Trigger Finger

‘Trigger Finger’ refers to a condition where flexing and extending one or more fingers has a ‘step’ in the action, sometimes a ‘lock’, rather than a continuous smooth movement. Pain is often but not always present through the ‘step’. Interestingly, passive movement through range of motion most often produces no ‘step’ or ‘lock’; the movement is smooth. Somewhere along the path of the tendon(s) connective tissue has built up and the tendon is ‘jumping’ over that build up. There would be only one reason for this build up from a bodyworker’s perspective – chronic hypertonicity focusing pressure on that area. (If there is a ‘step’ with passive movement also, then the buildup of connective tissue is greater than usual, and the pattern has been there longer. Treatment will be the same, but will probably take longer.)

From webmd.com – The problems often stem from inflammation of tendons that are located within a protective covering called the tendon sheath.

I completely disagree. I feel inflammation is never a cause of a problem, but always the effect of a situation, and the root of that situation is chronic hypertonicity. Put another way, hypertonicity causes inflammation, which can then lead to symptoms.
T/F will have a tensegrity pattern similar to ‘frozen shoulder’, just as there would be with anything going on in the arm. Start with the opposite side of the neck, usually mid-neck (C-3/4 area), and go through the sacro-iliac joints. Also (and always), check out occiput/C-1/C-2 on the same side as the T/F; this is the most common pattern producing arm pathologies.
To review the ‘patterns’ theory, the reasoning here is that all forces in the body must pass through the S/I joints (in LMD-speak, the #1 lever), and above that the head must balance over the spine (the #2 lever) along with the forces fed into the structure by the arms as part of #2 lever. A future article (soon) will go through Three-Lever Theory much more thoroughly.
Once you have response from the S/I’s and neck, and so are affecting the ‘sponsoring pattern’, you can address the effect it has in the arm. Using a massage lube of choice, thoroughly strip out the forearm. I like using thumbs and/or fingers to get a feel for the myo-fascial scene going on in there, and then use knuckles to do the work. Very slow and very thorough is the game.
Use the same idea in the entire arm, wrist, and hand. You are looking to break up the myo-fascial restrictions that the pattern in the torso (centered through levers 1 & 2) have created in the shoulder/arm/wrist/hand. I’m emphasizing the wrist, because the ‘trigger finger’ effect usually has created fascial issues/restrictions in the wrist.
The pattern can be further assessed by squeezing the client’s forearm at various points with your fingers while he/she flexes the T/F. In my experience, the degree of severity of the T/F always changes when I’m on the associated tendon, always becoming less severe. This can help with fine-tuning where I focus my fascial stripping.
Check out the range of motion in all the joints of the arm and shoulder looking for associated myo-fascial restrictions and treat as necessary. As you relieve the pattern in levers 1 & 2, this will be easier to accomplish.
Home exercise suggestions I like are using a child’s football and tennis ball to work the neck, SI/low back, shoulder, and any place particularly sensitive. I suggest that the client start face up on the softest, cushiest carpet in the house. Yoga mats work fine. I suggest they go slow and easy, exploring how it feels. Notice the word ‘suggest’ rather than ‘tell’. The difference between staying within our scope of practice and stepping outside of it simply comes down to the words we use: the outcome is the same.

8 comments on “Trigger Finger

  1. Awesome write-up! Though I’ve never worked on anyone with this, the more I read (and re-read!) all of the posts, the more everything takes root and solidifies further with the work… treat the problem, touch-up the symptoms, and always be like the 2-year old in always asking questions – the “Whys?”

    Also, great addition with the ‘suggest’ vs. ‘tell’ subtlety of word usage.

    How about some floating joint through the fingers, wrist, elbow, etc.?

    • Yeah, floating joint definitely. Going back and forth combining movement and technique, local and general aspects of the tensegrity pattern, guided by client’s tissue response. Should work

  2. Obviously it depends on the severity of the T/F, but would you try and get to addressing the effect on the arm/finger in a first session just to touch upon it, or wait until SI’s and neck were fully released more?

    • I don’t wait for a full Lever 1&2 release, but something noticeable; that’s where I usually start. It makes sense to me that some resilience in the overall pattern is the best place to start, so that anything I accomplish with the symptoms In this case the T/F) have a ‘place to go’.

  3. I suffer from trigger finger. I am a therapist and began to notice this condition about a year and a half ago. I was certain that I had to be practicing bad body mechanics or that I might becoming arthritic. However, since the problem was in both hands, in exactly the same finger, (definitely NOT an arthritic profile) I decided a doctor’s opinion was needed.
    I saw a hand specialist who prescribed an injection of cortisone in the area to address the problem which worked well–for about two months. Slowly, the condition returned. I had a second set of injections which ended up with the same result.
    I decided that a second opinion was a wise course of action and after seeing a second hand specialist, I was informed that the condition, in my case, was induced by diabetes, which I have managed for quite a few years. The first doctor never even asked me if I was diabetic and it never occurred to me to even say anything about the diabetres in the first place as there were so many other obvious reasons it could be happening. When I explained this diagnosis to my endocronologist, she affirmed the second doctor’s findings. Diabetes sometimes–not always–but sometimes, induces this situation/problem. It often manifests in other ways such as intercostalitis and can affect foot insertions as well.
    I think it is important that my scenario be taken into consideration for any therapist who has a client that might present with trigger finger or any of the above mentioned issues.
    From it’s first manifestation, the condition is steadily worsened for me and no amount of massage seemed to be of any help or to bring relief and i was seeing some very good practitioners.
    In 3 weeks from now, I am scheduled for laser surgery which will cut the tendon inferior to my phalanges, thereby alleviating the root problem of the tendons/cartilage being to tight to allow the muscle tissue to calm down and stop being irritated.
    The specialist has told me this is not an uncommon problem even for people without diabetes and that the success rate of this procedure is 99% with the only issue being possible infection at the site for a week. Since diabetics are also prone to infection, this is an issue I will be paying special attention to. The recovery time is two weeks with two weeks of therapy recommended.
    The debate I see here about whether the situation arises from the finger itself or an area referring to the finger will probably always remain a debate because many therrapists have different takes on what they contend with and ultimately how they see the proper course of action for relief. I’m merely writing this to alert interested parties that there is this third possibilty as well and it should be something all of us should be aware of.
    Thanks for reading.

    • Great hearing from you Dennis, and thanks for posting your experience. From our LMD/bodywork viewpoint, diabetes wouldn’t ‘induce’ T/F, but it, like any chronic problem, makes the body more vulnerable to almost any dysfunction. It’s semantics to a degree, but I feel it’s an important distinction. It leads to the LMD/bodywork view that the root is in the structure, and that is more than likely the opposite side of the neck, same side occiput C1-2, and SI’s. At this point for you, since you need to work, I would see the surgery as a viable option. Intervention is Western medicine’s strong suit, and it may be time for that. You might want to further investigate the post-surgery consequences of the cut tendon – no functional problems seems optimistic, though it may be true. I still contend that the T/F scenario is a symptom, and the ‘sponsoring pattern’ behind it will, more than likely, remain post-surgery. So, again from the LMD/bodywork view, diabetes isn’t a third possibility, it’s a factor that can lower the threshold of what problematic forces will alter the body’s alignment. It might, for example, play out like this: for you body mechanics during your work is more critical than for another, similar to what you eat is more critical than what someone without diabetes eats; understanding that both scenarios are very important to all of us.

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