The Hand to Shoulder Solution
Your new resource for hand, shoulder, and elbow pain. Together, we are giving pain the middle finger and gaining knowledge to live a better, pain-free life!
Discover what might be causing pain in your fingers, pain in your hand, pain in your wrist, pain in your arm, pain in your elbow, pain in your shoulder.
Learn about your body, arthritis, tendinitis, tennis elbow, fractures, golfer's elbow, and carpal tunnel syndrome.
Hosted by Carl Petitto, OT, CHT, and Certified Hand Therapist specializing in orthopedic conditions of the hand to shoulder. Also an expert in fabricating custom orthotics.
The Hand to Shoulder Solution
Ep 22 - Trigger Finger Unlocked: Understanding Your Symptoms and a guide for relief and treatment
Get ready to uncover the causes and solutions for trigger finger, a condition that affects many people's daily lives. We dive deep into the mechanics of how the tendons and pulleys work together and the issues that can arise when they don't. Discover treatment options, including conservative methods and when to consider surgical options, alongside essential recovery tips.
• Explanation of what trigger finger is and how it occurs
• Overview of treatment methods, including conservative and surgical options
• Practical tips for recovery to prevent future occurrences
Listen to our episode and learn how to address trigger finger effectively.
Hello and welcome to the new show, The Hand to Shoulder Solution, with me, Carl Petitto.
If you are experiencing pain in your arms and hands, this is your resource.
Subscribe, listen, and share to help us give pain the middle finger for good!
This is a resource to help you mitigate pain at home and become more educated on what to ask your doctors and therapists. No medical advice will be given, and you should always see your medical professional for any questions.
Thank you, and welcome to the show!
Welcome back to the Hand-to-Shoulder Solution Giving Pain the Middle Finger. I'm Carl Petito. I'm an occupational therapist and a board-certified hand therapist. I specialize in the rehabilitation of orthopedic conditions affecting the fingertips through the shoulder. Today I want to talk about trigger finger. What is it? How is it treated? What are the do's and don'ts? First, I want to explain that this is not treatment or treatment advice. This is information sharing so you know about the possible condition that is causing your symptoms and what kind of service you need to seek out in order to get it fixed. So let's get into it.
Speaker 1:Trigger finger it occurs when you try to open your hand and one finger is popping, it's catching, it's clicking. Sometimes it happens in the opposite direction, where it's hard to bend your hand and one finger is popping, it's catching, it's clicking. Sometimes it happens in the opposite direction, where it's hard to bend your finger down and it pops. So this has a lot. Well, it has everything to do with the tendon, which connects muscles to the bones and the tendon, is callus forms on the tendon and is getting caught on internal structure. It's a very mechanical problem and let's talk about the details. On the fingers there's structures called pulleys, and what the pulleys do is they keep the tendon against the bone so, as the muscle is contracting and pulling the fingers down, the muscle doesn't bowstring or pull away from the fingers. So I made this. The red cord is a representation of a tendon that connects muscle to the bone. The tendon travels through the carpal tunnel and then is held against the bones by. There's a. The black represents the pulley system. So there's a pulley that horizontally goes over the top of the tendon around each bone, each separate bone. This, just for the sake of simplicity, wrapped around my whole hand, but there's one on each of the four bones within the palm, for the each of the four fingers, and then that's the a1 pulley, there's a2, a3, a4, a5, etc. I just put a few on here so you get the idea. So these pulleys prevent bow stringing.
Speaker 1:If the pulleys weren't there, it would, the tendon would pull away and then you would lack the mechanical advantage and your finger wouldn't bend because you would just have a, a bow string, basically, and the finger wouldn't move all the way. So, as you can imagine, as that tendon is sliding through underneath the pulleys, that's a friction point, and what happens eventually is a callus forms on the tendon and that callus. In this case that's represented by the ball of white tape. Here the callus starts to catch on the pulley. It more often occurs on the A1 pulley, which is within the palm. Here and, by the way, the fingers, the big knuckles, bend at this crease in your palm. It's called the distal palmar crease and that's really the area of that pulley. So sometimes, if you're experiencing this and your finger is catching and most commonly occurs with a ring finger, I've had patients where it's happening with every single finger. It also happens with the thumb.
Speaker 1:You can feel sometimes a nodule there and that's the callus, which again is represented here by this white ball of tape. So as the muscle contracts, the tendon has to glide down to bend the finger and now the pulley, the nodule rather, is on the south side of that pulley. So as you straighten, now the tendon is going to glide north, that nodule pops underneath that pulley. So let's do it again. So now the nodule is south or proximal to the pulley and now, as you straighten the finger pop, that pops up through underneath that pulley. So one more time as you straighten the finger, and now that nodule or the callus on the tenon snaps underneath that pulley. So one more time as you straighten the finger, and now that nodule or the callus on the tendon snaps underneath a pulley.
