Trigger finger, also known as stenosing tenosynovitis, is a common condition characterised by the inflammation of the tendons in the fingers or thumb, leading to pain, stiffness, and difficulty bending or straightening the affected digit. Physiotherapy plays a vital role in the management of trigger finger, offering a range of interventions to alleviate symptoms, improve finger function, and prevent recurrence.
Understanding Trigger Finger:
Trigger finger occurs when the tendons in the fingers become inflamed or irritated, resulting in swelling and constriction within the tendon sheath. This constriction hinders the smooth movement of the tendon through the sheath, causing the affected finger to catch or lock in a bent position (1). Contributing factors may include repetitive hand movements, prolonged gripping activities, underlying medical conditions such as diabetes or rheumatoid arthritis, or direct trauma to the finger.
Differentiating Trigger Finger from Other Types of Finger Pain:
While trigger finger shares similarities with other finger injuries or conditions, such as arthritis or tendonitis, it has distinct characteristics. Trigger finger typically presents with symptoms such as pain, stiffness, and clicking or locking of the affected finger, particularly when bending or straightening it (2). Unlike arthritis, which often affects multiple joints and causes generalised stiffness, trigger finger primarily affects one or more fingers or thumbs, with symptoms localised to the affected digit.
What a Physiotherapist Can Do to Help:
Physiotherapists play a crucial role in the management of trigger finger by implementing targeted interventions to reduce inflammation, improve finger mobility, and restore normal tendon function. Treatment may include therapeutic exercises to strengthen the muscles and tendons surrounding the affected finger, and splinting to support the finger and prevent triggering (3). Additionally, physiotherapists may provide education on ergonomic principles and activity modification to prevent exacerbation of symptoms.
Signs and Symptoms:
Recognizing the signs and symptoms of trigger finger is essential for early intervention and effective management. Common indicators include pain or discomfort in the affected finger, stiffness or limited range of motion, clicking or popping sensation when moving the finger, and difficulty straightening or bending the finger without assistance (4). Symptoms may worsen with repetitive hand movements or gripping activities, such as typing, writing, or holding objects.
When to Seek More Urgent Help:
While many cases of trigger finger can be managed conservatively with physiotherapy, certain signs may indicate the need for more urgent medical attention, including severe or worsening symptoms, progressive loss of function or mobility in the affected finger, and development of complications such as infection or tendon rupture (5). In such cases, a surgical opinion may be necessary to explore options such as corticosteroid injections or surgical release of the affected tendon sheath.
Jargon Buster:
- Tendon Sheath: A protective membrane surrounding the tendons, allowing smooth movement within joints.
- Corticosteroid Injections: Medications injected into the affected area to reduce inflammation and alleviate pain.
- Tendon Release Surgery: Surgical procedure to release the constricted tendon sheath and restore normal tendon movement.
Myth Buster:
One common myth surrounding trigger finger is that it only affects individuals who engage in repetitive hand movements or gripping activities. While repetitive motions can contribute to trigger finger, the condition can also occur due to factors such as underlying medical conditions, direct trauma to the finger, or hormonal changes (6). Additionally, trigger finger can affect individuals of all ages, including children and adolescents.
Management Duration:
The management of trigger finger varies depending on the severity of symptoms and individual factors. While some individuals may experience relief with conservative measures within a few weeks, others may require more extensive treatment or intervention. Physiotherapy, combined with self-management strategies such as activity modification, splinting, and ergonomic adjustments, is essential for long-term management and prevention of recurrence (7).
How to Effectively Self-Manage:
In addition to physiotherapy interventions, several self-management strategies can help alleviate trigger finger symptoms and improve finger function. These may include practising gentle stretching exercises recommended by a physiotherapist to improve finger mobility, applying ice packs to the affected area to reduce inflammation and pain, and avoiding activities that exacerbate symptoms, such as prolonged gripping or repetitive hand movements (8).
eMed Physiotherapy:
eMed physiotherapy offers convenient access to physiotherapy services remotely, allowing individuals to receive personalised care from the comfort of their homes. Through teleconsultations and online exercise programs, eMed physiotherapy facilitates continuity of care and promotes active participation in rehabilitation. This approach ensures that individuals have access to timely support and guidance in managing their trigger finger effectively.
Conclusion:
Trigger finger can be a painful and limiting condition, but with the right approach to management, individuals can effectively alleviate symptoms and improve finger function. Physiotherapy plays a crucial role in reducing inflammation, improving finger mobility, and restoring normal tendon function. By incorporating targeted interventions, self-management strategies, and ergonomic adjustments, individuals can effectively manage trigger finger and improve their overall quality of life.
References:
- American Academy of Orthopaedic Surgeons. Trigger Finger. Accessed on January 20, 2024. https://orthoinfo.aaos.org/en/diseases--conditions/trigger-finger/
- Ladd AL, Weiss AP, Crisco JJ, Hagert E, Wolf JM. Trigger Finger: A Review of the Current Literature. J Hand Surg Am. 2017;42(5):429.e1-429.e16. doi:10.1016/j.jhsa.2017.01.010
- Gerwin M. Tenosynovitis and Tendonitis in the Chronic Hand. J Bodyw Mov Ther. 2017;21(1):216-225. doi:10.1016/j.jbmt.2016.06.005
- Murphy N, Sivarajan VB, Neary J. Trigger finger: diagnosis and management. Am Fam Physician. 2016;94(12):993-998.
- Huisstede BM, Hoogvliet P, Coert JH, Fridén J; European HANDGUIDE Group. Multidisciplinary consensus guideline for managing trigger finger: results from the European HANDGUIDE study. Phys Ther. 2014;94(10):1421-1433. doi:10.2522/ptj.20130227
- Middleton SD, Anakwe RE. Preventing recurrence of trigger finger. Orthop Trauma. 2017;31(4):249-253. doi:10.1016/j.mporth.2017.06.003
- Peters-Veluthamaningal C, van der Windt DA, Winters JC, Meyboom-de Jong B. Corticosteroid injection for trigger finger in adults. Cochrane Database Syst Rev. 2009;(1):CD005617. doi:10.1002/14651858.CD005617.pub2
- De Silva SP, Tsang K, Wijendra A, Kang N. Conservative management of trigger finger: A systematic review. J Hand Surg Eur Vol. 2021;46(4):383-388. doi:10.1177/1753193420938406
