♪ Bob and Brad ♪
♪ The two most famous ♪
♪ Physical therapists ♪
♪ On the internet ♪
- Hi folks. I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- Together we are the most famous
physical therapists on the internet.
- In our opinion, of course, Bob.
- Today we are talking about trigger finger
and trigger thumb, everything you need to know to fix.
- That's right Bob.
- This is very timely, Brad, because I have a friend
who just complained about it this weekend.
I was going to say, I'll make a video for you,
but I know we have one already, but,
and then you said you'd do one and that's great.
- Yeah, and my wife has trigger thumb.
I've got a little bit of trigger finger leftover.
And when I was a child, I had congenital trigger thumbs.
- So you're an expert on the user side.
- Say no more Bob.
And the treatment is coming along very well.
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- Yes.
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- Yeah.
Why don't they just sleep together on it?
- They did.
- Oh good!
- But, he snores.
- They make, they made up anyways.
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- So we're talking about the trigger finger, trigger thumb.
We're putting, put them both together
because they're very much related,
all of their different fingers.
- Same mechanism.
- Right.
If you have trigger finger,
typically it's either your ring finger
or your middle finger, that those are the most common ones.
- So, the third or fourth finger?
- Third or fourth.
It can be the pointer finger as well.
But they're most common.
Thumb is obviously the thumb.
Now, the thumb is different because
these fingers are obviously all flat.
They kind of work the same,
but the thumb is at a posing joint.
So it's treated a little bit different
and it responds and it reacts
a little bit different as well.
- What he's saying is that
these fingers kind of move in one plane.
- There you go.
- And this one can move in several planes
because it's circumduct.
- Right. Exactly.
I do want to talk about congenital trigger thumb, briefly.
It usually happens-
- Born with.
- Yeah, happens in the thumb.
I had it. I didn't know I had it.
My parents didn't, they didn't care.
It's like...
- Yeah! Right
- Well, it really wasn't a problem,
but you can't do this without it hurting.
And it goes, click, click, click.
And I remember doing that for,
I don't know how long when I was a child, it just went away.
And the good news is it usually does just go away.
It's not a big problem.
- Knowing you and your family,
I'm surprised they didn't cut it off.
- Why Bob? No, that's a lie, but I mean,
we normally did not go that far.
- Normally.
- And also as far as
when you get older,
it comes with the clicking.
The, this finger-
- And the catching.
- Yeah, you'll go so far and then it'll click
and then you got to go open it up and then it clicks again.
- And it can be very difficult to get it open again.
- Yeah, it can actually lock, go to here.
And it's very painful when it gets that bad,
you got to go and see the doctor
and get things taken care of from that.
- They'll often do an injection, right?
- Yeah, yeah.
We'll get into that a little bit more,
some of that treatment.
It is possible, worst case scenario is surgery.
It's not a big surgery.
They just go in and, and they cut the sheath,
that, the pulley that we're going to talk about
in a little bit.
So it's not a big deal, but oftentimes-
(indistinct)
- Not necessary in many cases.
The majority of cases, surgery isn't necessary.
So, should we talk about why-
- Yes!
- It clicks here and here?
So the thumb again is this joint typically.
Now, if you look at my hand,
I've got an incredible model here.
(Bob chuckles)
The blue line represents a tendon
that goes up into the finger.
Now, when you flex any of your fingers, this tendon,
the muscle in your forearm contracts, pulling on the tendon,
which goes through your carpal tunnel
and you just get flection.
But what happens is that tendon
goes through what they call a pulley. Okay?
And that's a sheath.
It's like a ligamentous tissue.
- [Bob] Right, right.
- Very strong.
And if everything's working right
it slides through there very gently.
- [Bob] Right, no problem.
- And same thing with the thumb.
Now, when you do this,
we have a muscle contracting with the pulley,
with a tendon going through.
And the pulley is at this joint right here.
That's what the red represents, is the pulley.
