 50% success rate (Stahl). Padded gloves may be worn to provide protection from direct trauma (Silver). If nonoperative treatment fails, surgery may be required to open the tunnel area and allow freer movement of the tendon (open surgical release). Occupational therapy may be recommended following surgery to restore normal hand movement. |
Source: Medical Disability Advisor
| Prognosis usually is very good. Some individuals recover spontaneously; most require corticosteroid injection with or without associated splinting. Some individuals may require up to three injections, but approximately 90% of cases are resolved satisfactorily. Surgery (open surgical release) usually has a very good outcome (Foye), although recovery may take several weeks. Ongoing (chronic) or recurring problems may result if the condition and accompanying inflammation are caused by an underlying disease. Some spontaneously resolved cases can recur without any known correlation with treatment or aggravating factors (Foye). |
Source: Medical Disability Advisor
| Note on research and authorship Rehabilitation of trigger finger or thumb addresses the constriction of the tendon sheath in the affected finger or thumb. The constriction commonly results from overuse or trauma to the underside of the finger or thumb. Rehabilitation begins with the goals of decreasing pain and inflammation. It then addresses the cause of the inflammation, restores mobility and strength, and educates the individual in ways to protect the finger or thumb from recurrence (Biese).
Treatment varies depending on the severity, duration, and management (operative, nonoperative) of the condition. Mild symptoms may improve by resting the affected hand. To control inflammation and discomfort, modalities such as cold or heat may be used in individuals with moderate to severe symptoms. Common clinical practice includes the use of a splint for up to 4 weeks, which is removed for exercise as indicated.
Hand exercises are progressed according to the individual's tolerance and response to treatment. A home exercise program should be taught and performed daily in conjunction with supervised rehabilitation. If the pain is not reduced, or if the clicking / locking of the digit is not alleviated by the nonoperative protocol, the physician may consider surgery (see Tendon Release) (Biese).
An ergonomic assessment may be useful for workplace modifications to reduce the risk factors associated with this condition. Wearing a custom splint during daily tasks may help to protect the involved finger(s) or thumb (Biese). |
| FREQUENCY OF REHABILITATION VISITS | | Nonsurgical | |
| Physical, Occupational or Hand Therapist | | Up to 12 visits within 6 weeks | | | | | | | | Surgical | |
| Physical, Occupational or Hand Therapist | | Up to 15 visits within 6 weeks | |
|
| The table above represents a range of the usual acceptable number of visits for uncomplicated cases. It provides a framework based on the duration of tissue healing time and standard clinical practice. |
Source: Medical Disability Advisor
| The triggering condition may recur in the affected area or, more commonly, in another tendon of the hand. Even after treatment, other conditions involving inflammation of the tendons (tendinitis and tenosynovitis) may remain active. Unresolved cases of trigger finger or thumb may result in increased pain and decreased functional use of the hand.
Digital nerve laceration can occur during surgery resulting in numbness to the digit and requiring additional surgery for nerve repair (Carrozzella; Thorp). |
Source: Medical Disability Advisor
| Restrictions may include temporarily limiting or avoiding of the affected hand, which may be protected by a splint. Individuals who require full use of both hands for job tasks may need to be reassigned to other duties until the condition is resolved. If the individual has had surgery, operation of motor vehicles may be restricted for a week or longer. Methods of performing job tasks may need to be evaluated for possible preventive measures to prevent recurrence. Company policy on medication usage should be reviewed to determine if pain medication use, if needed, is compatible with job safety and function. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Has diagnosis of trigger finger/thumb been confirmed?
-
Have conditions with similar symptoms been ruled out?
-
Is trigger finger/thumb associated with an underlying disease, such as rheumatoid arthritis or diabetes mellitus that may affect recovery?
Regarding treatment:
- If underlying cause or aggravating condition is known, how is it being managed?
-
Would splinting the affected fingers or thumb encourage healing and recovery?
-
Were anti-inflammatory medications or ice packs successful in reducing the swelling? If not, are corticosteroid injections now indicated?
-
Would padded gloves be useful in protecting the hands?
-
If surgery was required to open the tunnel area, was it followed by physical or occupational therapy to restore normal hand movement?
Regarding prognosis:
- Was condition resolved by surgical intervention?
-
Did individual experience any complications as a result of the open surgical release?
-
If inflammation was caused by an underlying disease, how is that condition being addressed?
-
Is there a chance that chronic inflammation may cause recurring trigger finger problems?
-
If condition developed relative to a certain occupation or repetitive task, will individual be able to avoid that activity?
-
Have methods of performing job tasks been evaluated?
-
What preventive measures are being taken to avoid recurrence?
|
Source: Medical Disability Advisor
| Biese, J. "Therapist's Evaluation and Conservative Management of Rheumatoid Arthritis in the Hand and Wrist." Rehabilitation of the Hand and Upper Extremity. Eds. E. J. Mackin, et al. 5th ed. Philadelphia: Mosby, Inc., 2002.Carrozzella, J. P., et al. "Transection of Radial Digital Nerve of the Thumb during Trigger Release." Journal of Hand Surgery 14 (1989): 198-200. Foye, Patrick M., and Todd Stitik. "Trigger Finger." eMedicine. Eds. Robert E. Windsor, et al. 18 Apr. 2008. Medscape. 6 Mar. 2009 <http://emedicine.medscape.com/article/328996-overview>. Murphy, D., et al. "Steroid Versus Placebo Injection for Trigger Finger." Journal of Hand Surgery 20 (1995): 628-631. Rhoades, C. E., et al. "Stenosing Tenosynovitis of the Fingers ans Thumb." Clinic Orthop 190 (1984): 236-238. Rodgers, J. A. "Functional Distal Interphalangeal Joint Splinting for Trigger Finger in Laborers: A Review and Cadaver Investigation." Orthopedics 21 (1998): 305-309. Silver, Julie K., et al. "Trigger Finger." Frontera: Essentials of Physical Medicine and Rehabilitation. Eds. Walter R. Frontera, et al. 2nd ed. Philadelphia: Saunders, Elsevier, 2008. Stahl, S., et al. "Outcome of Trigger Finger Treatment in Diabetes." Journal of Diabetes Complications 11 (1997): 287-290. Thorpe, A. P. "Results of Surgery for Trigger Finger." Journal of Hand Surgery 13 (199): 201-1988. |
Source: Medical Disability Advisor
| Feedback |
| Send us comments, suggestions, corrections, or anything you would like us to hear. If you are not logged in, you must
include your email address, in order for us to respond. We cannot, unfortunately, respond to every comment.
If you are seeking medical advice, please contact your physician. Thank you! |
Send this comment to:
Sales
Customer Support
Content Development
|
|
| |
|
|
|
|
|
This publication is designed to provide accurate and authoritative information in
regard to the subject matter covered. It is published with the understanding that
the author, editors, and publisher are not engaged in rendering medical, legal,
accounting or other professional service. If medical, legal, or other expert assistance
is required, the service of a competent professional should be sought. We are unable to respond to requests for advice.
Any Sales inquiries should include an email address or other means of
communication.
|