Management and referral for trigger finger/thumb
BMJ 2005; 331 doi: https://doi.org/10.1136/bmj.331.7507.30 (Published 30 June 2005) Cite this as: BMJ 2005;331:30All rapid responses
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Dear Editor,
Splinting of an injured part of the body has been in vogue since time
immemorial. It not only helps in pain relief, stabilizing fractures,
dislocations etc, but also helps in early healing and thereby becomes an
essential ingredient of first aid. Finger injuries are quite common in
practice [1] and usually require specialized care and intervention.
Speedy transfer to specialized centres for expert management and care may
not be possible in all cases. Moreover certain injuries may be considered
minor or insignificant and therefore neglected. Provision of a suitable
and comfortable splint would be of considerable help to a patient.
However, prefabricated splints for fingers may not be readily available.
In such cases, usually the affected finger is either strapped against
adjoining finger or a boxing glove bandage applied.
A comfortable, sturdy, viable and cheap ‘splint’ can be readily
created from an unused disposable plastic syringe within minutes.
Usually a 10 ml syringe would be required. However from within the range
of sizes of disposable syringes that are readily available, even in the
emergency kit, suitably sized splint can be created for varying
thicknesses of fingers and for different age groups. Disposable plastic
syringe is cut coronally into two halves and pruned into a desired length
and shape, providing a comfortable trough for a finger to be splinted
against. Few aeration holes can be created by using a heated needle. A
gauge layering can add to the comfort after which the finger can be
strapped against this ‘splint’ using adhesive tape. These structured
splints are comfortable, sturdy, acceptable, economical, and the splinted
finger can still be passed into a glove in cold weather without any
discomfort. This provides a comfortable trough rather than a plate, and no
special care required. Such a ‘splint’ can be viable alternative in
injuries of middle and distal phalanges, including non-displaced and
displaced fractures and mallet finger, until better alternatives are made
available for a patient.
With regards.
Reference:
1. Akhtar S, Bradley MJ, Quinton DN, Burke FD. Management and
referral for trigger finger/thumb. BMJ 2005;331:30-33.
Competing interests:
None declared
Competing interests: No competing interests
Well, the trigger is just the tip of the iceberg! It must trigger
one’s mind to investigate the cause rather than just treat it. The problem
may just settle on
treating the cause, e.g.anti-rheumatoid regimen. Moreover simple home
remedies like hot water fomentation often do the trick! Beware of the
steroid injection in diabetics for complications ranging from local to
systemic loss of glycemic control!
Competing interests:
None declared
Competing interests: No competing interests
I believe this technique described is a form of acupuncture under the
general title called, "Dry Needling." Personally I have had great results
treating trigger finger/thumb with this technique, although I have found 5
-6treatments are needed for chronic situations. The two references below
discuss this technique.
Cochrane Database Syst Rev. 2005 Jan 25;(1):CD001351.
Br J Sports Med. 2005 Feb;39(2):84-90
I persionally combine dry needling with myofascial release to patinet
tolerance,( as both treatments are very painful short term)
Competing interests:
None declared
Competing interests: No competing interests
Splinting for trigger finger only requires a limitation of the
flexion at the involved area not a rigid fixation. A single strip of tape
along the extensor surface of the finger will usually serve this purpose.
The tape may need to extend over the tip of the finger onto the distal
phanlax or require one or two circular 'anchors' around the finger to
stabilize. The advantages are that safe movement is still allowed, the
individual's hand function is less impaired than with rigid splinting and
application and reapplication is simplified.
Competing interests:
None declared
Competing interests: No competing interests
Not being hindered by excessive anatomical knowledge, I have been
treating trigger fingers over the last 15 years or more with a two or more
"one second" pricks at the side of the metacarpal joints with a thin
acupuncture needle.
Often I have also given an homeopathic remedy like silica or causticum or
others .
It seems to me that this single prick, if necessary occasionally repeated
has done its work over the many years. [Alas a bit sensitive, but lasting
for only a fraction of a second]
If a colleague wants to try this method then let him buy a box of
acupuncture needles [size for example 0.25x15] and try this out.
Competing interests:
interest in simple methods
Competing interests: No competing interests
a personal non medical response
My right hand and thumb joint became very inflamed and painful after
(I now realise) too heavy digging and shifting firewood involving
stretching that joint when carrying wide and heavy logs. I went to the
doctor who diagnosed arthritis but I decided not to take any medication at
that time, reading on the internet that I should continue to use swollen
and painful joints to keep them mobile so did although the pain was bad.
Then I developed the clicking of what I now know to be the trigger thumb.I
went to a physiotherapist who diagnosed it for me and made me a splint and
recommeneded a few gentle exercises plus mentioning the possible future
option of a cortisone injection without ultrasound or one with ultrasound
and failing that surgery. With the splint the pain and swelling decreased
rapidly but the clicking (without the splint) continued. I took the
homeopathic remedies mentioned in one of your responses and decided to go
to another physiotherapist where I had ultrasound, vigorous massage and
acupuncture. I had about two treatments for two weeks, then one a week for
two weeks and then a "wait and see approach. ". My thumb is now healed! I
have no joint pain and am careful not to overuse and stretch that joint.I
would say that the entire process took about 4 months but I believe that
had I recognised the trigger thumb for what it was immediately and had
treatment accordingly it would not have taken so long to heal.
Competing interests:
None declared
Competing interests: No competing interests