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. 2018 Aug 1;30(4):209–216. doi: 10.1089/acu.2018.29093.cpl

How Do You Treat Trigger Finger in Your Practice?

PMCID: PMC7497977  PMID: 32952778

Trigger finger is a condition in which a finger gets locked in a bent position due to tendinitis or tenosynovitis of the digital flexor. Normally, the tendon glides smoothly within the surrounding sheath. In trigger finger, the inflamed tendon can move out of the sheath when the finger is flexed, and when the finger is extended, it cannot move back into the sheath due to swelling. The finger then locks in a flexed position. When the finger is extended forcibly, it pops back into the sheath with a sensation similar to pulling a trigger.

French physician Alphonse Notta, MD, PhD, described this condition in 1850 and the associated tendon sheath swelling was called “Notta's node.”1 Any digit can be affected in adults, but, in children, the thumb is affected in 93%–97% of cases.2,3 This condition is one of the most common causes of hand pain, and the reported prevalence is 2% of the general population.4 The incidence rises to 17% in patients with diabetes.5 The cause is unknown; predisposing factors other than diabetes include female sex, rheumatoid arthritis, repetitive forceful use of a hand, and carpal tunnel surgery.

Diagnosis is made simply by taking a history and conducting a physical examination; no tests are required. Dupuytren's contracture can also cause flexion of the finger. In this case, scarlike bands are obvious in the palm. In trigger finger, the bent finger can be extended forcibly; in Dupuytren's contracture, this is not possible.

Modern biomedicine treatment involves corticosteroid injection (with a 57% success rate), percutaneous needle release (with a 100% success rate), and open surgical release (with a 100% success rate).6

Trigger Finger in Chinese Medicine

Tenosynovitis of flexor of the digitorum muscle falls within the domain of sinew blockage caused by injury to muscle meridians, which, in turn, causes obstruction of the flow of Qi and Blood. The muscle meridians are the media through which the principal meridians (PMs) exert their influence on the muscles and tendons and, like the PMs, there are twelve muscle meridians. They start at the Tingwell points like PMs and follow generally the same course as PMs but with two differences: (1) The flow of Qi in the muscle meridians is always from the periphery to the center (centripetal) irrespective of the direction of the flow in the PMs to which they belong; and (2) the muscle meridians have no connection with the internal organs. The three Yang muscle meridians of the upper extremities unite at GB 13 and the three Yin muscle meridians of the upper limbs unite at GB 22. These meeting points are important for their treatment applications.

Treatment with Acupuncture

To facilitate the flow of Qi in the involved muscle channel, reinforce the Tingwell, Tonification, and Meeting points. See Table 1. For example, if the index finger is involved, the LI channel is implicated. Reinforce LI 1 (the Tingwell point), LI 11 (the Tonification point), and GB 13 (the Meeting point). These points are reinforced bilaterally, except the Tonification point, which is stimulated only on the side of the lesion to create an asymmetrical stimulation, which is more dynamic.

Table 1.

Tingwell, Tonification, & Meeting Points for Arm-Muscle Meridians

Meridian Tingwell points Tonification points Meeting points
Lung LU 11 LU 9 GB 22
Large Intestine LI 1 LI 11 GB 13
Pericardium PC 9 PC 9 GB 22
Triple Burner TB 1 TB 3 GB 13
Heart HT 9 HT 9 GB 22
Small Intestine SI 1 SI 3 GB 13

Reduce the AhShi points. It is done better using 3–4 needles inserted in different directions. Treat daily or on alternate days; 10–15 treatments constitute 1 course. Electronic stimulation (reducing) using Pointer Excel 2 will make the treatment painless. In the majority of cases, this would be sufficient. If the condition is resistant, there is usually an underlying pathology involving Wind and Dampness. In such cases, reinforce:

  • BaXie Extra points

  • LI 3, TB 3, SI 3, and SI 5 to expel Wind and Dampness

  • TB 5 to stimulate the flow of Blood and Qi in the fingers

  • GB 34, an influential point for muscles.

A local injection of 5% Angelica sinensis with 1% procaine is recommended by some practitioners. The current author has no experience with this.

Evidence for Acupuncture

Inoue et al. reported that visual analogue scores for pain and snapping severity were improved significantly in 15 patients (in a total of 19 fingers) after acupuncture.7 Lee et al. reported a case in which bee venom acupuncture was used successfully in a patient who had side-effects following steroid injections.8 Kim et al. reported a case of trigger finger that improved with Hominis placenta pharmacoacupuncture.9 Lee et al. reported a case of trigger finger (of the thumb) that improved considerably following tendinomuscular meridian acupuncture, moxibustion, and bee venom pharmacoacupuncture.10 Schulman et al. reported a case of trigger finger in a patient with diabetes who was treated successfully with acupuncture and osteopathic manipulation.11 Diabetics are generally more resistant to treatment; the success rate for percutaneous release is 95%.12

The evidence for acupuncture for treating trigger finger is thin; it has not been researched sufficiently. This is probably because, despite the fact that acupuncture is effective, modern biomedicine treatment involving percutaneous tendon release is only minimally invasive and is almost 100% successful.

