Methods Of Diagnosing And Treating Trigger Finger

Trigger finger is a medical condition causing locking or catching sensations, stiffness, and pain when patients bend and straighten the affected finger. The most commonly affected digits are the thumb and ring finger, though the condition can also affect other fingers. When the thumb is affected, it's referred to as 'trigger thumb.' Each finger has bands of tissue, commonly called 'pulleys,' responsible for holding flexor tendons in place. With trigger finger, the A1 pulley located at the base of the finger thickens or becomes inflamed. The tendon can't glide smoothly through it, and over time it may become inflamed as well. An inflamed tendon develops a nodule which, when it moves through the A1 pulley, creates a painful popping or catching sensation.

Get to know the best options for diagnosing and treating trigger finger now.

Physical Exam

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A physical exam is generally sufficient for the diagnosis of most cases of trigger finger. To start the exam, the doctor will gently touch the patient's fingers and palms to detect swelling and pain. The fingers of both hands will be examined for comparison, and the doctor will check to see if the patient can smoothly move their fingers. Any evidence of locking fingers or stiffness will be noted. The patient may be asked to open and close their hands to see if this results in tenderness, and the doctor will feel the patient's palm to determine if a lump is present. Lumps associated with trigger finger normally move as the patient moves their finger. The physician may touch the lump while the patient moves the affected finger to find out more about how the lump moves.

Steroid Injections

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Steroid injections are a potential treatment option to help reduce symptoms of trigger finger for anywhere from one day to a few weeks. Corticosteroids are medicines that resemble cortisol, a hormone involved in adrenaline responses. Cortisol and corticosteroids both inhibit the immune response, which decreases inflammation. For trigger finger, the localized injections are administered into the sheath of the tendon at the affected finger's base. If one injection doesn't improve the symptoms, doctors may administer a second. When two injections don't provide symptom relief, other treatments are considered. Injections are generally less effective for diabetes patients, but they may still be a viable nonsurgical option. Individuals with diabetes should have their glucose monitored immediately after the treatment, though, since the injections can temporarily raise blood sugar.

Stretching Exercises

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Gently stretching the affected finger can sometimes help improve the overall range of motion and decrease feelings of stiffness. Patients should be careful to listen to their bodies, though. If the exercises are causing an increase in pain, they should stop. Additional irritation could make the inflammation worse. To do a finger extensor stretch, individuals should lay their palm flat on the table, then gently pull the affected finger up as far as it can go, before releasing it and repeating the motion. Individuals can also make a 'V' shape with their affected finger and nearest unaffected finger, then use their other hand to press the fingers against their neighboring digits. After this, they should release and move the two middle digits close together. A finger spread stretch is one of the simplest ones out there, and can be done with a simple rubber band. Patients should place the band around their fingers and thumb so they're pressed tightly together, then stretch all five digits, pushing back against the rubber band. They must hook the band around each finger in turn and repeat the exercise.

Anti-Inflammatory Medication

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A variety of over-the-counter medicines can help with alleviating trigger finger. Potential options include non-steroidal anti-inflammatory medications, which reduce inflammation the same way steroids do. Acetaminophen can also help reduce inflammation and pain. Usually, these medicines are used before a doctor prescribes steroid injections for treating trigger finger. If they don't offer relief, the next steps are the injections, followed by surgical intervention. Patients should be careful when they use anti-inflammatories, even if they're over-the-counter rather than prescription strength. This is because overuse can lead to stomach ulcers, which can cause death if they bleed without treatment. Patients may also develop kidney problems. If individuals have kidney issues already, they should ask their doctor about whether anti-inflammatories are safe to take. Acetaminophen is an effective alternative, since it's an analgesic rather than an anti-inflammatory medication.

Wear A Splint

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For some patients dealing with trigger finger, it may be helpful to wear a splint during the night to keep the affected finger from bending. When individuals sleep, they don't have control over how their fingers move, and they often wake up with increased inflammation and pain. Splinting may also help with long-term recovery, since it allows the finger to spend multiple hours each day avoiding irritation. In one study of trigger finger patients who used a splint program, a year after the treatment eighty-seven percent of them didn't need a surgical intervention or steroid injections. Other studies indicate splinting and steroid injections combined can be more effective than either therapy used alone. One clinical recommendation for how to splint is to splint the least restrictive joint that allows smooth tendon gliding.