Speaker 1:So how do we treat that? We need to stop that catching. So either we decrease the size of that nodule or we cut the pulley, which is the surgery for trigger finger. It's called trigger finger release surgery because it releases the pulley. So now there's nothing for the nodule to catch on anymore. Now again, sooner is always better.
Speaker 1:So if you're experiencing these symptoms, as soon as you start experiencing these symptoms, let's get it taken care of. Tell your doctor you want hand therapy and tell your doctor you want an injection. If it were me, I would just go ahead and get a steroid injection right there. Go to the hand therapist. What I do is I teach people what to do at home, how to use direct icing or cold running water to decrease inflammation.
Speaker 1:Decreases the size of the pulley. We're going to talk about some details. So we need the size of that nodule to decrease in order to avoid surgery. We need that size of that nodule to decrease. So now it can. If the decreases, then we that can slide through there without catching. So all right. So how do we decrease it.
Speaker 1:Number one let's stop it from catching. So let's decrease the movement of the tendon. How can we do that? So, specific taping techniques, if I, here's a little trick of the trade. So when patients come in and they're having trigger finger and I'll test them at certain positions and again, you know, this is something you really have to be seen by the hand therapist so we can figure this out. I'll do this on my index finger and if I tape the middle knuckle, that decreases tendon glide or tendon excursion we call it. So that works as it has a bracing effect, so it stops a little bit of movement. So now the tendon is gliding a little bit less internally and it doesn't have an opportunity to catch. If I didn't have the tape on there and it did a full fist, now the tendon is gliding all the way and it's catching.
Speaker 1:Patients will come in and say, yep, see, it's doing it, still doing it, catching, catching, catching. And they'll kind of retest it Frequently, sort of like when you have a sore in your mouth you want to keep touching it with your tongue. Every time it catches it aggravates the nodule and or aggravates the callus on the tendon and that callus or nodule gets bigger and bigger because it's aggravated. It's remember it's living tissue, so it gets inflamed. And because it gets flamed it gets bigger. And now, because it's bigger it's, it's catching harder on the pulley. So we need to make it stop catching on the pulley. So we need to make it stop catching. So if we brace it for a while, for usually three or four weeks, and prevent it from catching, then it's not going to irritate itself and that'll give it an opportunity to decrease in size.
Speaker 1:So another way to attack it, in addition to taping when up and around and busy, is to use direct icing. So I have my patients use an ice cube that they can either freeze a Dixie cup and, just if it's a plastic Dixie cup, just break off the plastic and then hold the ice with a small cloth or a napkin or something and glide the direct ice on the bare skin, just barely touching the skin back and forth, only till it's deeply cold, which takes 10 or 20 seconds, right when that's penetrating deep cold done, and I'll have people do that midday, at lunchtime, after dinner and also before bed. Or they can also use cold running water, only until it's deeply cold Again, 10 to 20 seconds. Ice pack doesn't really do it, frozen bag of peas doesn't really do it. It's just not cold enough and it's not close enough to the skin. But the cold running water or the direct ice really does it. And I have people just follow that crease back and forth right across their whole palm and they get all the a1 pulleys to every finger. Then in cases where people also have underlying osteoarthritis affecting them, I'll just have them go across here then really up back and forth over the whole palmar surface of all the fingers while they have the ice out. And it's quick and easy and usually really does the trick very nicely, with a combination of proper taping to brace it, to stop the catching so it's not self-irritating, and then the cold to shrink down the inflammation, to physically shrink the size of the nodule or the callus on the tendon. Another treatment tool that we use in the clinic is cold laser to penetrate the tissues with bright red light to reduce inflammation, and that is also effective. But starting with an injection of steroid to reduce the inflammation, very targeted, and then using ice and then blocking the tendon excursion so it's not catching, really does the trick In cases where it just won't go away and the patient is not responding to conservative treatment.
Speaker 1:Conservative treatment means without surgery and you know, and we should know, within four weeks. If it's not any better within four weeks, especially six weeks, you know most folks will just go ahead and have the surgery. It's probably 50 to 70% success rate with without surgery. Now surgery, you go under the skin and cut that ligament that forms the pulley. So then now the nodule. It doesn't matter if the nodule is there, there's nothing for it to catch on any longer. Now, after surgery, it's just about a one centimeter, about a half an inch, little incision, but it's deep and scar forms. So also it becomes tender.
Speaker 1:There's a lot of nerve endings in the palm, so we have to feel our environment. You have to be able to close your eyes and put a nickel in your palm and feel that it's a nickel. There's a lot of nerve endings in the palm, so it gets sore like anything else would, and our natural reaction is to rub something that's sore to just make it feel better. And rubbing it might feel good at the time while the person's rubbing it, but then the after effect is increased inflammation and that is very aggravation in the palm. And then also patients sometimes are told by different sources to rub that scar. There are times where scar massage should be done on different locations In this area.
