Trigger Finger: Causes, Symptoms, Treatment and Exercises

What Triggers Your Finger?

Do you have a finger that catches or clicks whenever you make a fist and is unable to extend on its own unless you passively flick it back into extension? Do you have a finger that can’t close into flexion when you make a fist but when you passively put your finger into flexion, you aren’t able to extend it again? Do you have a finger that is stuck in a flexed position and you cannot unlock back into extension no matter how hard you try? If any of the above descriptors sounds familiar to you, it may be that you have a condition called “Trigger Finger”.

Throughout your lifetime, you have a 2% chance of acquiring trigger finger (1). If you have it, there’s a likely chance that it is interfering with your work, your sports like golf, rock climbing, tennis, or even day-to-day activities like cooking, brushing your teeth, or holding a bag. So how does Trigger Finger work and what can you do about it?

What is Trigger Finger?

Trigger Finger is also known as stenosing tenosynovitis. Your hand is a very complex body part with numerous pulley systems throughout out the finger. These pulleys act as anchors for tendons that pass underneath them so that you are able to move your fingers into different positions. Your hand has the ability to make many different shapes, which include hook fist, straight fist, composite fist, table top fist (crimp grip for rock climbers!), and put your hand into full extension (Figure 1.)

Figure 1. A. Full extension, B. Table top fist, C. Claw grip, D. Straight Fist. E. Composite fist.

When you make the different types of fist, the tendons in your hand glide underneath the pulleys, which can be a source of irritation. In Trigger Finger, an enlarged flexor tendon or pulley may become entrapped with one another. Pain may be present over the area of entrapment and a subsequent trigger of the adjacent, distal joint may arise. Trigger finger usually occurs at the site of the A1 pulley where a thickening/bump can be felt. In this situation a trigger can be seen at the proximal interphalangeal joint (PIPJ) (Figure 2).

Figure 2. Trigger Finger Pathophysiology. Swollen tendon becomes entrapped underneath A1 pulley.

Less commonly, trigger finger can also be observed at the A3 pulley, where pain is felt over the PIPJ and a triggering occurs at the distal interphalangeal joint (DIPJ). (Figure 2). Regardless of where the trigger finger is, the act of making a fist can cause your finger to click, recreate your pain, or get stuck into flexion.

What Causes Trigger Finger?

The cause of trigger finger is often unknown (ie. Idopathic trigger finger), however, it can be associated with trauma, diabetes mellitus, rheumatoid arthritis, carpal tunnel syndrome, De Quervain’s tenosynovitis (2).

How Can Physiotherapy and Chiropractic Help with Trigger Finger?

Trigger finger can be tricky to treat, because if you, your Physiotherapist, or Chiropractor do not have the right expectations or an effective protocol in place, you may not find rehabilitation very successful, resulting in unnecessary injections or surgery. Effective treatment includes taping to correcting finger alignment, prescribing and wearing an appropriate splint (that does not need to be bulky, highly restricting or cosmetically unappealing), activity modification, self-massage, use of thermal modalities, and a set of exercises to promote proper mobility of the finger.

What Should Be Avoided With Trigger Finger?

As much as possible, you should avoid letting your finger lock or click. Therefore, work within your pain free and click free range of motion. This can be tricky to avoid, however with the right guidance and recommendations, there are ways to modify the way you do things and splints that can be used to prevent you from letting your finger lock or click.

How Long Does It Take To Recover From Trigger Finger?

There are 5 different classification levels for Trigger Finger, which vary in degrees of severity. At Rebalance Sports Medicine, your Physiotherapist and Chiropractor will be able to assess your trigger finger and identify the correct classification, to help inform your prognosis. Generally speaking, it takes roughly 8 weeks for a patient to drop down a classification level and up to 4 months of wearing a splint (3).

What Are Some Safe Home Exercises I Can Do For Trigger Finger?

1. Apply heat for 15 min over the palpable bump on your hand where pain is often felt.
2. Make a straight fist, table top fist, claw grip, straight fist and composite fist without allowing your finger to trigger. Repeat 5 times per grip, every 2-3 hours (Figure 1).
3. Gently massage the palpable bump with your unaffected hand for about 5 min a day.
4. Modify the way you do things in your day-to-day to reduce the number of triggering events.
5. Purchase the proper splint and wear it correctly for the prescribed duration. (Splinting is a critical component to treating trigger finger effectively; therefore your compliance with splinting is strongly correlated to your outcome).

If you suspect you have trigger finger, consider booking an appointment with one of our Physiotherapists or Chiropractors, who will be able to guide you through your process of rehabilitation.

References:

1. Strom L. Trigger finger in diabetes. J Med Soc N J. 1977;74:951e954.
2. Teo et al., Effectiveness of proximal interphalangeal joint – blockin orthosis vs metacarpophalangeal joint – blocking orthosis in trigger digit management: A randomized clinical trial. J Hand Therapy. 2018; 1-7.
3. Saldana MJ. Trigger digits: diagnosis and treatment. J Am Acad Orthop Surg. 2001;9:246e252.

Written by: Wesley Lai – Registered Physiotherapist