Trigger Finger, Explained And Fixed

Chapters

• 0:00 What Trigger Finger Is
• 0:45 Anatomy And Why It Catches
• 2:10 How To Confirm The Problem
• 2:59 Visual Model Of Tendons And Pulleys
• 4:05 Why Testing It Makes It Worse
• 4:22 When Surgery Enters The Picture
• 4:39 Night Pain And Morning Stiffness
• 5:38 Safe Morning Release Technique
• 6:10 Night Splinting And Palm Roll Hack
• 7:42 Ice Cube Protocol That Works
• 9:01 Clinic Splints And Success Rates
• 10:13 Resources, Contact, And Next Steps

Transcript

SPEAKER_00: 0:00

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 treating conditions that affect the fingertips through the shoulder. Today I want to talk a little bit more about trigger finger. It's very common. I see it in the often in the office quite often. And the sooner you can catch this, the better, because it's an inflammatory condition where inflammation uh causes a nodule, and friction, just wear and tear, causes a nodule to build up on the tendon, which I'll demonstrate, which catches on a pulley, a little loop of material, and when you bring it up, it snaps or pops up through. Now, let's talk about the anatomy briefly. This most commonly occurs with a ring finger. And as people get older and there's arthritis starts to set in, and then there's general inflamm inflammation around through the tissues, people start getting a little more susceptible to the trigger finger. And there's it can be treated with surgery or without surgery. Let's talk about without surgery. So, best practices is if you can get into the office as soon as possible, if you start seeing your finger catching and popping, and check on the back of your hand, if that tendon is not rolling back here and everything is staying in alignment, you don't see anything popping off, such as when you have a sagittal band rupture, which we talked about in a previous episode, then look to the other side, and on the palm, there's what's called the distal palmer crease, and that crease is where the big knuckles, big knuckles bend. And you can put your finger here and see if you you find in this case on my ring finger, see if there's a painful or just a tender nodule there, and when it catches, see if you can feel it pop or snap in that area. If that's occurring, get right into your doctor's office, get an injection of cortisone or some steroid that will reduce inflammation, and then they'll get you right into me, they'll get you right into the hand therapist. What do I do as a hand therapist? Let's back up a little bit first. I want to demonstrate the trigger finger. So I made this to demonstrate what's inside of your finger. So the red cord is your tendon, which connects to these muscles, and then it turns into a tendon, and then the tendon goes through the carpal tunnel. There's actually two to each finger, one to the thumb that travels through the tunnel, the carpal tunnel. But for the sake of demonstrating today, I'm just showing one tendon. And the white tape here is a nodule that forms on the tendon, or think of it as a callus. So the black areas are what's called pulleys. So if they weren't there as you bend, the tendon would bowstring, like a just just like a bowstring, it would come away from the finger as you close your fist. But it's the job of the pulleys to keep them there. So you can imagine that that's quite a friction point. So as the rope or the tendon is going underneath that strap, that material that's like a strap holding it against the bone, it's rubbing hard on that. And most often this happens at what's called the A1 pulley. There's one on each bone. Of course, I'm not able to demonstrate that on my hand because we're on the uh showing the external part of it. So, for sake of simplicity, I'm putting it around the whole hand, and that tendon that's quite a friction point, and then this nodule forms or this callus forms, and it slides underneath that pulley, and then when you pick it up, it's kind of stuck there, and then it you can watch it right here, pops through. And then you close your hand, it slides down pretty easy, and then you pull it up and it pops that triggering. So it's very tempting to kind of retest it. Is it still popping? Yep, it's still popping, yeah, it's still popping, like a sword you have in your mouth. You want to keep touching it with your tongue. Every time it does that, it aggravates it more, and then the callus gets bigger. Then eventually you need surgery. And what's the surgery? The surgery is to go underneath the skin and cut that ligament right there that holds the tendon against the bone, so now there's no longer anything for it to catch on, and there's and it moves freely. But we in orthopaedics we always like to prevent the need for surgery anytime we possibly can. And I want to remind you again that the sooner you catch this, the better. So here's an easy first aid thing to do at home. When you're sleeping, the natural resting position is flexion because the muscles that make your fists so you can grab things hard and you can pick up heavy things, they're naturally tighter and stronger than the ones on the