A trigger finger, also known as stenosing tenosynovitis, occurs when a finger or thumb “catches” or “locks” when bending and it is then difficult to straighten.
Causes of Injury
The exact cause of trigger finger is not clear and it usually occurs for no apparent reason. In some individuals it can occur after repetitive use of the hand or tools that press into the palm.
Tendons are tissues that connect muscles to bones. The muscles that move the fingers and thumb are located in the forearm. The flexor tendons are located on the palm side of the hand and work to bend and control the fingers and thumbs. There is a sheath covering these tendons, which helps to keep it in place next to the bones. If there is inflammation, irritation and thickening of the tendon and tendon sheath a nodule may develop on the tendon. If large enough, this nodule will interfere with the tendon’s sliding movement in the sheath. The nodule can then get stuck through the sheath, causing a ‘locking’ or ‘catching’ sensation as the finger is straightened. If this continues pain and further swelling will likely result, leading to an ongoing cycle of tissue damage, pain and loss of movement.
There are a number of factors that can increase a person’s risk of developing trigger finger, including:
- Older age
- Rheumatoid arthritis
- Renal failure
- Jobs or hobbies with repetitive hand use
Signs and Symptoms
- Shoulder pain when the arm is raised overhead, particularly out to the side/ ‘painful arc’
- Pain generally worsens over time
- Possible referral/spreading of pain down the arm
- Pain may be relieved by rest initially
- A “catching” sensation may be felt when the arm is lowered
- Muscle weakness
- Pain when sleeping on the affected side
Most individuals respond well to physiotherapy treatment. The aim of treatment is to reduce associated pain and inflammation. Treatment and management options include:
- Advice regarding activity modification/relative rest
- Physiotherapy- massage, ultrasound, joint mobilisation and stretches
- A comprehensive exercise program including range of movement exercises, strengthening, stretching, activity specific tasks and exercises to improve control of the shoulder.
- Pain relief and anti-inflammatory medications may be recommended.
If symptoms persist, an injection of corticosteroid and/or anaesthetic medication into the joint may be recommended to assist in reducing pain and inflammation. Surgery may be required if the shoulder still fails to improve. In this case, the surgery may remove any bone spurs or the bursa, shave off or remove part of an enlarged acromion and repair any damage to the rotator cuff.
Return to Activity
Approximately 60-90% of individuals see a substantial improvement in symptoms with three to six months of physiotherapy.