TRIGGER THUMB
What is it?
Trigger thumb is also know as stenosing tenosynovitis (swollen tendon) or stenosing tenovaginosis (swollen tendon pulley). Trigger thumb occurs when there is a problem with either the tendon, the sheath or the pulley caused by injury, inflammation or disease.
The tendons involved (FPL, FPB) are like strong sinews. They join the flexor muscles in the forearm to the thumb and when stimulated they bend the thumb towards the palm.
Each tendon is coated in a lubrication sheath which helps it to glide easily through a pulley at the base of the thumb.
Tenosynovitis describes the tendon bunching up to produce a knot or bump which gets caught in the pulley when trying to bend or straighten the thumb. The tendon can painfully release suddenly or click open and is worse when gripping or in the morning.
Less common is swelling inside the pulley, called tenovaginatis, which describes the space for the tendon shrinking. Pressure placed on the tendon as it tries to move through the pulley causes friction and additional swelling on the sheath over time.
What are the signs of Trigger thumb?
Signs and symptoms of trigger thumb include:
- Snapping or popping sensation when moving the thumb
- Soreness at the base of the thumb in the palm
- Pain and stiffness when bending the thumb
- Swelling or tender lump in the palm of the hand
- Locking of the thumb in the bent position (in severe cases)
- The thumb must be gently straightened with the help of the other hand
- Inability to fully bend the thumb
If bad enough, the thumb may not be able to bend or straighten at all. Often it is worse in the morning or after gripping actions.
Who gets it?
Who can get Trigger thumb?
Women after pregnancy have an increased risk of developing trigger thumb. Occupations more at risk include farmers, industrial workers, lorry drivers, photographers, hair dressers, dentists and musicians or anyone who has a job or hobby, or performs tasks requiring repetitive motions, are more at risk of developing Trigger thumb.
This is because they rely on their thumbs for multiple repetitive movements such as strong grasping or gripping which can irritate the pulley and tendon over time and cause thickening of the connective tissues.
People who have osteoarthritis, rheumatoid arthritis, gout, or diabetes are also at more risk particularly if they are between the ages of 40 and 60.
Complications
In cases that have developed suddenly, the tendon can become completely wedged inside the pulley making it very painful or impossible to straighten out the thumb. It is best to seek immediate treatment to reduce acute inflammation before attempting to prise the thumb open. Try an ice compress with complete rest and then gently straighten the thumb while bathed in warm water. Go slowly to reduce the risk of tearing the tendon sheath causing lubricating fluid to leak into the palm.
Chronic cases occur when the person describes little or no pain but has triggering of the thumb with every movement. At best it is annoying. At worst it signals that the pulley has stretched abnormally and the tendon has toughened which can lead to problems down the road.
What is the treatment?
It is really important to rest the thumb as soon as you suspect Trigger thumb and if it is very swollen try using an ice compress.
The thumb is used in 70% of hand movements so your hand Kinetics therapist will ensure you can still perform movement while resting only the selected tendon.
These can include:
- Splinting to rest only the affected tendon in the thumb
- Wax therapy to soften stiff connective tissues before exercise
- Ultrasound to help healing tissues align in the correct position
- Stretching muscle exercises to maintain length and strength in the tendons
- Massage to stimulate capillary action and reduce swelling
- Ice to reduce acute swelling
- Activity modification to prevent recurrence
What is the recovery period?
It usually takes about 3 to 4 weeks to completely rest the affected tendon while wearing a customised
thumb splint. The splint aims to keep the thumb in a comfortable position so the tendon can return to its normal size. After this time you may only need to wear a support for selective activities that have been identified to have caused your condition.
If your problem has been there for a long time other more invasive treatment approaches may be required in conjunction with splinting. Your Hand Kinetics therapist can recommend your GP organise injection therapy outlining that conservative non-invasive methods have been attempted first.
In some cases surgery may be required to release the tendon and this will require a short stint of intensive Hand therapy afterwards to maximise repair.
Treatment at Hand Kinetics?
Hand Kinetics can make sure your Trigger thumb gets better as fast as is possible without needing injection therapy or surgery.
Frequently our patients will say that their pain resolved within hours of attending their first therapy session.
Trigger thumb won't get better if left untreated. Contact Hand Kinetics and start getting better today or if you would like the diagnosis confirmed first we can organise a scan of your thumb at the Mourne Scan Clinic.
Hand Kinetics Telephone: 0044 28 417 72301
www.handkinetics.com
contactus@handkinetics.com
