Alternative names for trigger finger: Stenosing tenosynovitis or Stenosing tenovaginosis.

A patient was referred to me with a case of trigger finger. The patient complained of pain with finger flexion along with locking into this position every time he tried to actively flex his index finger. I had never treated a patient with this exact case of trigger finger before so I researched into the condition further;

Pathology

Trigger finger is a condition that affects the tendons in your hand. When your fingers or thumb is bent in the direction of your palm, the tendon can become stuck and therefore cause the finger to click or lock into that position.

Symptoms

Pain, stiffness, clicking, and a small lump of tissue at the base of the affected finger, known as the nodule.

Causes

Problems with the tendon or sheath, such as swelling, means the tendon can no longer slide easily through the sheath therefore making it hard to bend the finger. Another cause can be when the tendon becomes caught in the opening of the sheath, causing a painful click, like a trigger being released, as it is straightened. The chances of developing trigger finger are higher and more common in:

•Women
•Men and Women Over 40
•If you have certain medical conditions – around 10% of people with diabetes develop trigger finger, rheumatoid arthritis and gout

Treatment

•Rest and medication such as painkillers and non-steroidal anti-inflammatory drugs should help reduce the pain and swelling.
•Applying a splint to the affected finger to reduce pain and aid recovery.
•A Corticosteroid injection to reduce swelling.
•Surgery – This is only ever used when other treatments have failed. It involves releasing the affected sheath to allow the tendon to move freely again.
•Physiotherapy

Physiotherapy

•Ultrasound or laser to reduce swelling and accelerate healing
•Soft tissue massage
•Joint mobilisation
•Passive stretching
•Home exercises
•Acupuncture

Reflection

After research, I decided to try laser treatment of 6J (Joules of energy), continuous on the affected index finger flexor tendons, soft tissue release of the flexor tendons, joint mobilisations of the index finger distal interphilangeal and metacarpal interphalangeal joints and passive mobilisations into flexion and extension. I also encouraged the patient to take a course of non-steroidal anti-inflammatory drugs, ice his finger, perform flexion mobilisation and strengthen the finger extensors.

After 3 sessions his finger was locking less frequently, but he was still complaining of pain. I therefor trialled acupuncture for 3 further sessions using a trigger point of his flexor tendon and LI4 acupuncture point. This reduced his pain from 8/10 to 1/10 on the visual analogue scale and his pain no longer locks – therefore treatment was successful.

It’s nice to know how to treat future patients with trigger finger and if treatment is unsuccessful there are other options available such as a cortisone injection.