What is Trigger Finger?
Trigger Finger is the common name for 'Stenosing Tenosynovitis', a soft tissue problem of a tendon and/or tendon sheath that results in pain and limited mobility of (usually) a single finger.
The primary complaint people have with this issue is a 'clicking' or 'popping' when straightening their finger. This can include the inability to move the finger past a certain point until the 'pop' happens.
Why does this happen? What causes this physical dynamic? What are the symptoms of Trigger Finger?
How do you get rid if it?
Stenosing Tenosynovitis consists of 2 main parts:
1. Inflammation and swelling of a tendon sheath (painful!)
2. Eventual scar tissue buildup on the tendon that then has a hard time getting through the narrowed, inflamed, hardened tendon sheath tube.
Medical-Dictionary.TheFreeDictionary.com gives us the following two definitions:
stenosis /ste·no·sis/ (stĕ-no´sis) pl. steno´ses [Gr.] stricture; an abnormal narrowing or contraction of a duct or canal.
tenosynovitis /teno·syn·o·vi·tis/ (-sin″o-vi´tis) inflammation of a tendon sheath.
Inflammation causes the sheath to swell. This grinds on and irritates the tendon. Which then gets inflammed.
Then, due to damage or as the result of ongoing inflammation and how the body responds to that with scar tissue, a bump or nodule or a spot of enlarging of the tendon happens.
This irritates the tendon and tendon sheath even more, and the dynamic progresses until a person can't move their finger at all.
When the tendon slides through the sheath, this enlarging nodule gets stuck at the entrance to the sheath tube, or stuck inside.
This accounts for the finger getting 'stuck'.
The clicking and popping comes when the nodule suddenly moves and the finger straightens with extra velocity due to the muscle tension that was pushing against the resistance.
Trigger Thumb is almost exactly the same as Trigger Finger.
MayoClinic.com says this:
"The cause of trigger finger is a narrowing of the sheath that surrounds the tendon in the affected finger."
I disagree. I think that a narrowing of the sheath is a -symptom- of something. Tendon sheaths don't just narrow for no reason.
If a treatment operates under the context of the 'cause being a narrowing of the sheath', it is totally going to miss the -cause- of the narrowing of the sheath.
Another way of looking at the causes of trigger finger is to look at the activities that can result in this painful tendon problem.
Trigger Finger is essentially a Repetitive Motion Injury.
Any activity like typing, mousing, knitting, really anything that causes toe fingers to curl and straighten can do it. This includes holding a finger in a certain strained position.
Dental assistants can experience this from holding their tools.
The Process of Inflammation and the Pain Causing Dynamic play a role here exactly as they play a role in Tendonitis.
In my professional view, I believe that the repetitive activities aren't even the cause. But they do start a pattern of stimulus and response that are the true 'cause'. The source of the actual problem.
Same goes for Trigger Thumb, as the dynamic is exactly the same as Trigger Finger.
Primary symptoms are:
1. Mild to Severe Pain in the affected finger or thumb (usually only a single finger is affected).
2. A progressing experience of the finger 'sticking' or 'catching' when opening (or closing).
3. An inability to straighten the finger, followed by a 'pop' as it suddenly 'lets go' and straightens.
4. Stiffness and immobility in the finger.
For any treatment of Stenosing Tenosynovitis to be effective, it must reverse the dynamic that led the the problem in the first place.
Doctors like surgery because that cuts the tendon sheath and 'frees' up space for everything to move.
And in some cases that's true. But, the dynamic that caused the problem is still in place, and chances are, pain will return (if it ever goes away.
1. Stop the Inflammation process.
2. Reduce chronic tension on the Tendon.
3. Make any mass of scar tissue growth soft and mobile instead of 'dry and crunchy'.
4. Help the structure return to a happy and healthy pain-free ecology.
Trigger Thumb therapy is exactly the same.
I'm not a big fan of surgery for Tendonitis related problems.
Even severe, debilitating Tendonitis can be quickly reversed and healed.
Such is not the case for severe, debilitating Stenosing Tenosynovitis.
Once a bump or nodule of scar tissue grows large enough, there is nothing other than surgery to make it small again.
Once that scar tissue builds up enough, it is to big to fit through the tendon sheath.
No amount of massage or physical therapy can 'fix' it then.
In that case, I give a thumbs up to Trigger Finger surgery, to get in there and shave that tendon down. The same goes for Trigger Thumb surgery.
People get really good results with this surgery. Especially when compared with their other options (none).
Remember though, surgery doesn't do anything about the underlying cause of the scar tissue build up. And depending on your life situation, the process is likely to cause more problem in the future.
But depending on how well you heal and do post-surgery self care.....you might very well be just fine for a very long time.
Is there a connection to Tendonitis? Isn't it Tenosynovitis?
I believe that there is a connection to Tendonitis.
Tendonitis technically is 'inflammation of a tendon'. That absolutely happens as the tendon gets irritated and causes a build up of scar tissue that forms the nodule/growth on the tendon.
Tendon inflammation is part of the Tendonitis dynamic. There is pain. Then muscles tighten up to protect and guard.
This puts constant strain on the inflamed tendon. This irritates it more, which causes more Inflammation.
Which causes more scar tissue build up.
Understanding this dynamic is important because if you only focus on the nodule without understanding why it is there, why it is getting worse, why there is more pain and more limitation, then you will never know how to stop the progression.
It is totally possible to stop the progression of Trigger Finger and Trigger Thumb in it's tracks.
You just have to use the RIGHT tool.
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