- Hi, I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- And together we are the most famous
physical therapists on the internet.
- In our opinion, of course, Bob.
- Pay attention.
Today we're gonna talk about the top three ways
to treat trigger finger.
Trigger finger, by the way, is an overuse injury.
It can range from a slight pain to a severe pain.
Generally the biggest sign of it is
you'll bend your finger and then as you open it,
it snaps open. - Okay.
- It might give you a little bit of pain.
- So when you say overuse, give me an example.
- If you're like working on the garden,
and you're using a clipper. - Okay.
And you clip, clip, clip, clip, clip,
that would do it,
a lot of industrial jobs.
- Factory type work?
- Right, where you're using the hand over and over again.
- Yep.
- Very common in older women who are menopausal.
- Oh, really?
- Yeah, so that really doesn't have to do with the overuse,
but it does hit the group that tends to get it.
- Because of the calcium issues?
- I have no idea, Brad.
- Okay.
- But it very commonly affects the thumb,
the ring finger, and the middle finger.
- Okay.
- But it can happen in any finger,
and it can happen really at almost any joint.
- Okay.
- Should we try to explain this, Brad?
- Sure. - Just real quickly?
- Let's just use our model here with Leopold.
- Napoleon, bone apart. - Napoleon.
- All right, we have a long ligament here,
ligaments that run up into your finger here.
And when you pull on them,
they actually bend the finger.
- Right.
So the muscle is up here.
When the muscle contracts, the tendon...
Now every finger would have this red tendon,
but they're not red in your body.
But if you look at the tendon-
- There's actually two tendons
that actually even go through there.
- Yeah.
So if you look at that finger...
- See how it's bending it?
When he pulls on the rope, it bends it.
- Look at that. - Yeah.
- It goes much easier in real life, of course.
- And these tendons are running
underneath this black thing,
which is a ligament.
- Yeah.
- It's an annular ligament,
and you actually call it a pulley.
And that pulley helps hold the ligaments in place.
- This a very crude model.
- This is very crude.
And what we are trying to show right here is a nodule.
A nodule has developed on the tendon,
and that nodule actually gets caught
underneath the ligament here.
- So right there you can see
it goes underneath the ligament,
and then that's where it gets caught.
And that's when you straighten the finger,
that's when it pops out.
- It pops out.
Yep, simple as that.
So a little bit difficult to understand,
but generally if you have trigger finger
at this finger right here,
you're gonna feel a nodule right here,
quite often. - Okay.
- So the first treatment you're gonna do
is what we call cross fiber massage,
or transverse friction massage.
Basically, you're gonna find that nodule
in this whole area here,
and you're gonna rub across it.
I don't know how we do it on this man.
So you're gonna rub very hard across that.
I'm not just hitting the surface here,
I'm going down really, really deep, and rubbing.
- Could you actually put your finger across
so you got some support in the back,
and push with your thumb, and go back and forth?
- I think you could do that,
but you really don't need to.
You can put one finger on top of the other
and it just really does the job.
- And how long would you do that for, Bob?
- I would do it two or three minutes,
longer if you could do up to five even, you can do it.
- You're probably gonna get fatigued fingers.
- Your fingers are gonna get fatigued.
I would try it every day.
I would do it every day.
And right after you do the cross fiber massage,
and again you're trying to do it on the nodule,
and you're trying to do it on the annular ligament.
- To loosen that up?
- To loosen it all up.
'Cause a lot of times this has got problems too.
This is tightened up,
and it's got some scar tissue on it.
- Sure, okay.
- So you wanna do that,
and then right after that I want you to
go ahead and stretch the fingers.
- Okay, I'm gonna pull them back like that.
On that specific finger?
- On that specific finger.
- Sure.
- Or if it's the thumb,
you could do it on the thumb.
- Any red flag things you should-
if you feel sharp pain or anything like that,
should you stop?
- Yeah, you should always be concerned about that,
but really the pain is when it snaps open.
This usually doesn't bother it.
- So if you do this for say three days in a row,
you think they may start to feel some progress with it?
- Well, we gotta see.
The other thing you're gonna do then,
you can go ahead and actually work
the muscles that extend the finger.
- Okay.
- So you're gonna take a rubber band,
or this one's actually a doubled up rubber band,
and you're gonna put it on your fingers like this,
around all the fingers,
and then you're just gonna work on
straightening them like that.
- It's a nice exercise to strengthen the extensors
we call them of the fingers.
Yeah, and this shouldn't cause any snapping,
'cause in order to make it snap,
usually you have to make a full fist,
in order to make it snap,
to make that tendon or that bump
go underneath the ligament.
- Sure, that makes sense.
- So just like this.
And then finally,
if you wanna when you finish,
you actually can keep the tendon stretched,
and you can actually do an ice massage.
You wanna show, Brad, how that would be done?
- Sure, you take a little dixie cup like this,
if you fill it up almost full,
put it in your freezer,
let it freeze solid.
And then when the ice is froze solid in there,
you'd tear off the top like this,
just enough all the way around
so that the ice is exposed,
and then you would just rub it over that area.
- While you're stretching it.
- Okay.
For about five minutes is what I usually recommend.
- Yeah, it usually doesn't take much longer,
sometimes it freezes up a lot quicker than that.
You don't need to go much longer than that.
Now, if none of these things work,
then you're gonna need to go to the doctor,
and you can do a cortisone shot.
And a lot of times the cortisone shot
does relieve things,
in 66% of the patients,
but then it comes back quite often, unfortunately.
So only a third of those get lasting relief from the shot.
And the others have to have surgery.
It's a simple surgery,
if there is such a thing,
but I mean it's an outpatient.
And they go in and they release the tendon.
- Right.
So you're gonna go in, and leave the same day.
- Right, exactly.
So this is certainly worth a try.
- Right.
- So you're gonna do the cross fiber massage,
you're gonna do the stretch,
you're gonna do the strengthening,
and then the ice.
Give it a shot,
and see if we can help your trigger finger.
- All right, nice job, Bob.
Thanks for watching.