Trigger Finger Causes Treatments

00:05-03:54TRIGGER FINGER
03:59-10:06The Biomechanics of TRIGGER FINGER
10:11-13:10TRIGGER FINGER release SURGERY 
13:17-19:42Chiropractic management of TRIGGER FINGER

TRIGGER FINGER

Dr. Ben Boudreau: [00:00:06] What is a trigger finger, so trigger finger or trigger thumb? It happens to either the fingers or the digits, it can even happen in the fingers where it affects the movement of the tendons as they bend or as the fingers or thumbs are pointed and bent towards the palm of the hand called flexion. It’s also known as stenosing tenosynovitis. And so the ring finger or thumb is mostly impacted by this particular condition, and it causes a bump in your palm near the fingers where it’s mostly affected. And then when you move it, it can cause a clicking or popping sound to go along with it.

Your flexor tendon is what becomes really inflamed. What keeps those tendons nice and aligned is a little pulley or a little ligament that passes over the top. Tendons get inflamed, which is when they produce that bump. With that bumps trying to glide underneath that tendon, it just can’t get there. Sometimes it’ll get under, but it’ll snap-in. And then when you extend your finger to straighten it out, it’ll snap back out. And that’s what produces that. That’s snapping noise.

Dr. Clayton Roach: [00:01:20] And hence the word trigger finger, right? It kind of sounds like it and sometimes can be quite loud. And I had a patient do it in front of me, you know? Definitely. So basically, you imagine like the 10 Tino? And basically the pulley, the piece of tendon that’s on top. The tendon is supposed to glide very easily when the finger is trying to move. So when it becomes inflamed, there’s just no gliding.

Dr. Ben Boudreau: [00:01:58] Yeah. When the nodule gets inflamed, it becomes way too big. It can’t it doesn’t have that smooth transition, as it normally would with a normal synovial where it’s supposed to just glide in and out really easy. This condition is very common among diabetics as well as in rheumatoid arthritis. Anything that will cause any increased inflammation of the tendon will make this a lot worse. Someone who is working with their hands all day, maybe using something that has vibration and so a drill or anything like that is more likely to damage the tendons and cause that inflammation, which will then lead to a trigger finger later on. So definitely having the snapping and popping is a later stage of trigger finger or sinusitis. You want to catch it before that to have the best results with treatment.

Dr. Clayton Roach: [00:02:54] Yeah, I saw one of my patients is a famous fiddler, actually. And so what that trigger finger is on her the hand that holds the fiddle on her left hand. So the thumb is the one that has a problem. And like you said, you know, it can be the fingers, but a lot of times there’s a thumb as well. And her doctor said not to play for two weeks of the inflammation come down when you palpate and you feel that bump, it is very tender because of course, there’s inflammation there makes it very, very tender. Hmm.

The Biomechanics of TRIGGER FINGER

Dr. Ben Boudreau: [00:03:29] Yeah, absolutely. Certainly, when you notice that there’s something going on, you can definitely feel it. And so as part of our treatment or as part of our assessment for that particular condition, you have to be able to feel the palm more specifically where those flexor tendons are and try to see, OK, are we feeling a bump or do we have this lack of range of motion? Or can we literally not move that finger from that flex position to the extended position? Yeah. Maybe we can talk a little bit about the biomechanics of this condition called trigger finger. This is when the synovial of a tendon or the outside, the slippery component of the tendon becomes inflamed and it’s unable to pass underneath the arch or the ligament tendon that’s supposed to kind of keep it in place.

What happens is the finger will get stuck in flexion and then we’ll produce a popping noise when you go and bring it into extension. And so what we have here is a great visualization thereof the A1 pulley, which is the common tendon there, the common ligament that holds that tendon up and in place. You can see in the back there the nodule. And so this is the inflamed tendon when it becomes a big bump as well as the flexor tendon there.

Dr. Clayton Roach: [00:04:52] Yeah, so that’s a pretty good diagram there, explain that. The bump, just so you guys know, doesn’t always happen at that point, it can happen a little bit further up at the next joint as well, right? But typically it’s going to happen in the palm area right below the first knuckle.

