Advice from a Certified Hand Therapist: Trigger Finger

Advice from a Certified Hand Therapist: Trigger Finger

I noticed that after making a fist, when I try to straighten one of my fingers, it catches and becomes very painful. Sometimes it is necessary to take my other hand to force the finger back into a straight position.

The condition you are describing may be trigger finger (or trigger thumb), and is frequently caused by overuse. Some examples of activities that might initiate this condition are power washing a deck for several hours, using a rivet gun repetitively, leash training a dog or opening window latches that have a lot of resistance.

Why is there a hard nodule present in my palm? It’s tender to touch!

The nodule is actually extreme thickening of the tendon, and each time your tendon “triggers,” there is an inflammatory response that occurs (see diagrams below). Look at the swollen tendon in the first diagram, then take a look at the pulley in the second diagram. You will see that at some point, the nodule becomes so inflamed the tendon can’t glide underneath the pulley — that’s why it “triggers.”

Is there conservative treatment that will help this condition?

Glad you asked, because there is a cuff orthosis that a certified hand therapist can fabricate. This does not allow your finger to move into a fist position, preventing it from “triggering.” The orthosis is a bit larger if more than one finger is involved. There was an excellent study published in 1988 in the Journal of Hand Therapy that showed that no other treatment was necessary for 73% of the patients using this conservative management approach.

In addition to wearing the orthosis, your certified hand therapist will instruct you in tendon excursion exercises, which improve the health of the tendon.

How can I find a certified hand therapist in my area?
There is a handy Find a Therapist directory on the ASHT website,

Please be certain to start your treatment as soon as possible; if you have the condition for more than six months, it can be more challenging to treat!

Heidi Hermann Wright, DHS, MBA, OTR, CHT is a certified hand therapist and a member of the American Society of Hand Therapists (ASHT).