And when the tendon, gets a nodule on the tendon,
the nodule has to slide through that pulley
in either location.
And when it starts to get larger, that nodule,
it doesn't slide through very easily.
- [Bob] Or inflamed.
- Or inflamed or both.
So, look at this model.
This was kind of fun to make.
- It's a very good model.
- So we've got this represents this yellow rope.
If you will, gold rope represents-
- That's the tendon.
- The tendon.
Here, we gotta pulley, yeah.
They went to the hardware store and picked up a pulley.
And when things are going well,
the tendon easily goes through the pulley.
Life is good.
- [Bob] Yeah.
- [Brad] And then we'd get a nodule formed.
Can you see the blue line, Mike?
Now just a little bit of inflammation in there.
A little bit of scar tissue builds up
and it goes through a little bit harder.
- [Bob] Look how it's rough now.
- [Brad] Yep.
- [Bob] It doesn't make it through it as well.
- [Brad] This is exactly where my fingers right now.
I can feel it, but it's not a problem.
- [Bob] Is that on one hand?
- [Brad] Yeah, just on one hand.
- [Bob] And it's dominant hand? Your right hand?
- [Brad] Yes, exactly.
Now, if that tendon starts to build up,
that nodule gets inflamed,
like here we got this red represents
the inflammation of that nodule.
And it's bigger diameter, and it doesn't go through.
- [Bob] Now it's tough to go through.
- Pull, pull, pull, ugh.
And that's what you got to do.
Now, what happens is we talked about that surgery.
They cut that pulley.
- Right, right.
- And then it slides through easily.
But, what we wanted-
- Or, they might inject us and calm the inflammation down.
- There you go.
So avoiding that way before that,
we're going to give you a few options to do.
Now, one thing you wanted to do is
when you get that clicking and it hurts,
is don't continue to click it.
- Right!
- It just irritates it.
- Don't test it. - Yeah.
- Don't think you're going to click, click, click,
and wear it out.
- It's going to smooth it out.
- Yeah, it's, you're gonna irritate it,
make the inflammation worse, and then you'll have more pain.
- Won't be able to do it at all.
- Right.
So when it gets to the point where it's inflamed,
either the thumb, you can, or the finger,
you can put a cold pack on there
to help reduce inflammation, do some NSAIDs,
ibuprofen as tolerated.
As long as it doesn't,
doesn't match with your other medications,
if you are on other medications.
So get it to settle down, avoid using it.
Now the thumb, they make some little splints that work.
There's a figure eight splint that works on there.
Or you can put a thumb,
anything that prevents your thumb from moving.
- They actually have a splint for this too.
- Yeah, they do.
And I never had the need for it.
I could just avoid it for,
'cause I got the other fingers that compensated.
- They're not very, they're not good for liberal life.
Trying to work with them - Yeah, right.
- But one thing I found that worked,
'cause my wife has the thumb one now
and she'd go out and either at work,
trying to type or out like working in the flower garden,
or when she goes to her exercise class irritates it,
she needed a brace.
So I said, "Let's get some Kinesio Tape."
Show me your thumb, Bob.
So, here we go.
Now the advantage of this-
- [Bob] Now we're trying to help me not bend as much.
- [Brad] Yes. It's just going to support it.
So I just cut this in about half inch or 3/4 inch wide.
I'm going to go up from here and do a figure eight.
Now this roll, I got a roll of Kinesio Tape,
which I could tape this thumb about 20 times with,
costs me about the same as a thumb brace.
And the nice thing about the Kinesio Tape
is you can use it for any part of your body
if you like to do it.
- [Bob] I think it's more comfortable, too.
- It is. - By far.
- It allows motion, but it just restricts it enough.
- [Bob] So I still can bend, but I can,
it's restricted it somewhat.
- Right.
So it allows some function.
If you put a brace on there and leave it on all day long,
it's going to actually make it tight,
make the tissues tighten up
and then you have to do the range of motion to loosen it up.