Dr. Ben Boudreau: [00:05:13] Yeah. Yeah, and so the clicking sound occurs when the nodule moves through the tunnel formed by that one pulley ligament. And if the nodule becomes too large, it may actually pass underneath that pulley, but it can’t get back out. And so the finger will be stuck in either a flexed or a straightened position, which is no fun for the quality of the joints that are around that area, as well as they will become inflamed from a lack of range of motion leading to arthritic change. Hmm. So it’s more common among diabetics, so catching it early and notifying the patient what it is that’s going wrong is really important.

Dr. Clayton Roach: [00:06:01] Why do you know why it’s more common in diabetics Ben

Dr. Ben Boudreau: [00:06:04] Because they’re likely to suffer from more fluid buildup. Ok, more. But I believe it has the same. It has a lot to do with sugar, and so sugar is one of these inflammatory causing agents. Yeah, because people diabetics have difficulty levelling out their sugar levels. I believe it has. It has a lot to do with the inflammation that in that tendon there.

Dr. Clayton Roach: [00:06:30] That makes sense.

Dr. Ben Boudreau: [00:06:33] Now that’s that is purely based on what I know happens with a lot of diabetics when it comes to joints, especially. Yeah. Being that sugar is one of the strongest chemical stressors that you can have out there, it would certainly cause them to be a little more inflamed.

Dr. Clayton Roach: [00:06:51] So the way we diagnose this, right? Yeah. So typically, there’s going to be a palpable nodule that you’re going to be able to feel into the hand as you go and rub right up against the along the tendons of the palm. Also, a palpable click, when you extend and flex the fingers and that click again, is going to be from that nodule, making it through the pulley and then getting stuck in one position because it can’t make it back right? And it’s very, very painful.

Typically, in the morning is worse because you tend to sleep flex and then when you go to open up your hand. Sometimes you forget that it’s there and then you’ll just force it through. And then if the condition is allowed to progress, a nodule may swell to the point where it gets caught in. The finger is locked and bent basically saying that. So yeah, definitely not one of the hard conditions to diagnose. It’s fairly, fairly easy to diagnose because you’ll actually see the bump in the tendon.

Dr. Ben Boudreau: [00:07:56] And I just think that that’s, you know, like obviously one of that end-stage sort of end-stage conditions, right, because. Ideally, you would notice that your tendons are becoming inflamed prior to it developing a nodule like today, I had a patient come in who had pretty severe tendonitis, and so it goes along with tendonitis. When you inflame the tendon, you’re inflaming the Latino synovial as well, the outside that of that tendon. And what the patient noticed was this grinding right? So this, whenever he tried to move the tendon, was this kind of creaking in the stiffness.

That’s known as a shepherdess. So definitely prior to the patient developing a nodule like you see here and trigger finger, they would have had to go through these stages of inflammation, which would have led to that point. So it certainly is one of those conditions that when you start to notice that buildup and your hands are becoming very stiff and you notice that there’s shepherdess or a lack of range of motion that you have it checked as soon as possible.

Dr. Clayton Roach: [00:09:04] I mean, as chiropractors, you know, sometimes I forget how much our hands can feel and we take it for granted as we put our hands on so many people. It’s almost like a mechanic that can hear a noise in a car, and you can recognize what the problem is. I don’t know if you felt this before Ben, but there’s a different type of feeling when you feel the soft tissue and the soft tissue is basically anything other than visceral or hard tissue, not bone and not organs, but any soft tissue like ligaments and tendons when they are chronic and they’ve been inflamed for a while.

When you put your hand on it and you actually move the tendon, it actually has a leathery feel like you can kind of hear the little bit of gristle when it’s sliding underneath your thumb. And you know, that’s not a great sign because, you know, it’s been there for a while. And like you said, by the time the nodules are there, we know that this condition has been growing and growing and getting worse. So the key is to get this ahead of time. So that way you can help mitigate how bad this is going to get.

TRIGGER FINGER release SURGERY 

Dr. Ben Boudreau: [00:10:09] Yeah, and so there’s obviously there are different ways to manage this condition. One of them is a trigger finger release, and so this is a surgery that’s done and it’s a surgery to open the pulley. And so the incision, just like in the photo there, the bottom picture, the incision is made across that pulley. They’re just to free the tendon up. And so that way, it can glide without the need to pass underneath that tendon there.

