Does your thumb lock or click when you are bending and extending your thumb? Or maybe it won’t even straighten after bending it. As Burnaby Physiotherapists, we often hear complaints like this.

Unfortunately, you may have a Trigger Thumb.

To Understand The Trigger Thumb, We Must Have A Look At The Anatomy Of The Thumb:

The thumb consists of

Trigger thumb can be ‘triggered’ by

The tendon that is responsible for the trigger thumb flexes the thumb. They are the flexor pollicis longus and the flexor pollicis brevis. They originate in the forearm area and run down the palmar surface of the thumb.

The tendon and its outer sheath run through 3 pulleys called A1, oblique, and A2. The pulley that is commonly involved in the trigger thumb is the A1 pulley.

Next, you have the synovial sheath, which is a structure that surrounds and protects the tendons of the thumb. The synovial fluid provides nutrition and allows for proper gliding of the tendon.

The third possible structure that can cause the trigger thumb is the pulley system. The pulley acts like a tunnel where the tendon runs through. The job of the pulley is to keep the tendon close to the joint to effectively transfer force to the bone to generate movement.

To Understand The Trigger Thumb, We Must Have A Look At The Anatomy Of The Thumb:

When these structures are irritated, inflamed or injured, the space within the pulley is reduced. You end up with a stuck or a trigger thumb, as the tendon cannot properly glide through the pulley.

Who Gets Trigger Thumb?

Trigger thumb is seen more commonly in women. It generally affects people between the ages 40-60, although it has been presented in those younger than that.

Individuals who perform repetitive activities and overuse of the thumb like gripping and use of vibrating hand held machinery are more susceptible to trigger thumb. Other medical conditions such as diabetes and rheumatoid arthritis also increase the risk of a trigger thumb.

How To Manage Trigger Thumb?

Acute Management

If the trigger thumb is quite acute and presents with pain, swelling and disability, the general management

Keep your thumb moving in all directions making sure you are not reproducing pain or clicking. In the morning, you may get a bit of relief by soaking your hands in warm water.

A thumb brace to keep the thumb from being flexed or bent through the night can also be beneficial for your recovery.

Sub-Acute Management

When your trigger thumb has stabilized and there is less swelling and pain, you can start doing

Self friction massage

You can use this technique daily on the pulley and the tendon for 2-3 minutes per day (to loosen up scar tissue and adhesions that impedes on the smooth gliding motion of the tendon).

It may be uncomfortable at first. As you progress, you may notice that the thumb starts moving a little smoother and less catching.

Strengthening

Your Burnaby Physiotherapist may advise starting strengthening the thumb into extension. You can also help stretch the thumb flexors and you can do this with a theraband or even a rubber band. Simply wrap the band around your thumb and pull the band into extension, or making a thumbs up movement.

Tendon glide Exercise:

With this exercise, you want to make sure that your MCP joint is stable and not moving. Move the distal phalanx into flexion and extension to glide the tendon at the MCP region. There should be no pain or clicking when performing this exercise.

It is very important to minimize the stress and trauma that you are putting on your thumb. You may need to alter your use of the thumb for 3-4 weeks. Avoid any activities that involve putting pressure on the tendon and the pulley system. Activities like repetitive gripping, grasping and using vibrating machinery. Otherwise, the condition may be slow to improve and become chronic, frustrating you and your Physiotherapist.

What If Conservative Treatment Fails?

When conservative management has not achieved the desired effect, your doctor may consider a corticosteroid injection into the tendon sheath to decrease inflammation. And if that still doesn’t work and is bothersome, surgical release of the pulley is the last resort

In our Burnaby Physiotherapy practice, I always tell my patients to do everything possible to help manage this condition. With the right amount of discipline and consistency with your routine, practicing proper self-care and avoiding aggravating activities, the trigger thumb resolves over time.