So, I think this is a step in the right direction.
- Right, right.
- But you can still use a brace or the figure eight brace
if you would like.
- The next thing is,
- Cross fiber.
- Argh, I'm going to go to the range of motion first.
- Oh, sure.
- Because you do want to range of motion the finger,
you're just going to gently,
so you try and relax the hand.
Brr, completely relaxed.
Use the other hand and work the finger.
Whichever one it is,
extend it back, go all the way forward and flex it.
- Now the work is coming from this hand, right?
- Right. That's a good point.
- This part is being relaxed.
- Yep.
- The thumb as well,
go forward with it,
flex the distal or the farthest old joint,
and then come back.
You can do this stretch,
put your palm up, reach underneath
and gently stretch it.
Here is a really nice stretch to get that direction.
And you're going to do that a minute or so,
three times a day just to keep it
so it's, doesn't tighten up on you.
Now, the next thing,
you're talking about the cross friction.
- I would say this probably the most critical thing to do.
- This is what worked for me.
So you want to demonstrate, or you want me to?
- No go ahead, Brad.
- Okay so this is,
you take the thumb, this hand, put the hand back here.
You can see here's my pulley, that's tight.
And I'm going to put my thumb right over there
and you will feel when you start pushing around,
you got to get deep.
You're not going superficial.
You're going to see,
we're going to actual rub off the ink on here
or the, whatever this marker is.
And I'm going to push and I'll go up and down, cross.
Now we say cross fiber,
but I found that I went pretty much any direction
and I would just rub on it for about 30 seconds
and then I could flex it and it would be less triggered.
- [Bob] So you're trying to make the tendon smoother
and trying to take the lump out of it, basically.
- Yeah, I don't know if it's doing that
or if it's making the pulley relapsed, I don't know.
I don't care, I know it works.
- 'Cause you're right on the base of the finger.
- Yeah, right.
- Right where the pulley is.
- Yep, exactly.
And then if you're doing your thumb,
you have to do the same thing.
Now the thumb, you're going straight onto the finger,
but the thumb, you have to kind of come at a oblique angle.
So you're going to come in.
It's a little bit harder to get at,
but you can get at it and you'll feel it.
It's going to be a little tender.
- Right, find the tender spot.
- Yeah, and then when you find it,
you're going to work on it for a minute or two.
Don't get real aggressive if it's tender,
just be gentle with it
and get more aggressive as it feels better.
- Your fingertips too, right?
- Sure. Yep, exactly.
Yep.
Now, the other thing I found that worked really well is,
and actually after I started doing this,
it works for while,
I stopped doing the cross friction massage
because I just put pressure on the pulley.
And when I had pressure on it,
I could do this without any pain, any clunking!
So I would just do that for 10 to 15.
- I believe that's the McKenzie Method.
- Yep.
- That's what they recommend.
- Robin McKenzie...
- Physical therapist.
- He's passed away now, but his treatments live on.
And you can do the same with your thumb.
And as long as it's shows benefits.
- Yep, pretty good continuous pressure you put on there.
- Yep. Exactly, Bob.
So, work with those.
And I have a feeling you'll have success.
The majority of people will have success
as a matter of days.
Any, anything else Bob about these?
- No I think, you could possibly,
if you want to cool it down,
also you just put it in cool water.
Right? - Sure.
And work your hand while it's in there.
If you're able to move it without pain.
- Right.
Yeah, cool water, ice cubes in the water.
Good, direct way to get after it.
So, very good!
- Try, one of those things should work for you.
- Yep.
Once again Bob, we can fix just about anything except for-
- [Bob] A broken heart.
- That's right, Bob.
But we continue to work with it.
The trigger finger, the thumb thing
has got no relationship.
- I just hope nobody's waiting around for us
to come up with an answer.
- Bob, it's all going to come at once.
It's going to be like a revelation.
Adios.