Trigger Finger

“Trigger finger” is a condition that causes one of your fingers (often the thumb or middle finger) to become stuck in a bent position and then snap straight, like pulling a trigger and releasing it. Medically, it’s known as stenosing tenosynovitis.

The condition occurs when the tendon in the affected finger or thumb becomes irritated or inflamed, which leads to a narrowing of the sheath (the tunnel) that the tendon passes through. This makes it difficult for the tendon to slide smoothly, which results in the finger catching or locking in a bent position. When the finger finally straightens, it might snap or pop.

Causes

·  Overuse or repetitive gripping, especially in activities like typing, playing certain musical instruments, or using hand tools.

·  Arthritis, particularly rheumatoid arthritis, which can increase the likelihood of tendon inflammation.

·  Injury or trauma to the finger or hand.

·  Age: It’s more common in people aged 40 to 60, though it can affect younger people as well.

·  Diabetes: There is an increased risk in people with diabetes, likely due to changes in tendon health.

Symptoms

·  Pain at the base of the finger, particularly when bending or straightening it.

·  Stiffness in the affected finger, especially in the morning.

·  A clicking or popping sound when moving the finger.

·  The finger may lock in a bent position and then suddenly straighten with a snap.

·  Swelling and tendernesscan be seen at the base of the finger.

Physiotherapeutic treatment

Physiotherapy can be very effective in treating trigger finger, particularly in the early stages or when surgery is not yet necessary. The primary goal of physiotherapy is to reduce pain, improve the range of motion, and prevent further irritation or injury to the affected tendon and surrounding tissues.

1. Stretching and Range-of-Motion Exercises

Gentle stretching exercises can help improve flexibility and reduce stiffness in the finger joint. These exercises should be done carefully and gradually to avoid aggravating the condition.

• Finger Flexor Stretch:
  • Place your affected hand on a flat surface with the palm down.
  • Slowly bend the affected finger toward the palm and hold it for 15-30 seconds.
  • Repeat 3-5 times.
• Tendon Gliding Exercises:
  • These exercises help the tendon slide smoothly through its sheath. There are various finger movements that help in this process:
    1. Start with your fingers straight.
    2. Bend the top two joints (making a “hook” shape with your fingers).
    3. Straighten your fingers again and then bend your fingers into a fist.
    4. Repeat 10-15 times, moving your fingers through the different positions slowly and deliberately.
• Finger Extension Stretch:

Using your unaffected hand, gently stretch the affected finger back toward its full extension (straight position). Hold for 15-20 seconds and repeat 3-5 times.

2. Manual Therapy

 Physiotherapist may use hands-on techniques to help relieve tension and improve the mobility of the tendon and surrounding structures. This may include:

• Deep tendon friction massage: To reduce muscle tightness, improve circulation, and reduce swelling around the finger joint.
• Soft Tissue Mobilization: A technique where the therapist applies gentle pressure and movement to the soft tissues (like muscles and tendons) to reduce adhesions and restrictions.

3. Heat and Cold Therapy

Applying heat and cold to the affected area can help reduce pain and inflammation.

• Cold packs can be applied to the affected finger to help reduce inflammation and swelling (especially in the acute phase).
• Heat therapy (like warm towels or heat pads) can help relax the muscles and improve blood circulation when there is less swelling.

4. Splinting

A physiotherapist may recommend a splint or brace that keeps the affected finger in a neutral position (not bent or straight) to avoid excessive motion and allow the tendon to rest. Typically, splints are worn at night, but your therapist may also suggest wearing them during activities that might strain the finger.

5. Strengthening Exercises

Once the pain and inflammation start to subside, Physiotherapist may suggest strengthening exercises for the finger to help restore full function and prevent future flare-ups.

• Rubber band exercises:

Place a rubber band around your fingers and thumb, and stretch them apart. This exercise helps strengthen the finger extensors.