If you’ve ever had trigger thumb and you’re a musician, you understand how frustrating it is. It can quickly turn into a chronic, painful condition, unless it is treated early, and with a common sense approach. Often, conventional treatments fail. I recently had a patient who tried two cortisone injections, yet it did nothing to relieve the pain and triggers.

 

Trigger thumb

Trigger thumb, or stenosing tenosynovitis, occurs when the tendon sheath in the palm becomes inflamed and thickened. The tendons to the thumb and fingers pass through these sheathes as a pulley system.

Because these tissues become thickened with small nodules, the tendon doesn’t glide smoothly within it. When the thumb is flexed, the tendon skips, causing a click, or trigger, in the thumb. There is also pain and discomfort. It makes hand movements clumsy, and for someone like a pianist, it can ruin a career. If left untreated, the thumb may freeze in a flexed position as the nodules get stuck in the tendon sheath.

To treat this condition, we must consider the disruption of the pulley system in the hand, yet also focus on the surrounding muscles in the wrist.

Due to the dysfunction in the thumb, other muscles compensate to support the faulty movement, so those muscles must always be addressed in treatment. As long as there are nodules and thickened tissue, the tendon will not slide into the sheath.

Our first step is to “shrink” the nodule(s), and reduce the thickened tissue. Deep pressure applied in a horizontal and vertical direction across the tendon and sheath will help make tissues more pliable. Applications of cold laser along the thenar eminence (the group of muscles in the palm) as well as the sheath help promote healing. PEMF (pulsed electromagnetic field) is also applied on the dorsal side of the hand during the cold laser application. This allows for two complimenting adjuncts – photon and magnetic field – that are both pro-active treatments that keep working hours after application.

Finally, the patient performs gentle thumb and finger resistance exercises with rubber bands that challenge the tissues in extension. These movements promote circulation and the production of hyaluronic acid between the tissue layers.

Trigger thumb is treatable; it takes a common sense approach that addresses all the surrounding tissues as well as the injury location.