TRIGGER

FINGER
NUR MUZAIYANATUL MILATI BINTI MAHAMUD

OCCUPATIONAL THERAPY U29

 WHAT IS TRIGGER FINGER?

• A condition affecting tendons that flex the fingers and thumb,

typically resulting in a sensation of locking or catching when you
bend and straighten your digits.

• Other symptoms may include pain and stiffness in the fingers and
thumb. The condition is also known as stenosing tenosynovitis.
 CAUSES

Medical Condition Forceful Hand

Activity Age

Diabetes & Forceful use Fingers Common in Older

Rheumatoid Arthritis & Thumb Individu
 SYMPTOMPS
TRIGGER FINGER

A Tender Lump
Base of the finger or thumb on the palm side of the hand.
Pain when Bending or
Straightening finger

Popping, Catching or Locking

Sensation
Finger or thumb movement Stiffness & Locking when wake up
in the morning
Symptoms may improve throughout the day
with consistent, gentle use of the hand.
DOCTOR EXAMINATION
TRIGGER FINGER

Tenderness over the flexor tendon sheath in the

palm of your hand

A palm of your hand

Tenderness over the flexor tendon sheath in the

Thickening or swelling of the tendon sheath at the

base of your finger or thumb

Thickening or swelling of the tendon sheath at the

B base of your finger or thumb

Aclicking or catching sensation when you bend and

straighten your finger or thumb

A clicking or catching sensation when you bend and

C straighten your finger or thumb
MANAGEMENT
TRIGGER FINGER

Non Operative Management

A Corticosteroid Injection
• Goal of the injection is to reduce the inflammation
and pressure on the tendon for better gliding through
the flexor pulleys.

Side Effects
• Flaring at the injection site
• Local infections
• Tendon ruptures
• Allergic reactions
• Atrophy of subcutaneous fat tissue.
MANAGEMENT
TRIGGER FINGER

Patient Education
B
• Rest
• Modifications of activities
• Specialized tools
• Splinting
• Modalities
• Posture
MANAGEMENT
TRIGGER FINGER

Splinting
C
• Best ways to limit movement
• Usually worn for 6-10 weeks
• Two major types of Splinting:
a) Splinting at the DIP Joint showed 50%
resolution of patient’s symptoms.
b) Splinting at the MCP Joint with 15
degrees of flexion showed 92.9% resolution
of patient’s symptoms.
MANAGEMENT
TRIGGER FINGER

Exercises
D
1. Digit blocking: patient blocks the MCP joint and allows the PIP joints to bend.
This exercise could be done with all fingers simultaneously or individually. The
same activity could be repeated at the DIP joint. Repetition and frequency are
advised according to the level of stiffness and pain

2. Tendon gliding

3. Active range of motion: Finger abduction and adduction are recommended to

strengthen the interossei and the lumbricals
MANAGEMENT
TRIGGER FINGER

Other Modalities
E
• Modalities such as heat/ice, ultrasound, electric stimulation, massage, stretching,
and joint motion (active and passive) can have some positive effects on the trigger
finger.
• Aims : heat can help by providing increased blood flow and extensibility to the
tendon. Stretching after applying heat can provide more extensibility with plastic
deformation. Joint movement and mobilisations increase joint and soft tissue
mobility via slow, passive therapeutic traction and translational gliding
 OPERATIVE MANAGEMENT

Endoscopic Surgical Open Surgical

Technique Technique Percutaneous Release
 STAGES OF STENOSING TENOSYNOVITIS
TRIGGER FINGER

STAGES DESCRIPTION

1 normal

2 A painful palpable nodule

Title here
3 Triggering

4 The proximal interphalangeal (PIP) joint locks into flexion and is unlocked with active PIP
joint extension
5 The PIP joint locks and is unlocked with a passive PIP joint extension

6 The PIP joint remains locked in a flexed

position
 PARTICIPANT PERCEIVED IMPROVEMENT IN
SYMPTOMS RATING SCALE
TRIGGER FINGER

Rating Description

1 Resolved

2 Improved, butTitle here

not completely resolved

3 Not resolved

4 Resolved but triggering at the distal

interphalangeal/proximal
interphalangeal joint(s)
5 Resolved at ten weeks versus six weeks
 OT MANAGEMENT
TRIGGER FINGER

WEEK INTERVENTION PATIENT HOME GOAL

EDUCATION EXERCISE
1st day - 5th ▪ Splinting – Wearing schedule : ▪ Gentle finger Pain reduction,
Full extension Day & night time flexion, decreases
▪ Pain Management use extension, numbness and
▪ AROM at finger and especially wear at abduction, achieve full PROM
UE. work or during adduction
▪ Edema Title hereresistive /
highly AROM exs -
management repetitive motions. 10rept 3-5
▪ Massage *Decrease splint time/day
▪ Joint protection after 4 week. ▪ Week 4 –
technique Length of time may tendon glide
Assessment: also be dependent exercise
Week 1- Pain, Edema to symptom &
Week 4- ROM (UE), response to tx.
ADL/ Long term use for
IADL, Pain, Sensation 10 week.
After4- 6 week
splint using on
night time.
 OT MANAGEMENT
TRIGGER FINGER

Week Intervention Patient Education Home Exercise Goal

4 – 6th Hand therapy ▪ Do not Start ▪ Thumb and finger Return to

week ▪ Start on thumb, finger squeezing exs (5rep/ full
and wrist exercise – and thumb 5time/day)- with AROM_x0002_PROM,
stretching & joint
motion pressing hold each position Restore
▪ ADL/IADL ▪ Join 10sec grip
Title here
Retraining_x0002_modifi protection ▪ Gentle hand and Strength
cation of technique wrist extension
activities (light exs against
Assessment resistance )
Week 6-Functional
▪ Cont. hand
assessment e.g Manual
ability measure, DASH grip_x0002_program
- Pre driving assessment (repeated
- A/PROM, sensation & 5 times/day)
Pain ▪ Tendon gliding
 OT MANAGEMENT
TRIGGER FINGER

Week Intervention Patient Education Home Exercise Goal

6 - 8th week Hand therapy ▪ Patient can do ▪ Strengthening ▪ Restoration

▪ Hand
grip_x0002_strengthening lighter task exercise as of wrist
program (house tolerated_x0002_wrist power
with thera-putty, power cleaning & curls with ▪ Return to
web, etc.
▪ Add thumb and wirst work task) graded weight, daily living
exs with multi-direction Title▪ Ergonomic
here biceps and activities &
Add biceps curls and Education_x0002_joint shoulder routine
shoulder strengthening
exs if they are weak protection (5rep/
Assessment: technique & 5time/day)
Week 6 -Ergonomic energy ▪ Tendon gliding
assessment for home &
work- repetition work task conservation
& posture during repetitive
task
Week 8- Strength testing
(dynamometer, pinch
gauge)
 OT MANAGEMENT
TRIGGER FINGER

Week Intervention Patient Education Home Exercise Goal

8-12th Return to work after 8 week for sedentary jobs Return to work
weeks 10-12 weeks for heavier jobs
Assessment
Week 12- Assessment- Work assessment (FCE- job
Title here
demand involves aspects of lifting, carrying,
pushing/pulling, balance, fine motor, and cardiovascular
tolerance.
OUTCOME MEASURE
TRIGGER FINGER

1. Pain – Numeric Pain Rating Scale

Title here

2. Grip Strength – Jamar Dynamometer

THANK YOU FOR YOUR
ATTENTION
TRIGGER FINGER