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88 m a s s a g e & b o d y wo r k s e p te m b e r/o c to b e r 2 0 2 1 side of the fingers, so flexion is affected more than extension. If the condition is seriously advanced, the finger may be stuck in partial flexion or stuck in extension, and the client may be unable to move it past that point. It is also common for the client to report grating sensations (crepitus) during finger or thumb movements. There is no gold standard or definitive clinical test to diagnose trigger finger. Identifying the condition is based primarily on a detailed clinical examination. Ultrasound is frequently used as a diagnostic tool to measure the thickening of the affected tendon sheath, which may help identify the condition. Ultrasound evaluation would be used in conjunction with a detailed physical exam to identify the likelihood of trigger finger existing. TREATMENT The preferred treatment for trigger finger starts with conservative strategies. Unfortunately, there are no firmly established conservative treatments that show high success. Conservative treatment usually begins with splinting the affected joint region to decrease the load on the tendon. Activity modification is also crucial at this point to keep from overloading the tendons and causing further inflammatory aggravation. Fibrous adhesions can develop between the tendon, sheath, and connective tissue pulley and appear to be a primary factor in the condition's perpetuation. Gentle movement within the tolerable range is usually encouraged so that additional tissue adhesion does not develop. Sometimes ice is recommended to decrease inflammatory activities, but heat might help increase pliability of the affected tissues and encourage a greater degree of movement. Friction Massage It is unclear what role massage can play in addressing trigger finger. It is likely to be more helpful early on before significant tendon nodules and more extensive fibrous adhesions have developed between the tendon, sheath, and overlying connective tissue pulley. There are a few studies that refer to massage being helpful in the early stages. However, they do not specify what techniques or methods of massage are likely to be most helpful. 4 Friction massage is often used to address similar problems such as tenosynovitis and tendinosis. The idea is that friction helps reduce adhesions between adjacent tissues and encourages greater mobility. This effect might occur in massage treatment of trigger finger to some degree as well. However, more research should be done in this area to test this theoretical idea. Friction massage should not be detrimental as long as it is performed within the client's comfort and pain tolerance. In addition, teaching the client to do self- massage on the affected areas may be helpful because they can apply this technique in just a few minutes several times a day. Friction techniques are likely to be more effective when performed repeatedly as opposed to a once-a-week treatment. This is an instance in which client education and self-massage strategies can be a critical part of therapy. Corticosteroid Injection If initial conservative treatments are ineffective and the condition is in its early and mild stage, the next treatment usually attempted is corticosteroid injection. Injections are given in the region of the affected tendon and pulley to help reduce inflammation, decrease pain, and encourage movement. Steroid injections have shown some promise Trigger finger is not as common as other wrist and hand problems, like carpal tunnel syndrome, but can be incapacitating and painful. or grating sensations with movement. If the condition is advanced, they may also report the joint getting stuck in either flexion or extension. Movement limitations are likely, with a possibility that the digit cannot bend or straighten at all. There is likely to be an increased degree of tenderness near the MCP joint. It will be helpful to ask questions about any existing metabolic challenges, such as diabetes, hypothyroidism, rheumatoid arthritis, or any of the other metabolic factors we know may be related. There may not always be evidence of any specific overuse, but ask questions to identify if there have been any significant increases in biomechanical stress of the fingers or thumb. Swelling, a bump, or a protrusion may be palpable if a tendon nodule has developed. If the condition is on one side, you will feel the difference in size between the affected and unaffected side. It may be challenging to make this comparison if both sides are involved, but enlargement around the joint is common. The area in which the tendon nodule has developed is also likely to be painful with palpation. Use caution when applying pressure, as the pain can be sharp and sudden when the damaged tissue is touched. Both finger/thumb passive or active flexion and extension are likely to be painful. Active movement may be more painful because of the greater load on the affected tissues. There may also be pain during resisted finger flexion or extension (manual resistive tests) if a nodule is encountering the connective tissue pulley. In most cases, a nodule and restriction will be on the palmar