What Makes You Click

Saturday, May 20, 2006 | 0

By Jomar Almeda

Trigger finger, also called stenosing tenosynovitis is a condition in which the fingers or the thumb clicks, locks, and snaps. This is commonly associated with pain and is felt when the finger is flexed (bent) and extended (straightened). This occurs as the involved finger or thumb gets trapped in the bent position, and snaps as it is straightened.

How Does It Happen?

Tendons are cord-like structures that connect muscles to bone. Our body's movement is accomplished by the synchronized contraction and relaxation of the various muscle groups. When muscles contract, it shortens, and this force is transmitted to the tendons, which in turn pulls on the bone that it is attached to. In the hand, tendons pass through fibrous sheaths, where they normally glide smoothly. Trigger finger is brought about by thickening with resultant stenosis (narrowing) of the sheath that surrounds the tendon of the affected digit. In time, the tendon sheath becomes even more stenosed, and the continued irritation causes the tendon to swell. As the inflamed tendon glides through the narrow sheath as the finger is flexed and extended, it becomes briefly caught at one end, and then briskly snaps as it gets through.

Causes, Symptoms, and Diagnosis:

In most cases, trigger finger is attributed to repetitive or forceful use of the fingers and thumb. Prolonged, strenuous grasping, and use of power tools, may also aggravate the condition. Trigger finger may also be associated with medical conditions such as rheumatoid arthritis, gout or diabetes. It is 3 times more common in women than men, occuring most frequently in people between the ages of 40 to 60 years.

The pain, stiffness, clicking, locking, and snapping is usually worse in the morning or after a period of inactivity. It is often associated with pain and tenderness at the base of the affected digit, where occasionally, a nodule may be palpated. As the condition becomes more severe, the flexed finger becomes even more painful and difficult to extend, and can only be straightened with the aid of the opposite hand.

No imaging or laboratory tests are necessary as diagnosis is generally established by an accurate physical examination of the hand and digits.

Treatment:

Initial management is by modification or avoidance of activities that are known to have caused the triggering. If needed, the physician may provide a splint to rest and temporarily restrict motion of the involved digit. Oral anti-inflammatory medications may help relieve pain from swelling and inflammation. In some instances, your doctor may recommend corticosteroid injection into the tendon sheath. Some patients improve after 1 injection, but some may require more. Benefit is less likely when the triggering has been present for a long time, or in the presence of an associated medical condition.

When symptoms are non-responsive to conservative treatments, surgery to relieve the constriction may be required.

Prevention:

When doing office or hobby work, take at least 10 minute breaks every hour. Gently stretch the hands, arms, and neck, and loosen up the legs and back by walking around. Reward your body with the attention it deserves to maintain good physical conditioning. "To keep the body in good health is a duty... otherwise we shall not be able to keep our mind strong and clear." - Hindu Prince Gautama Siddharta, 563-483 B.C.

Prior to his involvement with Workers' Compensation, Jomar Almeda, M.D., a graduate of the U.E.R.M. College of Medicine, has over 12 years of active orthopaedic practice in Manila, Philippines. He was Arthroscopy Journal's Traveling Fellow in 2000, and later become an International Member of the Arthroscopy Association of North America in the same year. Jomar also received extensive training at the Nobuhara Orthopaedic Hospital and Institute of Biomechanics in Japan, at the National University Hospital in Singapore, and at Warwick Valley Orthopaedic Surgery, PC in New York.

Jomar is also specialized in Occupational and Industrial Medicine and had served as a medical consultant for various multi-national companies in his native country.

Jomar, a graduate of a comprehensive WorkCompSchool program, is now sharing his professional expertise in WorkCompSchool's faculty, with a premier online course currently in the production stages. He can be reached at jomar@lamedcenter.com.

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