Dr. Clayton Roach: [00:10:40] Yeah. And I mean, when you think about it, you know, a lot of times and I’ve seen a few patients, they’ll get one surgery and then later on because, you know, the person might still be working on a jackhammer and, you know, their condition. The reason behind their condition doesn’t change, meaning their occupation or the cause. And so it continues, and they might have it in another finger. Also, what happens is there is also scar tissue that’s going to be formed from the surgery.

At times, scar tissue, as the tissue starts to kind of heal, can become a little bit more like the scar tissue is. It can be thicker than the tissue that was there before and can also cause other issues as well. You’re also changing the dynamic of that joint as well. So there can be changes that aren’t always positive. But will you be able to better open your finger? Yes. Rarely is it full range of motion again, though.

Dr. Ben Boudreau: [00:11:42] Yeah. And so I just really like that point that you mentioned about, you know, the surgical scars, the post-surgical scars, because we do see that all the time in practice when we’re looking at patients’ hands, these are very common surgeries that are done for trigger finger. The amount of scarring that patients have can actually hinder their range of motion anyway, to the point where they almost have just as much range of motion after their surgery as they did prior to their trigger finger. And so it’s one of those things. Even after your surgery, you have to continue to move through and get that scar tissue moving because as Dr. Roach said it’s so stiff and tight that it’ll almost mimic a trigger finger anyway.

Dr. Clayton Roach: [00:12:27] Because you got to remember as the skin leaves on top of the muscle right, which leaves on top of the bone, which has ligaments. So when there’s inflammation or scar tissue after the surgery, one of the limitations the reason behind limitation in the range of motion is actually because the skin is bundled up. From the surgery, so the skin actually doesn’t glide and can’t open up because it doesn’t have the elasticity that it used to have. So a lot of times the pain is less and the movement is a little bit better. But one of the reasons they say, you know, I’m glad I got the surgery is because they don’t have the pain anymore and they’re not afraid to open up their hand, even though their hand can’t open up that great even after surgery many times.

Chiropractic management of TRIGGER FINGER

Dr. Ben Boudreau: [00:13:10] Yeah, yeah, for sure. And so another one of the things you can do is before you want to consider doing surgery, you should always try one of the more preventative measures, which is, of course, doing exercises for the hand, as well as some manual therapy to help with that. So visiting a chiropractor is a great way to identify the nature of the injury and develop a treatment plan for that. Because if you don’t know why it’s there, then how are you supposed to change your lifestyle to make up for why it got there in the first place? And so chiropractic is a great way to discover basically your story, how you got to that point and then sort of work backwards and build blocks for the future?

Dr. Clayton Roach: [00:13:54] Yeah. And we forget how much the muscles attach to the joints, right? Any bony structure has attachments that we call origins or insertions to the muscles. When we don’t have great joint mobility, it creates a reflex allergenic meaning like an arc of processes that happen. So when the joint is not moving well, then the muscle doesn’t move as much as it used to. The muscle doesn’t move as much as it used to, and that way the brain doesn’t get as much feedback from that. The brain thinks that there’s a problem. It gets the muscles to tighten up even more. The joint moves less. Eventually, you get inflammation and the, you know, the process goes on and on and on.

Why would you go to a chiropractor? This is the fact that we could detect, perhaps that the joint is not moving well because the symptoms, you know, might be there, but very minimally. Like, I don’t know what’s wrong with my hand, but it seems like it catches a little bit. And that little catch is what later on needs to a trigger finger where what we can do is one probably give you some exercise at home on how to keep that hand stretch. You know, one of them is the one that I like is you put an elastic around your fingers and you open up that elastic and work those extensions. That’s a good one there.

But also what we can do is mobilize and adjust the actual pick joints, the joints of the proximal phalanges that the knuckle the one after so we can mobilize those joints, those fingers where there are muscles attaching to. And if we’re increasing the range of motion, the muscle moves more and we mitigate the amount of inflammation that’s there, thereby reducing the chances of that nodule forming that can go through that pulley.