Percutaneous Release

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When trigger finger causes chronic symptoms that don't respond to nonsurgical treatment, doctors may recommend a percutaneous release surgery. In some cases, patients with trigger finger may lose the ability to move their tendons through the sheath entirely, leading to the finger being permanently stuck in a curled position. Surgery frees the constricted sheath of the tendon, which in turn restores free movement to the affected digit. The procedure is done with local anesthesia. It can either be completed through a surgical incision or by piercing the finger with a needle. Regardless of the method, the procedure is considered a mostly low-risk one. With needle procedures, the needle breaks apart the constricted tissue, guided by a real-time ultrasound scan. Since there isn't an incision, stitches aren't necessary. Some professionals prefer open surgery because an incision allows the surgeon to clearly see the affected tissue, but a needle procedure has fewer risks and a shorter recovery time.

Apply Ice

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Patients with trigger finger may wish to apply ice to the affected area. To make an ice pack at home, five or six ice cubes can be placed in a plastic bag. The bag should be wrapped in a towel before it is placed on the skin. Reusable gel packs can also be used, and these should be wrapped in a towel as well. Applying ice directly to the skin could result in ice burns. Ice packs can be applied as often as needed, and most patients use these three or four times per day. Since the palms and fingers do not have a lot of fat, the ice pack should be left on the affected area for no longer than ten minutes at a time, and the patient may wish to wait at least an hour before re-applying the ice. If the ice pack is left on the area for longer than ten minutes, this could lead to frostbite. Patients who have high blood pressure, diabetes, poor circulation, or heart conditions should check with a healthcare provider before using an ice pack.

Use Soft Grip Covers

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Trigger finger is often caused by repetitive hand motions and gripping handles or objects for an extended period. It can be exacerbated by the use of vibrating equipment such as power tools. To reduce strain on the hands and fingers and minimize the effect of vibration, patients may want to use soft grip covers. These covers provide a cushioning layer between the hand and the device being used. Patients might choose to purchase covers for household equipment, bicycles, steering wheels, or motorcycles online, and workplaces may provide soft grip covers for individuals in certain occupations that require heavy use of machinery. It can be helpful to know the diameter of the handle to be covered, and patients may want to consider trying covers made of different materials to find one that suits their needs. Most covers are made of foam or rubber, and they can be installed simply by slipping them over the handle of the device to be covered.

Tenolysis

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Tenolysis is a surgical procedure sometimes used to treat cases of trigger finger that have not responded to conservative treatment. This surgery can be done with local or general anesthesia, and patients need to stay in the hospital for one to two days after the procedure. Patients having general anesthesia will not be able to eat or drink anything after midnight on the night before their surgery, and some medications may need to be discontinued for seven days before the operation. During the procedure, the surgeon removes lumps and adhesions that prevent the tendon from gliding smoothly. They will begin by placing a tourniquet near the surgical site to restrict blood flow to that area. Next, the surgeon will make an incision so they can see the tendon and surrounding tissues. Some of the tissue will be cut to release the tendon. The surgeon will check the patient's ability to move the affected area during the procedure. Based on this information, they will know whether the tenolysis has been successful or whether an additional surgical intervention such as tendon reconstruction is needed. The incision site will be closed with stitches, and the area will be bandaged. Tenolysis performed on the flexor tendon of a finger typically takes around forty-five to sixty minutes. After returning home, patients are advised to avoid strenuous activity for at least four weeks, and a physical therapy program is recommended to regain range of motion, strength, and function in the finger.

Tenosynovectomy

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A tenosynovectomy is an operation that removes the tendon sheath that covers the affected tendon. This procedure may be recommended to prevent tendon rupture and allow the tendon to move freely again. This operation can be done as an outpatient procedure with local anesthesia, and it usually takes around thirty minutes to complete. After applying a tourniquet and numbing the surgical site, the surgeon will make an incision at the base of the patient's thumb. Next, they will locate the extensor retinaculum, a band of fascia that goes across the tops of the tendons. This may be done endoscopically. After locating the extensor retinaculum, the surgeon cuts it to release it. Special care is taken during this process to avoid damage to the radial nerve or tendons underneath the extensor retinaculum. The surgical site is closed with stitches, and a bandage is applied. Recovery from this procedure may take three to six months.


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