Speaker 1:It's nice I usually have my patients just put some, give it a. I tell them, you know, give it a little hug, a little light pressure. Light pressure is calming and soothing, it's relaxing for it, but it's not aggravational. And all the people come in after the surgery and they have an inflamed hand, it's red, it's kind of swollen, and they're sitting there talking to me and while they're talking to me they're just habitually kind of rubbing their hand and that is just terrible for it because it increases the inflammation. But the trap is it feels good while they're rubbing it. Then the after effect is no, it hurts more than they remember that. It felt great when I was rubbing it. So I go back to rubbing it. But I have people just leave it alone, stick another cold running water a few times a day, like we talked about, and then after that, if they feel like it just needs something to just soothe it, a little bit of light, really light pressure, to just hold it there gently.
Speaker 1:And then sometimes too, even the smallest little surgery might exacerbate or excite any underlying osteoarthritis. Arthro means joint, itis means inflammation, so inflammation of the joints and the arthritis will just get, you know, more inflamed, which causes some joint stiffness, and then that will spur a person to want to just kind of keep it moving and keep it loose and keep it moving. That's another don't, that's another thing to not do. And again, because it's the hand, it's handy, it's right there, you can just kind of do it whenever you think of it. But that's the wrong thing because at the end of the day you know you can have a thousand repetitions, 10,000 repetitions. I have patients again, they're just sitting in front of me and they're talking to me and they're moving it and moving it and when they're all done moving it, they move it some more and my hand would get sore. I think thank goodness I don't have any problems with my hands. If I did this throughout the day I would have problems with my hands, I would get arthritis, the joints would get inflamed. We're not designed to sit and move continuously. That's not healthy.
Speaker 1:The main points here are we need to reduce this catching, either by reducing the size of the callus or the nodule, or with surgery to cut the, cut the ligament, so the nodule is no longer catching on anything. And this ligament? You're probably wondering why cut it? Isn't it there? For a reason? We can get away without that. We don't really don't really need that there. It won won't impede function, but anytime we can even ask the surgeon, the surgeons will tell you. Anytime you can avoid your surgery. It's just. It's a good thing If we can fix it with conservative means. That's always better.
Speaker 1:Now let's talk about something else. Let's say you wake up in the morning and your finger is stuck down there. What do you do? I have a lot of patients come in at the first visit. They're say you know it's stuck, I just grab that finger and I just yank that out and it hurts thinking about that. So the thing to do is, if your finger is stuck down there and it doesn't want to open, you put that hand under cold running water. Excuse me, 10 or 20, 25 seconds. Get that deeply cold While it's under the water. Open it slowly, gently, and you'll feel it kind of slide through a pop up there gently. Now if you force it and just aggravate, I mean it just hurts thinking about that, right, but if you've just forced that, it's all the more. Uh, aggravation to that callus, to that nodule, and really you know it has an after effect of even more irritation and inflammation.
Speaker 1:Now I mentioned waking up with your fingers stuck down like that. If that's happening, I always ask patients in the clinic is that happening? Are you waking up with your fingers stuck down? Sometimes people are having, you know, two different fingers and sometimes it's all their fingers. They're having it. I will actually take a cloth in the clinic, roll it up and then I then I tape it around three or four different spots on it so I make a cylinder and then at night they can put that cylinder in their palm and then tape it around the back of their hand with coban.
Speaker 1:It's. It's coban c-o-b-a-n. Only sticks to itself, not to the skin, so it's more comfortable. It's about two inches wide. Sorry I don't have an example with me right now, but it sticks to itself. It's like ace wrap, that's. That's self-adherent and you just wrap it around the hand.
Speaker 1:Then now you have that cylinder and it blocks your movement. So it doesn't give that triggering a chance to trigger. So it blocks the movement at about here. So the nodule doesn't pop underneath at all. So patients don't get stuck down when they're sleeping, because, by the way, wouldn't you know, normal resting position is fingers bent.
Speaker 1:Why is that? We need a tight grip right. So these tendons which connect to these muscles are shorter than these that open because they need to be stronger. This is just for positioning, so when these contract on this side, they open my hand so I can get around something and grab it, and that's where this comes in. So these are tighter, so they're naturally going to rest in a flexed or bent position, and that's usually what happens is people are waking up with it stuck. So those are some good tips to help you on your road to recovery, sort of some first aid, things you can do with cold, et cetera, and then get seen in the clinic. That's the main message. Sooner is always better than later. So thank you for subscribing, thanks for listening, write in with any questions, share some experiences you've had. You got to get into orthopedic office. Get this fixed ASAP and you'll be really glad you did All right, thank you.