What’s Trigger Finger? (Stenosing Tenosynovitis)
What is Trigger Finger?
Trigger finger is a condition where there is a size disparity between the flexor tendons and the surrounding pulley system at the first annular pulley (the A1 pulley). This causes the tendon to catch on the pulley as it attempts to glide through unless enough pressure is developed to allow it to forcefully move through the pulley. The exact cause of trigger finger is not always clear, but it is often attributed to overuse injuries or repetitive motions. Our Vancouver physiotherapists see this in a (surprise) number of rock climbers.
What are signs and symptoms of Trigger Finger?
Initial symptoms of trigger finger include a painless sense of catching, snapping, or locking during finger flexion (curling/bending the finger). In the subacute and early chronic phases, this catch, snap, or lock that occurs with flexion of the fingers will become painful. Once the condition becomes chronic, signs and symptoms include difficulty extending the finger, and tenderness at the base of the finger at the metacarpal-phalangeal joint. A tender nodule may be felt near this area, and symptoms may be provoked by stretching the affected tissue into extension (straightening of the fingers).
How does a physiotherapist assess Trigger Finger?
Testing for trigger finger is fairly simple and straightforward. With the hands palm-side up, actively flex and extend the fingers. Try different ranges and angles and note any sense of catching or locking of the fingers with these movements.
If you notice that your symptoms mainly bother you during or after training but do not occur on rest days, it is likely a sign of acute inflammation causing a closing of the space and the subsequent catching, which then reduces once the swelling has subsided. This may be an early warning sign for trigger finger but likely means that you are in the very early stages and the condition has not fully developed, which is also a good indication for a successful recovery.
You may also be able to assess for trigger finger by looking for nodules or differences in the tissue comparing side-to-side or joint-to-joint. To do this, place your hand over the first knuckle of the finger (where the finger and hand meet), and perform flexion and extension while simultaneously looking for any symptoms of trigger finger such as catching, clicking, or popping. Compare this to other fingers on the same hand as well as comparing it to the same joint on the other hand.
What is included in the treatment for Trigger Finger?
Treatment for trigger finger includes a combination of activity modification to reduce symptoms and soft tissue mobilization and stretching of the finger to prevent the tendon from catching or locking as it passes through the A1 pulley.
Activity modification: Pay attention to activities that involve excess or constant flexion at the MCP and PIP joint. Note any specific climbing movements or grip positions that aggravate the condition.
Stretching the A1 pulley: allows for more motion and space for the tendon to glide through the pulley system
Soft tissue mobilization may be helpful if you feel a nodule. This may be connective tissue and/or adhesions that need to be reduced.
Original Article by Rachel Rubin-Sarganis
Photo by Charles Deluvio