Trigger Finger

THE CLINICAL SYNDROME

Trigger finger is caused by an inflammation and swelling of the tendons of the flexor digitorum superficialis due to compression by the heads of the metacarpal bones. Sesamoid bone in this region may also cause compression and trauma to the tendons. The inflammation and swelling of the tendon is usually the result of trauma to the tendon from repetitive motion or pressure overlying the tendon as it passes over these bony prominences. If the inflammation and swelling becomes chronic, a thickening of the tendon sheath occurs with a resulting constriction of the sheath. Frequently, a nodule develops on the tendon due to chronic pressure and irritation. These nodules can often be palpated when the patient flexes and extends the fingers. Such nodules may catch in the tendon pulley and produce a trigger phenomenon that causes the finger to catch or lock as the nodule catches on the pulley.

Trigger finger is caused by repetitive microtrauma from repeated clenching of the hand.

Coexistent arthritis and gout of the metacarpal and interphalangeal joints may also be present with trigger finger and exacerbate the pain and disability of trigger finger. Trigger finger occurs in patients engaged in repetitive activities that include hand clenching such as gripping a steering wheel or holding a horse’s reins too tightly.

SIGNS AND SYMPTOMS

The pain of trigger finger is localized to the distal palm with tender tendon nodules often being palpated. The pain of trigger finger is constant and is made worse with active gripping activities of the hand. Patients will note significant stiffness when flexing the fingers. Sleep disturbance is common, and often the patient will awaken to find the finger has become locked in a flexed position during sleep. On physical examination, there will be tenderness and swelling over the tendon with maximal point tenderness over the heads of the metacarpals. Many patients with trigger finger will exhibit a creaking sensation with flexion and extension of the fingers. Range of motion of the fingers may be decreased due to the pain, and a trigger finger phenomenon may be noted. Patients with trigger finger will often demonstrate nodules on the tendons of the flexor digitorum superficialis.

TREATMENT

Initial treatment of the pain and functional disability associated with trigger finger should include a combination of the nonsteroidal anti-inflammatory drugs or cyclooxygenase-2 inhibitors and physical therapy. The use of physical modalities including local heat as well as gentle range of motion exercises should be introduced several days after the patient undergoes the following injection technique. A nighttime splint to protect the fingers may also help relieve the symptoms of trigger thumb. Vigorous exercises should be avoided because they will exacerbate the patient’s symptomatology.

Injection of trigger finger is carried out by placing the patient in a supine position, with the arm fully adducted at the patient’s side and the dorsal surface of the hand resting on a folded towel.

The use of physical modalities including local heat as well a gentle range of motion exercises should be introduced several days after the patient undergoes this injection technique. A hand splint to protect the fingers may also help relieve the symptoms of trigger finger. Vigorous exercises should be avoided because they will exacerbate the patient’s symptomatology. Simple analgesics and nonsteroidal anti-inflammatory drugs may be used concurrently with this injection technique. This injection technique is extremely effective in the treatment of pain secondary to the trigger finger.

Low intensity laser therapy as well as a coordinated wellness program is also effective in treating this disorder.

Low Intensity Laser Therapy (LILT)

The low intensity Laser (LILT) sends photons (light) into the injured tissues and can penetrate two to three inches to treat affected areas. It uses a natural enhancement of the cellular machinery that can and has been dynamically measured in published studies to promote healing without burning affected tissue .Once the photons find the injured tissues, they stimulate and energize the cells to repair and strengthen at a remarkable rate. The treatment does not hurt, takes about 30 minutes and is very cost advantageous.

Wellness Program

A wellness program whichindividualizes treatment for age, performance and function has been shown in pilot studies to improve the overall health and well being of the individuals evaluated. A well conceived dietary and supplementary regimen based on scientific age –related decline in certain necessary compounds can improve quality of life, correct the ravages of hormone imbalance, balance critical neurotransmitter function without resorting to powerful drugs for depression that often have unfavorable side-effect profiles and restore vitality and youth in daily exercise routines. Furthermore, when wellness products are utilized with success, individuals often seek less costly interventions including unnecessary surgeries and narcotic options to treat pain. For more information go to www.drpwellness.com.