Welcome to Momentum Health's patient resource about Trigger Finger and Trigger Thumb.
Trigger finger and trigger thumb are conditions affecting the movement of the tendons as they bend the fingers or thumb toward the palm of the hand. This movement is called flexion.
This article will help you understand:
how trigger finger and trigger thumb develop
how doctors diagnose the condition
what can be done for the problem
Hear from some of our patients who we treated for Hand Pain
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I have seen several practitioners within Momentum West Springs for acute injuries involving a fractures wrist, L4-L5 disk injury and shin strain. I felt in these instances that I was focused on and my... ”
“ I have seen several practitioners within Momentum West Springs for acute injuries involving a fractures wrist, L4-L5 disk injury and shin strain. I felt in these instances that I was focused on and my injuries were well addressed with an appropriate care plan and follow up, I have resolved all of these issues and continue to see practitioners ( Jason) or ongoing maintenance and injury prevention. I have also seen pelvic floor physiotherapists within the clinic which have made incredible improvements in hypertrophic muscles due to heavy weight lifting and activity I am involved in as well more recently after having my first child and navigating postpartum to return to the level of fitness I am accustomed to. Susan has been an incredible resource and practitioner individualizing my care and helping me manage these issues in their acute stages and preventing these same problems from re-occurring. I cannot recommend this clinic enough for all of the issues I have encountered. ”
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Over the past few years I have suffered from back, neck, arm and hand ailments. I sought treatment by going to Momentum Health at Deerfoot City and have done so for some time now. All the staff have... ”
“ Over the past few years I have suffered from back, neck, arm and hand ailments. I sought treatment by going to Momentum Health at Deerfoot City and have done so for some time now. All the staff have been welcoming, courteous and professional. Mark Taylor has been my physiotherapist for the past year. He is very professional, friendly and skilled at his job. He has been successful at treating a number of my physical ailments and relieving the pain. I would highly recommend him to anyone seeking a physiotherapist. ”
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I would highly recommend Mark and Safia at Momentum Health for physiotherapy. I received treatment over 6 months for a WCB claim involving wrists, elbows and knees. They took the stress out of the WCB... ”
“ I would highly recommend Mark and Safia at Momentum Health for physiotherapy. I received treatment over 6 months for a WCB claim involving wrists, elbows and knees. They took the stress out of the WCB claim process and continued with thorough reviews to make sure treatment was complete and did not end prematurely. They assessed my condition, developed a treatment plan, and then patiently helped me carry it out. They selected and taught me exercises appropriate to my level of recovery and gave feedback through all the stages. I also received in clinic treatment including muscle release, heat and dry needling. To top it off, the atmosphere in the clinic was always friendly and happy, so treatment became the highlights in my week. They seemed to care for the whole person not just the physical condition in need. Thank you Mark and Safia! ”
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I am filled with deep gratitude as I express my heartfelt appreciation to Momentum Health Physiotherapy, with a special mention of immense gratitude to Amy and Nicole. Their unwavering dedication and... ”
“ I am filled with deep gratitude as I express my heartfelt appreciation to Momentum Health Physiotherapy, with a special mention of immense gratitude to Amy and Nicole. Their unwavering dedication and vast knowledge played a pivotal role in facilitating my recovery journey after enduring the challenge of breaking both my wrists and femur. Through their exceptional support, I was able to regain my strength and relearn the invaluable skill of walking. I am truly humbled and sincerely thankful for their outstanding contributions to my healing process. Thank you from the bottom of my heart. ”
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I had the best service possible. My first appointment Alisha assessed my wrist injury while explaining all that we needed to do to get my wrist back functioning. I returned 3 days later Katie was... ”
“ I had the best service possible. My first appointment Alisha assessed my wrist injury while explaining all that we needed to do to get my wrist back functioning. I returned 3 days later Katie was ready to get me started on a recovery program. She got me doing exercises that I could also do at home. 9 treatments and I'm as good as gold. I would recommend this team to everyone, so friendly and ready for your arrival. Also Its very clean. Nancy leclair ”
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I did some physiotherapy work over 3-4 months with Russ for Carpal Tunnel Syndrome. Although it wasnt fun work I was finally able to get the CTS to calm down and me back to doing the activities I like... ”
“ I did some physiotherapy work over 3-4 months with Russ for Carpal Tunnel Syndrome. Although it wasnt fun work I was finally able to get the CTS to calm down and me back to doing the activities I like to do. Thanks Russ! ”
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I seen Christina Ergang and I absolutely love the sub-occipital release she does. I found she did a nice deep massage in my forearms to help with my carpal tunnel. ”
“ I seen Christina Ergang and I absolutely love the sub-occipital release she does. I found she did a nice deep massage in my forearms to help with my carpal tunnel. ”
“
I have seen several practitioners within Momentum West Springs for acute injuries involving a fractures wrist, L4-L5 disk injury and shin strain. I felt in these instances that I was focused on and my... ”
