Triggered by Trigger Finger?

On any given day, we utilize our hands for many different actions at work, home, and sports activities. Hands are so important that the main function of our shoulders and elbows are to position our hands in space for gross motor and fine motor movements.  Hands have many small bones, joints, ligaments and tendons working together to support a seemingly infinite number of actions.  Hands are constantly working, performing many alternating repetitive and unique activities over the course of each day. Additionally, our hands are extremely sensitive and yet strong.  Able to perform the most simple and complex tasks.  This is why hand injuries like sprains, fractures, and tendon injuries are both painful and can take a long time to recover from and get back to normal functioning.

Some recent examples of hand injuries seen at Sports Health Northwest include:

• Several months ago, while vacationing in another country, a 59-year-old patient tripped and fell injuring her left wrist, foot, and knee. Though her hand wasn’t x-rayed or treated when she was initially seen by a local clinic, her persistent pain, weakness, and limited motion with daily activities like getting dressed and gripping objects led her to seek treatment at our sports medicine clinic when she returned.  Her x-rays showed a fracture of the small finger metacarpal bone. After a short period of immobilization, she is now back to golfing, gardening, and other activities she enjoys. 

• Recently, I had a patient who had been struggling for months with pain in both thumbs due to repetitive use. He was able to use a computer and type without pain, but his daily work also required use of his hands to repeatedly grip and twist and turn objects in a rotational screwdriver type motion.  He had developed pain in his thumb joints and tendons from repeated fine motor movements limiting his ability to perform pinching and gripping related tasks.  With rest and topical anti-inflammatory medication followed by strengthening exercises, and task modifications, he has been able return to full work.

• Another patient enjoyed tying fishing flies and rowing his drift boat on the rivers around Portland, Oregon, but a trigger finger on one hand soon turned into trigger fingers involving both hands affecting his long finger and made it painful and difficult to perform the fishing activities he enjoys. However, an injection and splinting the affected fingers helped him enjoy his summer fishing and boating. 

Trigger finger is a common condition caused by abnormal movement of a thickened, sometimes inflamed, or swollen flexor tendon as it glides within its tendon sheath through the first annular pulley, which may also be narrowed and thickened.  Trigger finger causes pain, catching, and/or locking of the affected digit. Treatment is typically conservative, including rest, splinting, and oral and topical nonsteroidal anti-inflammatory drugs (NSAIDs).  Corticosteroid injections are usually considered when conservative management is not effective or function is impaired. 

Although corticosteroid injections (CSI) can be effective at relieving symptoms they have to be utilized with caution as unwanted adverse effects, such as fat atrophy and hypopigmentation of the skin and elevated blood glucose levels in patients with diabetes mellitus can occur.  An injectable NSAID such as ketorolac at the level of the first annular pulley could avoid these adverse effects and may be more effective in treating trigger finger.

As described above, these unique and painful hand injuries involve a joint, tendon, and/or bone related injury to the hand.  While treatment and expectations for recovery vary from person to person and injury to injury, At Sports Health Northwest, we want to help you recover from your hand injury and get you back to the sports and work activity you enjoy and rely on.

Author

David Westerdahl MD FAAFP RMSK Sports Medicine Physician and owner Sports Health Northwest, Inc.