opposite side. The ones on the opposite side just open your hand. That's for position, so you can position your hand so you can get around something and grab something. You can bring you can pick up heavy objects, bring food to you. That's very important. You save your life, you grip the edge of a cliff and prevent yourself from falling. These have to be very powerful because they're so powerful when you're resting, it's like this. Then wake up in the morning, and it's terrible, terrible catch right there. If this is happening to you, and you wake up in the morning that's stuck right there. Here's something not to do is don't just grab it and rip it right, pull it hard. That's going to be very painful and aggravate that severely. And what you do is you put it under the cold running faucet, you decrease inflammation, shrink down the problem area, and then just straighten the big knuckle first. Okay, let all the fingers go together, and then the middle knuckle, and then the last one. It might catch very gently, but you go out nice and slow. And now let's talk about fully preventing that from being stuck when you wake up in the morning. The thing to do is to wrap enough bulk around your finger so that it splints the finger out straight so it's not resting in that bent position. So let's do the ring finger, and you're just gonna. This is called coban C O B A N. It's like A strap that only sticks to itself. So you can go around that middle knuckle of your finger. Now, when I close, that finger stays out straight. Sometimes, if that's not adequate enough, make you can make it a little bit thicker. But another thing that's very common to do is take a washcloth and fold it so it's thick, and then roll it up in a cylinder, and you put that in your palm, you tape it around the back of your hand, and then that stops you from flexing all the way. I really like this. This is one of the most effective things to do, and then when you wake up, it's not going to be stuck down into that triggered position, and that'll be a good first step in preventing the need for surgery because that'll allow this callus to not be so aggravated, it'll allow the inflammation in the size of this callus to reduce because as that gets smaller, it won't be catching on that pulley anymore. Now, what what else shrinks? Ice shrinks, cold shrinks. So you take an ice cube from the freezer, hold it with a little napkin or a cloth or something, and just glide it on the distal pommer crease back and forth. I you know, if it's triggering on one finger, sometimes it's multiple fingers, don't sometimes it's the thumb. I just tell patients as long as you have an ice cube in your hand and you're and you're on this area, just do them all. Just go over here, and then the thumb is right here on this crease. When you feel the thumb, there's two bumps in there. They're supposed to be there. They're called the sesamoid bones. They're little little P shaped bones, they're like little kneecaps. We can talk about that later. But they're supposed to be there. Don't rub anything. If you're rubbing it, you're you're increasing inflammation, you're aggravating it. Glide the ice only until it's deeply cold, 10 to 20 seconds. Right when it's deeply cold, you're done. An ice pack will not work. An ice pack on the hand, it does not penetrate enough, it doesn't get in there good enough. Frozen bag of peas, it molds onto the hand. Yeah, pretty good. It's just not effective enough. You need the ice cube on the skin, get it deeply cold, 10 to 20 seconds, it's super easy, then put it back in the freezer. I tell people to do this at lunchtime, at dinner time, and before bed more often if necessary. It's quick and easy and the most effective. Some cases, what I'll do in the clinic is I'll make a custom molded splint on the finger. Sometimes I have to make a splint around the hand that that holds the finger. If this has been going on for six months or a year, we can still treat this. There's probably a 50% chance that it'll get better without surgery. If it's been going on for you know a month, uh uh you know, the less time it's been going on, then we have 70 to 80 to upwards of 90% chance of getting this better. We also need a compliant patient who follows instructions and avoids certain things and and follows the the directions during the day and at night. It's not it's not a a big uh lot of things to do, it's what not to do and some very targeted specific things to uh to take care of. Thank you for watching. Check out the other episodes, check out my website, carlpetito.com. There's a lot of information on there. There's there's a lot of very common conditions that I talk about that are can be they can become very complex. So look at the details. And if you're having any pain, um you can also contact me on YouTube. Uh soon I will be offering meetings online where we can meet, quote unquote, face-to-face online and talk about problems, and I can steer you in the right direction, maybe give you some first aid things to do, um, and keep an eye out for that coming after the first of the year in twenty twenty six.