Why is my thumb clicking and locking down?

Trigger Thumb: Causes, Symptoms, Diagnosis and Treatment

Insight Hand Therapy is a Hand Therapy Clinic located on the Gold Coast, providing specific assessment, treatment and active rehabilitation for hand and upper limb injuries / conditions. Telehealth hand therapy services are also offered for those who do not live on the Gold Coast or Northern NSW, or for those who are unable to attend a face-to-face appointment. The below information is intended for general information purposes and should not substitute individualised, medical or therapy advice. Please get in contact with us directly for more information or for an appointment with an Accredited Hand Therapist (as awarded by the Australian Hand Therapy Association).

The thumb plays an extremely important role in hand function. It allows us to grasp objects and perform various daily activities. However, when we experience pain or difficulty in moving the thumb, it can be incredibly frustrating and make simple tasks very challenging! Trigger thumb is a common condition that affects people of all ages, but it is most common in individuals above the age of 50. In this blog, we will discuss the causes, symptoms, diagnosis and treatment options for trigger thumb.

What is Trigger Thumb?

Trigger thumb, also known as stenosing tenosynovitis, is a condition where the thumb gets stuck or locked in a bent position due to inflammation of the tendon that bends the thumb, and/or its pulley. The pulley is a small tunnel-like structure which the tendon glides through, keeping the tendon nice and close to the bone during movement. Trigger thumb usually starts with a clicking sensation when the thumb bends and straightens. Eventually, the thumb may become painful, swollen, and difficult to move.

Causes of Trigger Thumb:

There are a few factors which increase the risk of an individual developing trigger thumb. These include:

·       Repetitive Movements: People who perform repetitive movements that involve bending and straightening the thumb, such as repetitive gripping or grasping, are at higher risk of developing trigger thumb.

·       Medical Conditions: Trigger thumb is more common in people with certain medical conditions such as arthritis, gout, and diabetes.

·       Age: Trigger thumb is more common in people above the age of 50.

 Symptoms of Trigger Thumb:

The symptoms of trigger thumb usually develop gradually and become worse over time. The most common symptoms of trigger thumb include:

·       Pain and stiffness of the thumb

·       Clicking or popping sensation when the thumb bends or straightens (be be painful or pain-free)

·       Difficulty moving the thumb

·       Swelling at the base of the thumb (sometimes a lump or a nodule can be felt)

 Diagnosis of Trigger Thumb:

If you experience any of the symptoms mentioned above, you should consult an Accredited Hand Therapist (as awarded by the Australian Hand Therapy Association). Your hand therapist will perform a physical examination, and ask about your medical history and symptoms. Often trigger thumb can be diagnosed with thorough physical assessment alone, however if clinically appropriate, your hand therapist may recommend imaging tests such as an X-ray or ultrasound to rule out other conditions that may cause similar symptoms, such as arthritis.

Treatment of Trigger Thumb:

The treatment of trigger thumb depends on the severity of the condition. In most cases, your hand therapist will likely recommend wearing a custom-made splint to immobilise the thumb which will allow the inflammation to settle and allow the tendon to glide freely through the pulley. The type of splint will vary, and will depend on the severity of the condition and the needs of the individual. People with trigger thumb often need to wear this splint for 4 – 6 weeks, and the hand therapist will prescribe specific gentle exercises to ensure that the joints do not become stiff during this process.

In more severe cases, or in individuals who have had trigger thumb for a longer period of time, a cortisone injection may be required in conjunction with splinting, to reduce the inflammation and relieve pain. The injection is given directly into the affected area under the guidance of ultrasound. Cortisone injections can often help to settle down the symptoms, however it is important to note that these injections are not 100% effective and sometimes individuals do not feel relief following this treatment. Additionally, cortisone injections should not be given too frequently as they may weaken the tendon and cause further damage.

If these treatments are ineffective in settling down trigger thumb symptoms, surgery may be necessary. The surgery involves making a small incision at the base of the thumb, over the pulley, to relieve pressure and allow the tendon to move smoothly. The procedure can be done either under general or local anaesthesia (depending on surgeon and individual preference). Following surgery, recovery time is relatively short and involves wound and scar management, and some gentle exercises.

Prevention of Trigger Thumb:

Although trigger thumb is not always preventable, there are some steps you can take to reduce the risk of developing the condition (especially if you have known arthritis of the hand). These include:

·       Avoiding repetitive activities that require lots of bending and straightening of the thumb

·       Taking frequent breaks during activities that require repeated motion of the thumb (e.g. pruning in the garden)

·       Put down that stress ball! Often people think that these symptoms require squeezing of a stress ball to assist strengthen the muscles in the hand – often repetitive motions like this can cause trigger thumb (or trigger finger) and make the condition much worse!

·       If you notice any of the above symptoms as listed above, make sure that you get in contact with a hand therapist ASAP (early treatment often leads to improved results)!

Trigger thumb is a common condition that can affect anyone, but it is more common in people above the age of 50. The condition causes pain, stiffness, and difficulty moving the thumb. If you experience any of these symptoms, you should consult an Accredited Hand Therapist (as awarded by the Australian Hand Therapy Association), such as Insight Hand Therapy. Treatment of trigger thumb depends on the severity of the condition and may involve wearing a custom splint, cortisone injections, or surgery (in severe cases). Taking preventive measures, such as avoiding repetitive activities or taking frequent breaks in activities that require repeated motion of the thumb, can help reduce the risk of developing trigger thumb.