Hooper's Beta Ep. 31

Intro:

In this weeks video/blog we answer a viewer question in depth regarding trigger finger (stenosing flexor tenosynovitis, but that's just word vomit so let's stick with trigger finger).

What is Trigger Finger?

Trigger finger simply put is caused by a disparity in the size of the flexor tendons and the surrounding retinacular pulley system at the first annular pulley, the A1 pulley. The tendon will catch on the pulley as it attempts to glide through, until enough pressure is developed to allow it to jolt through, hence, "trigger finger".

Keep in mind, this will be relative to the size disparity which may be correlated to how long you have been dealing with this issue. A subtle catch may be an early warning sign, whereas a hard catch may be a more chronic issue that needs to be dealt with professionally. The cause is sometimes unclear, but it is often attributed to overuse or repetitive behaviors.

Signs & Symptoms:

Signs and symptoms for this are much more straightforward. Someone suffering from this will initially describe a painless catching, snapping, or locking of one or more of the fingers during flexion of the affected joint. This will progress to painful episodes and the person may also develop difficulty extending the fingers.

Symptom Progression:

• Initial: Painless catch/snap/lock during finger flexion

• Subacute - Chronic: Painful catch/snap/lock

• Chronic: Difficulty extending Other signs and symptoms may also include tenderness at the base of the finger at the MCP joint. A tender nodule may be felt near this area, and symptoms may be provoked by stretching the affected tissue into extension

Testing:

Testing for this is more straight forward. Simply place the hands in the palm up position and actively flex and extend the fingers. Try different ranges and angles in an attempt to make the finger catch.

If you notice that this mainly bothers you climbing but does not happen on rest days, these are likely signs of acute inflammation causing a closing of the space and the subsequent catching, which then reduces once the swelling has subsided, hence, only catching while climbing. If this is you, this may be an early sign and that means there is still a good chance to recover from this.

Finally, while it does take a fine touch, you may be able to look for nodules or differences in the tissue comparing side-to-side or joint-to-joint. To do this, place your hand over the PIP, and perform flexion and extension, while looking for any abnormalities such as catching, clicking, etc. Compare this to other fingers on the same hand as well as comparing it to the same joint on the other hand.

Treatment:

1. Activity modification - Pay attention to activities that involve excess or constant flexion at the MCP and possible PIP joint. Pay attention to your climbing style and your activities of daily living. Don't make dramatic changes, rather practice good load management.

2. Splinting

   1. Oval 8 - available on Amazon. This blocks MCP and PIP mobility

   2. Custom - available from an occupational therapist. Blocks the MCP mobility but allows for PIP flexion, which is more functional.

3. Stretching the A1 pulley (see the above video for demonstration)

4. Soft tissue mobilization (STM) may be helpful if you feel a nodule. This may be connective tissue and/or adhesions that need to be reduced. You have to be careful because if you are too aggressive you can just cause more inflammation and more locking.

5. Physician prescribed NSAIDs - For patients not advancing with conservative care Corticosteroid injections Injection #2 If all else fails → Surgery

Differential Diagnosis:

The differential diagnosis includes other conditions that can lead to locking, pain, loss of motion, and swelling of the MCP joints such as Dupuytren's contracture, diabetic cheiroarthropathy, MCP joint sprain, infection within the tendon sheath, calcific peritendinitis or periarthritis, or noninfectious tenosynovitis

References:

Makkouk, Al Hasan, et al. “Trigger Finger: Etiology, Evaluation, and Treatment.” Current Reviews in Musculoskeletal Medicine, vol. 1, no. 2, 2007, pp. 92–96., doi:10.1007/s12178-007-9012-1.

Patel, M R, and L Bassini. “Trigger Fingers and Thumb: When to Splint, Inject, or Operate.” The Journal of Hand Surgery., U.S. National Library of Medicine, Jan. 1992, www.ncbi.nlm.nih.gov/pubmed?term=1538090.

Rodgers, J A, et al. “Functional Distal Interphalangeal Joint Splinting for Trigger Finger in Laborers: a Review and Cadaver Investigation.” Orthopedics., U.S. National Library of Medicine, Mar. 1998, www.ncbi.nlm.nih.gov/pubmed?term=9547815.

Yamazaki, Atsuro, et al. “A1 Pulley Stretching Treats Trigger Finger: A1 Pulley Luminal Region under Digital Flexor Tendon Traction.” Clinical Biomechanics (Bristol, Avon), U.S. National Library of Medicine, 7 Dec. 2019, www.ncbi.nlm.nih.gov/pubmed/31865255.

Disclaimer:

As always, exercises are to be performed assuming your own risk and should not be done if you feel you are at risk for injury. See a medical professional if you have concerns before starting new exercises.

Written and Presented by Jason Hooper, PT, DPT, OCS, CAFS

IG: @hoopersbetaofficial

Filming and Editing by Emile Modesitt

www.emilemodesitt.com

IG: @emile166

Special thanks to The Wall for letting us film!

IG: @thewallclimbinggym