Trigger Finger and its Physiotherapy Management

1. Trigger Finger
Dr.Ahmad Merajul Hasan Inam

2.  Trigger Finger is a common condition which may cause significant functional
impairment. It is a tenosynovitis in the flexor sheaths of the fingers and
thumb as a result of repetitive use.
 The inflammation may cause the tendon to become nodular. It most
commonly occurs in the ring finger and the thumb but can present in any
finger.
 It could be A1,A2 or A3 Types

4. Etiology
 The etiology of trigger finger is multifactorial. There are some associations
with specific comorbid diseases in adult patients with trigger finger, for
example, diabetes, amyloidosis, carpal tunnel syndrome, gout, thyroid
disease, and rheumatoid arthritis.
 In children, the etiology appears to be developmental, with a mismatch in the
size of the flexor tendon of the thumb and its tendon sheath.

5. Epidemiology
 Trigger finger has a bimodal incidence, with a first peak before eight years of
age and the second peak in patients in their 40s and 50s. Overall, trigger
finger is more common in adults.

6. Pathophysiology
 Microtrauma, whether through repetitive use or compression forces, results in
inflammation and injury of the flexor tendon-sheath complex. The greatest
degree of force occurs on the A1 pulley, and hence, this is the one that is
most commonly affected.

7. Clinical Presentation
 Patients typically present with either discomfort or functional limitations in
the affected digit.
 Patients may note progressive discomfort on the palmar aspect of the
affected digit when flexed, and there may also be swelling or a nodule
present.
 Patients frequently complain of a painful click in the digit.
 Patients may also present with locking of the finger during extension, or
inability to move a finger from a fixed flexed position.

8. Diagnosis
 Ultrasound can be obtained in assessing this condition. Ultrasound may
demonstrate thickening of the pulley as well as inflammation and irregularity
of the underlying flexor tendon. However, it may not reliably predict the site.
Ultrasound can be used dynamically to demonstrate the catching and clicking
during tendon sliding.
 Plain radiographs are useful to rule out other conditions, such as an occult
fracture. In general, MRI and CT scans may not be required.

9. Treatment / Management
NON-SURGICAL
 Treatment of trigger finger usually is nonoperative particularly especially if it
is uncomplicated and of a short duration of symptoms. It includes steroids
injection and splinting.
Splinting
 It is based on the concept that is limiting tendon gliding; inflammation can be
reduced. In an MCP blocking splint, at 10 to 15 degree of flexion for 6 to 10
weeks. However, it .is less likely to benefit those patients who suffer from
severe or prolonged symptoms.

10. SURGICAL
Open release of the A1 pulley is considered the gold standard for surgical
management of trigger finger. A surgical release should be considered when there
is
 No improvement with splinting and/or injection treatment
 Irreducibly locked trigger finger
 Trigger thumb during infancy

11. Physiotherapy
ELECTROTHERAPY-
 In the early stages, particularly when clicking can be felt in the tendons
during movement but the patient still has full active ROM, it is often
beneficial to try a variety of modalities such as heat packs ,Laser and
ultrasound.which may help to thin out the thickened part of the tendon and
allow it easier access through the tendon sheath.
 A further method of producing a good stretch of the flexor tendons is to apply
muscle stimulation of the forearm flexor muscles.The patient then holds the
fingers in full extension, either actively or passively, while the muscle
stimulation contracts the affected muscles.

12.  Manual Therapy

13. EXERCISES-
 Fully straighten fingers
 Make a table top by bending the large knuckles and keeping the rest of the
fingers straight. Return to start position.
 Bend the tips of your fingers into a hook, whilst keeping the knuckles straight.
Return to start position.
 Make the table top positions and touch your palm keeping the end joints
straight
 Prolonged fascial stretches, where each stretch is held for 2-3 minutes or
longer has occasionally proved useful in more severe or chronic
cases.stretching of the affected tendons will normally produce results in six
to eight sessions of treatment over a 2-3 weeks period.

14. RESTRICTIONS
 Avoid excessive use of full-hand grip or repetitive movements of the fingers in
order to reduce irritation of the tendon sheaths.
 Wear gloves to use a tool that vibrates whether in a home or work activity.
 Where extension of the fingers is particularly difficult then a custom-made
splint can be supplied to maintain the fingers in extended position.this can be
worn for half the day, 1 hr on and 1 hr off, for 2-3 weeks.