Issue link: https://www.massageandbodyworkdigital.com/i/1402696
L i s te n to T h e A B M P Po d c a s t a t a b m p.co m /p o d c a s t s o r w h e reve r yo u a cce s s yo u r favo r i te p o d c a s t s 87 back and forth inside the sheath, so it does not rub against the pulleys. However, pathologies of these tendons and their surrounding synovial sheaths may still develop from excessive friction or other factors. Trigger finger/thumb is one of those situations. PATHOPHYSIOLOGY Trigger finger is also called stenosing tenosynovitis. The term stenosing means narrowing and refers to the narrowing of the space for the tendon inside the sheath due to fibrous adhesion and inflammation. Tenosynovitis refers to inflammatory irritation between the tendon and the surrounding synovial sheath. Stenosing tenosynovitis develops because of excess irritation between the tendon, sheath, and the flexor pulleys in the finger. Trigger finger generally develops when inflammation and swelling occur at the interface between the tendon and one of the pulleys, usually at the A1 pulley. Inflammation occurs in the tendon, the sheath, the connective tissue pulley, or a combination. The thickening prevents the tendon from gliding smoothly through the pulley, resulting in pain, limited movement, and strange sensations. A fibrous nodule can also develop on the tendon that prevents the tendon from sliding underneath the pulley. With force, the nodule can pop underneath the pulley. The sudden motion and popping of the tendon nodule are like pulling a trigger, which is where the condition gets its name. It is usually quite painful when the nodule pops back and forth under the pulley as well. There is about a three-to-one ratio of females to males who develop this condition, and it is most common in people in their 50s and 60s. 2 It is more frequent in the thumb and ring finger, though it can also occur in the index finger and long finger. People are more likely to develop this condition in their dominant hand, which strengthens the idea that some of the problem may be related to chronic overuse and physical load on the finger tendons. Forceful gripping, blunt trauma, or repetitive finger/thumb movements also seem to be related to developing the condition. It affects about 2–3 percent of the general population. In addition to biomechanical causes, there seems to be a strong correlation of trigger finger with various metabolic conditions, particularly diabetes, affecting up to about 10 percent of that population. 3 Other metabolic challenges that can also play a prominent role in trigger finger development include rheumatoid arthritis, Dupuytren's contracture, osteoarthritis, de Quervain's tenosynovitis, osteoarthritis, hypothyroidism, and carpal tunnel syndrome. The nature of the relationship of these conditions to trigger finger is not very clear, other than they all involve systemic inflammation. Trigger finger/ thumb can also be a combination of biomechanical or metabolic factors. ASSESSMENT During your initial history, the client is likely to report pain and stiffness, with limited motion in bending the finger or thumb in flexion. It may also hurt as they fully straighten the digit. They may also report popping Connective tissue pulleys of the thumb. Image from 3D4Medical's Complete Anatomy application. 2 A1 A2 oblique