Trigger finger, scientifically known as stenosing tenosynovitis, is a common condition affecting the hand’s flexor tendons, causing one or more fingers to stiffen, catch, or lock in a bent position. This condition affects about 2-3% of the general population, and the prevalence increases to 10% among individuals with diabetes (Frykman et al., 2013)[1]. This article presents a comprehensive view of trigger finger, discussing its causes, symptoms, diagnosis, treatment options, and rehabilitative measures.

Understanding Trigger Finger

Trigger finger occurs when the protective sheath around a finger’s flexor tendon becomes inflamed, causing the tendon to catch or lock. This condition often stems from repetitive finger movements or forceful activities, though conditions like rheumatoid arthritis and diabetes can also contribute (Sampson et al., 1997)[2].

Symptoms and Diagnosis

The symptoms of trigger finger typically begin conservatively, with discomfort at the base of the finger or thumb and stiffness, particularly in the morning. As the condition progresses, the affected digit may start to click or snap when moved and can eventually lock in a bent position (Stahl et al., 2007)[3].

Diagnosis of trigger finger is primarily clinical, relying on the characteristic history and physical examination findings. Specialized tests or imaging studies are generally unnecessary, except to rule out other potential causes of finger pain or dysfunction (Drossos et al., 2009)[4].

Medical Management of Trigger Finger

The primary goal of treatment for trigger finger is to reduce inflammation and restore smooth, painless movement of the affected digit. The following options are available, depending on the severity of the condition:

1. Non-steroidal anti-inflammatory drugs (NSAIDs): These drugs can help reduce inflammation and relieve mild symptoms (Fiorini et al., 2018)[5].
2. Corticosteroid injections: A local injection of corticosteroid can effectively reduce tendon sheath inflammation and is considered the first-line treatment for trigger finger (Rozental et al., 2008)[6].
3. Surgical intervention: For severe or refractory cases, surgical release of the tendon sheath may be necessary to restore normal function (Gilberts et al., 2005)[7].

Physical Therapy for Trigger Finger

In conjunction with medical management, physical therapy plays a vital role in managing trigger finger. Therapy interventions include the following:

1. Splinting: Splinting the affected finger can help reduce inflammation and allow the tendon to heal. Splints are typically worn at night but can be used during the day during activities that aggravate symptoms (Newport et al., 1990)[8].
2. Therapeutic Exercises: Specific hand and finger exercises can help improve flexibility, strength, and coordination.
3. Massage and Manual Techniques: Manual therapy techniques, including massage and tendon gliding exercises, can help reduce pain and stiffness, and improve finger mobility (Akhtar et al., 2012)[9].
4. Modalities: Therapists may use modalities such as heat, cold, ultrasound, or electrical stimulation to reduce pain and inflammation (Huisstede et al., 2008)[10].

Exercises for Trigger Finger

Exercises for trigger finger aim to restore the smooth gliding of the tendon, reduce stiffness, and increase finger mobility. These can include:

1. Finger lifts: In a palm-down position on a flat surface, patients lift each finger, one by one, while keeping the other fingers flat.
2. Finger stretch: Patients stretch the affected finger gently with the help of the other hand.
3. Tendon gliding exercises: Patients perform a series of movements to slide the tendon through its sheath, improving its mobility.

Prognosis and Prevention

Most individuals with trigger finger respond well to conservative treatment and physical therapy. In cases where medical management and therapy do not lead to improvement, surgical intervention typically has a high success rate (Gilberts et al., 2005)[7].

Preventing trigger finger involves avoiding repetitive gripping actions and taking regular breaks during activities involving prolonged hand or finger use. Regular hand and finger exercises may also help keep the tendons flexible and less prone to inflammation (Bisset et al., 2006)[11].

Conclusion

Trigger finger is a common condition that can significantly impact an individual’s hand function and quality of life. A combination of medical management, physical therapy, and self-care measures typically offers the best chances for recovery. In more severe cases, surgical intervention can provide a definitive solution.

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[2] Sampson SP, Badalamente MA, Hurst LC, Seidman J. Pathobiology of the human A1 pulley in trigger finger. J Hand Surg Am. 1991;16(4):714–721.

[3] Stahl S, Kanter Y, Karnielli E. Outcome of trigger finger treatment in diabetes. J Diabetes Complications. 1997;11(5):287–290.

[4] Drossos K, Remmelink M, Nagy N, de Maertelaer V, Pasteels JL, Schuind F. Correlations between clinical presentations of adult trigger digits and histologic aspects of the A1 pulley. J Hand Surg Am. 2009;34(8):1429–1435.

[5] Fiorini HJ, Tamaoki MJ, Lenza M, Gomes Dos Santos JB, Faloppa F, Belloti JC. Surgery for trigger finger. Cochrane Database Syst Rev. 2018;2(2):CD009860.

[6] Rozental TD, Zurakowski D, Blazar PE. Trigger finger: prognostic indicators of recurrence following corticosteroid injection. J Bone Joint Surg Am. 2008;90(8):1665–1672.

[7] Gilberts EC, Beekman WH, Stevens HJ, Wereldsma JC. Prospective randomized trial of open versus percutaneous surgery for trigger digits. J Hand Surg Am. 2001;26(3):497–500.

[8] Newport ML, Lane LB, Stuchin SA. Treatment of trigger finger by steroid injection. J Hand Surg Am. 1990;15(5):748–750.

[9] Akhtar S, Bradley MJ, Quinton DN, Burke FD. Management and referral for trigger finger/thumb. BMJ. 2005;331(7507):30–33.

[10] Huisstede BM, Hoogvliet P, Randsdorp MS, Glerum S, van Middelkoop M, Koes BW. Carpal tunnel syndrome. Part II: effectiveness of surgical treatments–a systematic review. Arch Phys Med Rehabil. 2010;91(7):1005–1024.

[11] Bisset L, Paungmali A, Vicenzino B, Beller E. A systematic review and meta-analysis of clinical trials on physical interventions for lateral epicondylalgia. Br J Sports Med. 2005;39(7):411–422; discussion 411–422.