“ I have seen several practitioners within Momentum West Springs for acute injuries involving a fractures wrist, L4-L5 disk injury and shin strain. I felt in these instances that I was focused on and my injuries were well addressed with an appropriate care plan and follow up, I have resolved all of these issues and continue to see practitioners ( Jason) or ongoing maintenance and injury prevention. I have also seen pelvic floor physiotherapists within the clinic which have made incredible improvements in hypertrophic muscles due to heavy weight lifting and activity I am involved in. Lee has been an incredible resource and practitioner helping me manage these issues in their acute stages and preventing these same problems from re-occurring. I cannot recommend this clinic enough for all of the issues I have encountered. ”
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Rachel and Kaylie have been very helpful when it comes to physiotherapy for my wrist. My range of motion has improved immensely since seeing them. They are always happy and a pleasure to be around :) ”
“ Rachel and Kaylie have been very helpful when it comes to physiotherapy for my wrist. My range of motion has improved immensely since seeing them. They are always happy and a pleasure to be around :) ”
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Joel and Amé recently helped me out with some reoccurring wrist pain I had been experiencing. After only 2 visits the pain has not returned and I am feeling much better! Joel helped to figure out the... ”
“ Joel and Amé recently helped me out with some reoccurring wrist pain I had been experiencing. After only 2 visits the pain has not returned and I am feeling much better! Joel helped to figure out the underlining issue so I don’t have to continue using creams and medications to numb the pain. Thanks for the help :) ”
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I've been going to Momentum Health for 2 years now with various injuries and Joel and Ame are a dream team! They are both so friendly and welcoming from start to finish. Having used them to resolve... ”
“ I've been going to Momentum Health for 2 years now with various injuries and Joel and Ame are a dream team! They are both so friendly and welcoming from start to finish. Having used them to resolve issues in my wrist, legs and shoulder, I know that no matter what my issue may be they will come up with a effective treatment program both in and out of the office to get me moving again! Thanks Joel and Ame for helping me reach my fitness goals! ”
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Its been amazing few months i started here with Lora and Amie. I had post car accident back pain for almost 3 years. Lora and Amie worked with my pain, determine my core muscles being weak and... ”
“ Its been amazing few months i started here with Lora and Amie. I had post car accident back pain for almost 3 years. Lora and Amie worked with my pain, determine my core muscles being weak and prescribed correct exercise. Its been improving drastically. Same time, they did amazing work with my palm pain which started to develop few months ago. Thank you for taking care of my pain. ”
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I am dealing with a lower back injury for a while now and i tried different treatments that didn't really work . With the supervision of Amie and the work of Nicole, i am seeing a lot of improvements.... ”
“ I am dealing with a lower back injury for a while now and i tried different treatments that didn't really work . With the supervision of Amie and the work of Nicole, i am seeing a lot of improvements. Nicole was massaging the painful area and pressing with her fingers on the sensitive spots which was relieving the pain away, she also gave me sets of exercices to practise at home, which were easy to get them done. I am happy with the results so far!! Thank you Nicole for your hard work and devotion for healing me and thank you Amie for following up. ”
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Carlee and her team was amazing. This is the second time I injured my wrist after a nasty fall on ice. Carlee's team took time to figure out and isolate where the pull was coming from. After a careful... ”
“ Carlee and her team was amazing. This is the second time I injured my wrist after a nasty fall on ice. Carlee's team took time to figure out and isolate where the pull was coming from. After a careful examination on the first day, they found it was deep within the tissue. They spent around 6 treatments of ultrasound therapy, tensor therapy, massage and gave me the exercises and stretches as homework to get me back into form. It helped and I was at 95% by the 5 session. Now back at doing normal things like opening jars and typing without pain. Thanks Momentum Health. ”
The tendons that move the fingers are held in place on the bones by a series of ligaments called pulleys.
Pulleys
These ligaments form an arch on the surface of the bone that creates a sort of tunnel for the tendon to run in along the bone. To keep the tendons moving smoothly under the ligaments, the tendons are wrapped in a slippery coating called tenosynovium.
Tenosynovium
The tenosynovium reduces the friction and allows the flexor tendons to glide through the tunnel formed by the pulleys as the hand is used to grasp objects.
Triggering is usually the result of a thickening in the tendon that forms a nodule, or knob. The pulley ligament may thicken as well. The constant irritation from the tendon repeatedly sliding through the pulley causes the tendon to swell in this area and create the nodule. Rheumatoid arthritis, partial tendon lacerations, repeated trauma from pistol-gripped power tools, or long hours grasping a steering wheel can cause triggering. Infection or damage to the synovium causes a rounded swelling (nodule) to form in the tendon.
Triggering can also be caused by a congenital defect that forms a nodule in the tendon. The condition is not usually noticeable until infants begin to use their hands.
Symptoms
What does a trigger finger or thumb feel like?
