Trigger Thumb

THE CLINICAL SYNDROME

Trigger thumb is caused by an inflammation and swelling of the tendon of the flexor pollicis longus due to compression by the head of the first metacarpal bone. Sesamoid bones in this region may also cause compression and trauma to the tendon. 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 thumb. Such nodules may catch in the tendon sheath and produce a triggering phenomenon that causes the thumb to catch or lock.

Trigger thumb is caused by microtrauma from reptitive pinching movement of the thumb.

Arthritis and gout of the first metacarpal joint may also coexist with trigger thumb and exacerbate the pain and disability of trigger thumb. Trigger thumb occurs in patients engaged in repetitive activities that include hand grasping, such as shaking hands by politicians, or activities that require repetitive pinching movements of the thumb. Video games and frequent card playing have also been implicated in the evolution of trigger thumb.

SIGNS AND SYMPTOMS

The pain of trigger thumb is localized to the palmar aspect of the base of the thumb in contradistinction to the pain of de Quervain’s tenosynovitis, in which the pain is most pronounced more proximally over the radial styloid. The pain of trigger thumb is constant and is made worse with active pinching activities of the thumb. Patients will note the inability to hold a coffee cup or a pen. Sleep disturbance is common, and patients often will awaken to find that the thumb 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 base of the thumb. Many patients with trigger thumb exhibit a creaking sensation with flexion and extension of the thumb. Range of motion of the thumb may be decreased due to the pain, and a trigger thumb phenomenon may be noted. Patients with trigger thumb often demonstrate a nodule on the tendon of the flexor pollicis longus.

TREATMENT

Initial treatment of the pain and functional disability associated with trigger thumb should include a combination of the nosteroidal 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 quilter’s glove to protect the thumb 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 thumb 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.

This injection technique is extremely effective in the treatment of pain secondary to the trigger thumb. Coexistent arthritis and gout may also contribute to the pain and may require additional treatment with more localized injection of local anesthetic and methylprednisolone acetate.

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.