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This month’s blog was written by special request—someone wrote in asking what I do to treat trigger finger. This annoying condition is exemplified by the ability to bend the finger but either an inability to straighten it again or a painful “snapping” sensation when straightening it.
Clearly having your finger (or thumb) stuck in a bent position can affect the ability to grasp objects and perform the most common daily activities. This alone would be frustrating, but having that “snapping” sensation and pain every time you straighten your finger will really wear on you!
One do-it-yourself approach is to simply use the other hand to assist in straightening the bent finger. This approach prevents that snapping and pain and enables you to use the affected hand …until the next time you bend your finger and again can’t straighten it.
BEWARE THE MAINSTREAM MEDICINE APPROACH
Watch out if you seek medical attention for trigger finger. the general theory behind why it occurs is that there is some type of structural variation to the connective sheath (or “tunnel”) that the finger’s tendon runs through, which somehow is catching the tendon, causing it to get stuck and causing the finger to stay bent.
The most common mainstream treatment for trigger finger is a cortisone shot into the offending joint. The thought here is that inflammation is preventing the tendon from gliding through the tunnel properly. In truth, cortisone rarely works long term. It may provide short term relief— but that is actually because the shot also contains lidocaine, an anesthetic pain reliever). Cortisone shots rarely, if ever, have any lasting effect on trigger finger.
When the cortisone shot doesn’t work, the next common step is surgery to reconfigure the tunnel so that the tendon can run through it smoothly. Other types of treatments for trigger finger are splints and taping the joint. Wrong! Wrong! Wrong!
The problem with everything in the existing medical approach to addressing trigger finger—one that I’ve written about numerous times already—is assuming that the cause of the symptoms is where the symptoms exist. In every case of trigger finger I have treated, the person could either not straighten the finger back after it was bent or could do so but it was very painful. Ultimately, the person was forced to use the other hand to straighten the finger every time it was bent. The ability to return it to the straightened position was easy under this circumstance—and with no pain.
If there were a true structural limitation, the finger would not be able to be straightened at all! This logical understanding explains why all the treatment in the world to the joint with the limited motion does not resolve the issue.
WHAT REALLY TRIGGERS—AND TREATS—TRIGGER FINGER
Now I will provide the more logical explanation for trigger finger and the one that has allowed me to resolve this issue in every case I have treated. The problem is not at the finger joint. It stems from the elbow. Here’s why…
Trigger finger and trigger thumb are the result of the person flexing or bending the finger. The tendons performing the act are the finger tendons on the palm side of the hand. When the finger flexors shorten, the finger extensors (the muscles on the opposite side of the hand) must lengthen. These muscle/tendon mechanisms originate at the elbow and end at the last joint near the tip of the finger.
If these muscles strain, they tend to shorten. If they shorten enough, they lose their ability to lengthen over all the joints—including the wrist and finger joints, so that when a finger is bent enough, these muscles can get stuck. So the inability to straighten the finger after it has been bent is not a result of some effect on the finger flexor muscle. It is the fact that the length of the finger extensor has been so altered that it can no longer perform its function of straightening the finger.
The muscles that need to be strengthened are the finger extensors, wrist extensors and then two muscles in the shoulder and shoulder blade region that support the arm and any objects that are held. A simply stretch of the wrist and finger extensors can be used in the short term to return the finger extensors to their optimal length to allow them to function properly and end the trigger finger. Here is the full routine.
Perform these exercises three times a week. For each exercise, do three sets of 10 repetitions with a one-minute break between sets. Continually increase the resistance until the muscles are strong enough to perform your functional activities without strain or other symptoms.
Place a rubber band around your hand so the band is touching the finger tips at the level of the farthest joint. Open the fingers as far as you can, then return to the start position. Try to emphasize the use of the affected finger as much as possible.
Attach a resistance band to the leg of a chair. Wrap the other end around the hand until resistance is obtained at the start position. Start with the wrist pointing down as much as possible. Then raise the wrist as high as possible while keeping the forearm on the arm of the chair. Return to the start position.
Tie a knot in the center of a fitness band and secure behind the top of a closed door. Sit in a chair facing the door. Leaning back with an angle at the hip of about 30 degrees, reach up for the elastic band so that the start position begins with the arms nearly straight and the elbows just unlocked. Pull down keeping your arms wide and bringing the elbows just below shoulder height and slightly behind the line of the shoulders. At this point, you should feel the shoulder blades squeeze together (the elbows will barely reach behind the line of the shoulders if performing this exercise correctly). Then return to the start position. If the elbows start to drop so they are lower than the shoulders, you are using the incorrect muscles to perform the exercise.
Lower Trap Exercise
This exercise is critical to achieving complete functional capacity of the shoulder. To perform this exercise, sit in a sturdy chair and lean back slightly—about 10 degrees. This will prevent the resistance from pulling you forward. Start with your arm halfway between pointing straight forward and pointing straight to the side, with your hand at shoulder height and your elbow just unlocked. Begin to raise the resistance until the arm reaches about 130 to 140 degrees (about the height of the ear). Then return to the start position at shoulder height. Make sure you are sitting and are supported with a chair back if possible. You want to be leaning back about 10 degrees to prevent the resistance from pulling you forward.
Wrist and Finger Extensor Stretch
Wrap the fingers of the unaffected hand around the affected hand. Try to bend the wrist down while trying to close the fingers into a fist. Make sure that the elbow of the arm being stretched is maintained in a straight position. This allows the wrist and finger extensors to be lengthened optimally. Hold the stretch for 20 seconds. Pause, and repeat the stretch.
This stretch can be performed as often as you choose during the course of the day every day to maximize the length of the wrist and finger extensors.