The symptoms of trigger finger or thumb include pain and a funny clicking sensation when the finger or thumb is bent. Pain usually occurs when the finger or thumb is bent and straightened. Tenderness usually occurs over the area of the nodule, at the bottom of the finger or thumb.
Nodule Area
The clicking sensation occurs when the nodule moves through the tunnel formed by the pulley ligaments. With the finger straight, the nodule is at the far edge of the surrounding ligament. When the finger is flexed, the nodule passes under the ligament and causes the clicking sensation. If the nodule becomes too large it may pass under the ligament, but it gets stuck at the near edge. The nodule cannot move back through the tunnel, and the finger is locked in the flexed trigger position.
Flexed Trigger Position
Diagnosis
When you visit Momentum Health, our physiotherapist will first take a history and do a physical exam. The diagnosis of trigger finger and thumb is usually quite obvious on physical examination. Usually a palpable click can be felt as the nodule snaps under the first finger pulley. If the condition is allowed to progress, the nodule may swell to the point where it gets caught and the finger is locked in a bent, or flexed, position.
Some patients may be referred to a doctor for further diagnosis. Once your diagnostic examination is complete, the physiotherapists at Momentum Health have treatment options that will help speed your recovery, so that you can more quickly return to your active lifestyle.
Our Treatment
Non-surgical Rehabilitation
Momentum Health programs of physiotherapy or occupational therapy are most effective when triggering has been present for less than four months. Our physiotherapists may build a splint to hold and rest the inflamed area. We will have you do special exercises to encourage normal gliding of the tendon. Your Momentum Health physiotherapist will show you ways to change your activities to prevent triggering and to give the inflamed area a chance to heal. Our therapy sessions sometimes include iontophoresis, which uses a mild electrical current to push anti-inflammatory medicine to the sore area. This treatment is especially helpful for patients who can't tolerate injections.
Your doctor may recommend a cortisone injection into the tendon sheath to decrease the inflammation and shrink the nodule. This can help relieve the triggering, but the results may be short lived.
When triggering has been present for more than four months, nonsurgical treatment is usually short-lived. You may get some relief of symptoms with a cortisone injection. If you wear a splint, the nodule may shrink temporarily, but patients often end up needing surgery for this problem.
Post-surgical Rehabilitation
You'll probably wear a fairly large padded bandage on your hand over the area after surgery until the stitches are removed. This is to provide gentle compression and reduce the bleeding and swelling that occurs immediately after surgery. The bandage can be removed fairly soon after surgery, aand is usually only required for the first 24 to 48 hours. When you begin your physiotherapy after surgery, we'll begin with gentle range-of-motion exercises.
You will particularly benefit from physiotherapy if your finger or thumb was locked for a while prior to surgery. In these cases, the finger or thumb may not straighten out right away after the surgery. Our physiotherapist may apply a special brace to get the finger or thumb to straighten it. We may also apply heat treatments, soft-tissue massage, and hands-on stretching to help with the range of motion.
Some of the exercises we’ll have you do are to help strengthen and stabilize the muscles and joints in the hand. Our physiotherapist will use other exercises to improve fine motor control and dexterity. We will provide tips on ways to do your activities while avoiding extra strain on the healing tendon. Although the time required for recovery varies among patients, as a general rule, you may need to participate in physiotherapy two to three sessions each week for up to six weeks.
At Momentum Health, our goal is to help speed your recovery so that you can more quickly return to your everyday activities. When your recovery is well under way, regular visits to our office will end. Although we will continue to be a resource, but you will be in charge of doing your exercises as part of an ongoing home program.
Momentum Health provides services for physiotherapy in Calgary.
Surgery
The usual solution for treating a trigger digit is surgery to open the pulley that is obstructing the nodule and keeping the tendon from sliding smoothly. This surgery can usually be done as an outpatient procedure, meaning you can leave the hospital the same day.
The surgery can be done using a general anesthetic (one that puts you to sleep) or a regional anesthetic. A regional anesthetic blocks the nerves going to only a portion of the body. Injection of medications similar to lidocaine are used to block the nerves for several hours. This type of anesthesia could be an axillary block (only the arm is asleep) or a wrist block (only the hand is asleep). The surgery can also be performed by simply injecting lidocaine around the area of the incision.
Once you have anesthesia, your surgeon will make sure the skin of your palm is free of infection by cleaning the skin with a germ-killing solution. An incision will be made in the skin. There are several types of incisions that can be made, but most are made along the natural creases and lines in the hand. This will help make the scar less noticeable once the hand is healed.
The skin and fascia are separated so the doctor can see the tendon pulley. Special care is taken not to damage the nearby nerves and blood vessels.
Next, your surgeon carefully divides the tendon pulley. Once the tendon pulley has been separated, the skin is sewn together with fine stitches.
Why do I have this problem?
Your doctor may recommend a cortisone injection into the tendon sheath to decrease the inflammation and shrink the nodule. This can help relieve the triggering, but the results may be short lived.