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Why Won’t My Finger Straighten?

by | Jul 28, 2023 | Conditions | 0 comments

Why do fingers and thumbs get stuck?

Fingers and thumbs are very nimble and flexible. In particular your thumbs have a near 360° range of movement as the position of the thumb in opposition to the fingers gives humans the unique ability to firmly grasp and manipulate objects.

However sometimes your fingers and thumbs stop doing what you want them to. Instead one or more of your digits can become stiff with a popping or clicking sensation when you move it. Over time this can progress to the inability to straighten your digit without manipulation or it can get permanently locked in a bent position. This can be accompanied by thickenings or nodules that develop in the palm of your hand beneath the affected digit.

This is not usually painful but it is extremely inconvenient as it reduces what you can do with your hands. Medically the diagnosis can be one of two conditions. Trigger finger where the cause of the restriction in your finger or thumb is a thickening of the tendon that moves the digit. Or Dupuytren’s contracture where the cause is a thickening of the fascia in the palm of your hand.

Looking at each of these conditions anatomically helps us to understand more about them.

Trigger Finger

The technical term for trigger finger is stenosing tenosynovitis which means a thickening and irritation of the tendon sheath for the digit which means the tendon can no longer glide smoothly. Finger tendons are the end part of the muscles in your forearms. Each finger has its own muscle to bend and straighten it, and the thumb has eight.

The tendons are each encased in a sheath and these are held close to the finger bones by bands of fascia called pulleys. The most significant of these pulleys is the A1 pulley where the finger meets the palm. This pulley can become inflamed and over time can develop into a nodule which further restricts movement. The popping sensation when straightening the digit is the nodule popping through the pulley.

Images courtesy of the American Society of Orthopaedic Surgeons

Medical causes of trigger finger are not clear but can be linked to age, medical conditions or forceful use of the fingers and thumb. Medical treatment includes rest, nightsplints to keep the digit straight while you sleep, stretches, anti-inflammatories, steroid injections or, in worst cases, surgery to release the A1 pulley. Surgery is not always successful and the digit may remain bent and/or restricted in movement.

Dupuytrens Contracture

Dupuytrens contracture is a condition where the fascia in the palm of your hand becomes abnormally thickened at the base of your fingers. This may develop into a hard lump, a band or cording which can restrict movement. Again, medical understanding is not clear but it is thought to be hereditary and linked to age and medical conditions. Common treatment includes steroid injections, needling to break down the restrictions and surgery, with varying degrees of success.

What’s the difference?

Generally the medical difference between the two conditions is regarded that trigger finger starts with the fingers and causes difficulty in straightening them. Dupuytrens contracture starts in the palm and causes permanent contracture of the affected digits.

How is fascia involved?

In our experience the symptoms and diagnosis are not so clear cut and whatever the diagnosis the fascia is very much involved, not just in the digit or palm, but also further ‘upstream’ in the forearms and even into the neck.

For many people the cause of their stuck digit, nodule and thickening of the palm is overuse, in particular fine movements of the fingers and thumbs. This can typically be computer work, texting or gaming, but equally can be due to manual work such as carpentry or gardening, knitting or crafting.

Any work involving the fingers and thumbs requires your forearm muscles to work overtime to move your digits. These muscles are small and tightly packed into a confined area, each in its own fascial sheath. As an interesting nerdy point, the muscles on each side blend together to form common tendons that attach into the humerus, your upper arm bone, just above the elbow. Restrictions here can cause tennis and golfers elbow, but that’s another blog.

If the forearm muscles are overworked they become tired and then irritated which creates swelling and changes the surrounding fascia from fluid and soft to dehydrated and hard. This restricts the movement of the muscles and in turn the movement of the fingers and thumbs they connect to.

So from a fascial point of view the restrictions of trigger finger or Dupuytrens contracture are never just to be found in the digits or palm, but also in the forearms. And if the forearms are restricted, there’s a good chance this will also be restricting the arm nerves right up into the neck where they first exit the spinal cord.

Myofascial Release can help

Myofascial treatment of trigger finger or Dupuytrens contracture includes release of restrictions from the neck down the arms, with focus on the forearms, palms and digits. Nodules or tight bands can be treated as a form of scar tissue and gradually encouraged to break down.

A significant part of the myofascial approach is to encourage self treatment. Rest and a reduction of the activities that are contributing to the condition are important. Equally important are myofascial self-help exercises to help release the restrictions that are causing the problem. Our Fascial Fix video for Trigger Finger shares some helpful exercises:

 

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