Trigger thumb is a condition where the thumb is locked in a bent position due to swelling of the flexor tendon. It causes pain and can impair hand function, especially for those with repetitive gripping jobs. Women are more affected, and treatment depends on severity and duration.
Trigger thumb is a condition in which the thumb is locked, usually in a bent position, due to a localized swelling of the flexor thumb tendon that limits its range of motion within the flexor tendon sheath. It is characterized primarily by painful locking or activation of the thumb and can cause significant impairment of hand function, especially for those individuals whose hobo jobs require repetitive gripping. Its cause is generally unknown, but it may be associated with certain metabolic and inflammatory diseases. Risk factors include repetitive gripping and certain diseases, and women are more affected. Treatment of this condition depends on the degree of its severity and duration.
The location of the thumb lock depends on the location of the swelling on the tendon. If it is proximal to the flexor tendon sheath, the thumb is locked in a bent position. In the event that it is within the flexor tendon sheath, the thumb is locked in a straight position. Aside from painful activating and locking, other signs and symptoms of trigger thumb include morning stiffness of the thumb, clicking or popping when you move the thumb, tenderness, or a lump that moves with flexing or straightening the thumb and active shooting.
Trigger thumb usually affects the dominant hand, but other fingers can also be involved. Individuals whose hobo jobs require repetitive gripping are at high risk for this condition. Certain metabolic and inflammatory conditions, such as diabetes, hypothyroidism, rheumatoid arthritis, amyloidosis, gout, or chronic infection, cause the tenosynovia to become inflamed, leading to a tight, narrowed space within the sheath tendon, thus limiting the sliding movement of the tendon. The tenosynovium lines the tendon sheath and secretes a lubricating fluid for the sliding movement of the tendon. Women are four times more likely to develop a trigger thumb.
Diagnosis of trigger thumb is usually based on the history and physical examination. Lab tests are generally not ordered for trigger thumb with unknown cause. Imaging modalities and laboratory tests are not necessary, but help confirm or rule out suspicion of associated metabolic or inflammatory conditions.
For mild cases of trigger thumb, treatment is usually non-drug. This includes resting the affected hand for 4 to 6 weeks, switching to and avoiding jobs or hobs that require repetitive gripping or grasping actions for at least 3 to 4 weeks, splinting for up to 6 weeks, performing gentle finger exercises, soaking in warm water especially in the morning and massaging. For severe cases of trigger thumb, treatment includes pharmacological and/or surgical approaches. Pharmacological approaches include the use of nonsteroidal anti-inflammatory drugs or steroids to relieve symptoms, and the surgical approach includes surgical release of the affected tendon.
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