Trigger finger is a difficult condition to treat, it causes clients many issues... but where does this condition come from and what can be done about it?
What is Trigger finger?
Well, let's take a look at the anatomy. The picture to the left shows the flexor tendons of the finger and see how it runs under the tendon sheath? Keeping it simple 😀, if this tendon gets inflamed and swollen it can catch in the sheath creating a locking, or popping sensation as it unlocks.
How do we get it?
Trigger finger tends to be an overuse injury, so think about carpenters, electricians anyone who grips things a lot in their daily work. It is also very common in diabetics due to collagen accumulation in the tissues (Sarkar 2019), arthritis, gout and underactive thyroid are all risk factors (NHS).
What can we do about it?
Depending on the severity, there is plenty we can do.
If it is mild, icing the inflamed area may help.
Stretching the trigger finger is really useful, keep the palm of the hand static on a table top and stretch the affected finger by lifting it upwards.
Using a night splint can be really effective, they are easy to find online and this will stop the finger getting "stuck" in a flexed position while your client is asleep.
Strengthening work for the hand and specifically the extensor muscles is an additional element that can help. As the finger looses its mobility, due to getting `'stuck`' the flexors will shorten, but the extensors will slowly weaken, so even if you get rid of the inflammation and adhesion, the client may be left unable to straighten their finger due to weakness. An elastic band works well for this.
Soft tissue work, such as frictions can help to reduce the nodules. Myofascial release can also help to reduce the stiffness of the fingers.
If that doesn't work, the next thing to think about is a steroid injection to see if that can calm the inflammation down. A cochrane review for the benefits of steroid injections can be found here.
The final option is surgery, but that is a bit dramatic, so hopefully with a bit of work your client won't need to get to this stage.
What is the root cause?
So, let's just think about this for a moment, trigger finger, if it isn't caused by a disease condition such as diabetes, is likely due to overuse. Look at the job your client does and look at their whole upper body posture. If a carpenter, for example, is finding their hands are getting tired from sawing all day, they will compensate for this by gripping harder and this in turn will cause the forearms to overwork. As they overwork, they will start to utilise the biceps and before you know it, your client presents with, not just the start of trigger finger, but neck pain and maybe even numbness in the hands etc. Now, you need to look at the whole upper body, not just the finger to solve this issue for the long term.
So while you deal with the trigger finger itself, also work on retracting their shoulders, perhaps put tape round their saw to widen the handle and stop them gripping so hard, and above all strengthen the forearms and shoulders so they can manage the work they need to do.
If using this for CPD try to think about the following situation:
A female client presents with the beginnings of trigger finger. She has recently retrained as a chiropodist and as her workload has increased her fingers are causing her problems. She gets intermittent catching of her first finger which is worse in the morning but eases as the day goes on. What can you do to help her symptoms and the root cause.
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