Trigger Finger Lock Up

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Category: Soft Tissue Rheumatism Articles Published on Wednesday, 25 June 2008 Written by Yong Tsai, MD
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Have you ever had your finger or thumb “lock up”? Are your hands often in a tight gripping position during work or play, like driving a truck, sewing, dealing cards? If so, you may have a trigger finger or thumb.

The most commonly injured body tissue is the tendon, a tough, fibrous, ropelike material that connects our muscles to our bones. Unfortunately, because tendons have little blood supply, they can take a long time to heal.

In the case of trigger finger or thumb, repetitive motion or pressure on the tendon over the heads of the metacarpal bones creates inflammation and swelling. If this becomes chronic, the tendon sheath can become thick, resulting in sheath constriction along with the development of nodules, which can be felt upon flexion and extension of the affected finger. Such nodules act like a “knot” in a cord passing through a pulley; thus locking up the finger or thumb.

Usually localized to the distal palm, the associated pain is constant and worsens with hand gripping activities. Often, patients wake up to find their affected finger or thumb in a locked flexed position, which creates a restless sleep pattern. Furthermore, trigger fingers and thumbs creak upon flexion and extension.

The cause of trigger finger or thumb is repetitive movement, with increased degrees of motion, time and clenching. Some patients clench their hands because of stress, overuse, compulsion, or determination. “Clenchers”, who drive a long distance to work and who do not like their supervisor, are likely candidates for trigger finger or thumb. Further possible causes include prolonged card playing, sewing, reading with rapid page turning, horseback riding with tight gripping of the reins, and practicing of a musical instrument.

Getting the right treatment and getting it early are very important to prevent the permanent pain and function disability that can be associated with trigger finger because of continued trauma to the tendon and tendon sheath.

A good course of treatment includes corticosteroid injections into the tendon sheath, which is extremely effective in controlling pain, along with simple analgesics and non-steroidal anti-inflammatory drugs. Next, physical modalities such as local heat and gentle range of motion exercises should be started several days after the injection, however vigorous exercise should be avoided. Wearing a hand splint or a quilter’s glove not only protects and compresses the fingers, but it may also relieve some symptoms. Referral to an occupational therapist for further advice and splinting instruction is a good idea, but if all else fails, surgery may be required. However, most importantly, modifying your behavior and decreasing your hand “clenching” activities is the foremost preventive measure.

Be good to your hands and lose that tight grip. You can stop their lock-up.

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