Dr. Ben Boudreau: [00:15:40] Exactly. And so making sure that the joints remain healthy encourages the health of the tendons and ligaments around those joints, getting healthy blood flow, as well as identifying those lifestyle factors that may have contributed to that in the first place. Really, it’s great to have someone to have a consultation with right there who’s ready to tackle that and especially knows a thing or two about the condition at hand. The exercises are definitely going to help with encouraging the normal gliding of that tendon.

Ensuring that you’re not developing any of those nodules because you’re fully gliding the tendon back and forth, changing the activities that you’re doing to prevent future episodes and creating a better lifestyle habit. All in all. There’s also Marty or A.R.T. that we practice here in the practice to help encourage healthy motion of the muscles and tendons, right? And so really, really important to be done. So especially early on in care, definitely having a checkout and certainly, a chiropractor is somebody that you can talk to about these types of conditions.

Dr. Clayton Roach: [00:16:53] Yeah. No, definitely. And, you know, in many times, it’s funny because I had patients in the past that, you know, would mention something like that, and they start treating the hands and or feet or whatever it was outside the spine. And then they come back next time said, My gosh, you know, I had that pain for like seven years I never thought about. Talk to you about, you know, my thumb or my toe or whatever it was. That’s when they start talking about all these things that they’ve been holding back, that they didn’t think that we could help them with and was like, Oh, what about my I don’t know the knee and hip. You’re always better off asking because there might be something that we can do.

Of course, the thing that we’re going to do, probably nobody else does, you know, just because of the inherent fact that chiropractors, you know, what we do is not done by a massage therapist or a physiotherapist. Many times when people ask us, you know, what about my knee? You know, I’ve been having these usually going everywhere else. What we’re going to do is going to be different. Sometimes because it’s different. There’s a good result that happens from us doing our thing. Don’t hesitate to ask about things outside the spine because you think that that’s all we do.

Dr. Ben Boudreau: [00:18:04] Yeah, absolutely, there’s definitely a lot more to chiropractic than the spine, although the spine is the most important part of the body to the to us. I want to talk about the little bits of exercise that I have there at the top of the slide here. Not to be construed with advice or anything, but if you do have difficulty with your tenants in your hand or you find that they’re very stiff, those are for exercises to do in a row. Just a flat hand here, tabletop partial curl and then making a fist at the bottom just like that. That way, you’re moving your tendons through a full range of motion with the flat hand tabletop, partial curl, closed hand and then a fist. Also good for individuals with carpal tunnel.

Dr. Clayton Roach: [00:19:03] Yeah. The only other one that I mentioned was the one with the elastic, where you can get elastic and you wrap it around your fingers and you just practice opening up your hand with that elastic. Because many times when you take a look at your data, we’re usually grabbing stuff. We’re not opening up our hands very similarly to our posture, where we’re usually forward and we’re not extending right. We tend to contract during the day and we need to work on it. You know, extending so our sensors, our fingers doing this, that’s extension are doing this, that’s flexion. We need to do an extension a lot more. So definitely those exercises with the elastic and the ones that are here. That’s the way to go. Supplement of the month. Yes.

Dr. Ben Boudreau: [00:19:50] We introduced this great supplement last week on Hump Day Conversation forty-three. The supplement this month is Bergamot BPF, and so it’s derived from a citrus fruit in Calabria, Calabria, Italy Italia, Calabria Italia. And it decreases inflammation, as well as the bad cholesterol LDL low-density lipoprotein. You do not want high levels of LDL in your bloodstream. It gets sticky, catches your arterial walls and can lead to a slew of health issues. What they found that in Calabria, this area of Italia. A lot of people had low levels of LDL and low levels of heart disease, low cholesterol levels. Calabria and Bergamot are beautiful fruit. And basically, that’s a supplement of the month. So if you do suffer from inflammation, high levels of cholesterol, consider taking a bergamot supplement.

Dr. Clayton Roach: [00:21:00] Whoa. All right. This week Take care, guys, have a great night and talk soon. Bye-bye. Hi, what’s up, guys? Listen, if you like this episode, you’ll probably like the other ones. Chances are pretty good, so here’s what you need to do. You need to like us and follow us on Facebook. Following means, you get notified when these two guys are alive. Next, family, friends. You need to share these episodes because you never know you might help them because they need this information as well. And guys,

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