References

  • 1.Clapham PJ, Chung KC. A historical perspective of the Notta's node in trigger fingers. J Hand Surg Am. 2009;34(8):1518–1522 [DOI] [PMC free article] [PubMed] [Google Scholar]
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  • 12.Arief M, Patel M. Comparison of cortisone injection and percutaneous trigger finger release for diabetic trigger fingers in 293 patients: Level 1 evidence. [abstr]. 68th Annual Meeting of the ASSH Meeting Abstracts: Education Through Technology, San Francisco, CA, October 3–5, 2013. In: J Hand Surg. 2013;10(38):e3 [Google Scholar]

Address Correspondence to:

Poovadan Sudhakaran, MBBS, PhD

MastACU, MastTCM

26 Tuckers Road

Templestowe 3106

Australia

dr.p.sudhakaran@gmail.com

Trigger finger (also called stenosing flexor tenosynovitis) is due to the disproportionate size of the flexor tendons and the surrounding retinacular pulley system at the first annular pulley (A1) overlying the metacarpophalangeal joint.1 The condition causes pain, clicking, locking, and reduced range of motion (ROM) of the affected finger.1 Trigger finger is seen commonly in patients suffering from diabetes or rheumatoid arthritis, is more common among women, and is typically noted in the fifth to sixth decade of their lives.2 Although the specific cause is not known, overuse of the joint is the most common associated factor. The mainstay treatment options are rest, splinting, corticosteroid injection, nonsurgical manipulation, and minor surgery (in complicated cases).3,4

Acupuncture, a salient therapy in the systems of Oriental Medicine and Traditional Chinese Medicine (TCM), works on the principle of regulating the flow of Qi (subtle energy) in terms of balancing two opposite forces. These forces are Yin (the passive, feminine, and sustaining principle of the Universe) and Yang (the active, masculine, and creative principle of the Universe). Acupuncture is performed by inserting fine needles along the meridians (subtle energy channels) to restore and maintain health.

Case

Mrs. S.L., a 46-year-old female with diabetes, came to our Integrated Centre for Yoga with chief complaints of severe pain in her index finger, stiffness, and reduced ROM of the finger that had lasted for 8 months. On examination, it was noted that there was tenderness at the base of the palmar aspect of the fingers and flexion deformity of the index finger. Snapping was observed when the patient attempted to extend her finger from its flexed position at its metacarpophalangeal joint. In addition, a small palpable nodule that moved along with movement of the index finger was seen at its base. This patient's pain was aggravated by household chores and was reduced when she rested.

Her pulse examination revealed Excess energy in the Gall Bladder and less energy in the Large Intestine and Spleen. According to TCM, trigger finger and other musculotendinous disorders result from vitiation of the Wood element with an Excess of Yang in its meridian, resulting in an inflammatory process.5 Thus, this patient's therapy was aimed at dispersing the Excess Yang from the Gall Bladder meridian. The points chosen were analgesic local points and influential points for treating the muscles and tendons. A series of 7 acupuncture sessions were given, each of 30 minutes' duration.1 1-Tsun needles were used, and the points shown in Table 2 were punctured.6 Figure 1 shows important acupuncture points for trigger finger.

Table 2.

The Points Used in Treating Trigger Finger

S.N. Acupuncture point used Needling Stimulation
1 GB 34 bilaterally (Yanglingquan) 0.5 cun
slightly oblique
Electrical stimulation
2 ST 36 (Zusanli) 1 cun
perpendicular
Nil
3 LI 2 (Erjian) 0.2 cun
slant
Electrical stimulation
4 LI 3 (Sanjain) 0.2 cun
slant
Electrical stimulation
5 LI 4 (Hegu) 0.5 cun
perpendicular
Electrical stimulation
6 LI 11 (QuChi) 0.5–0.8 cun
perpendicular
Nil
7 SP 10 (Xuehai) 1 cun
perpendicular
Nil
8 AhShi points Points of most tenderness around the inflamed area Nil

S.N., serial number.

FIG. 1.

FIG. 1.

Important acupuncture points for trigger finger.

This patient was able resume her activities comfortably. Her pain, tenderness, and severity of snapping were reduced by 80%, as shown on a visual analogue scale, with improvement in ease of extension from a flexed position at the corresponding metacarpophalangeal joint after the acupuncture sessions were completed.

References

  • 1.Makkouk AH, Oetgen ME, Swigart CR, Dodds SD. Trigger finger: Etiology, evaluation, and treatment. Curr Rev Musculoskelet Med. 2008;1(2):92–96 [DOI] [PMC free article] [PubMed] [Google Scholar]
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Nishitha Jasti, BNYS and Hemant Bhargav, MBBS, MD, PhD

Address correspondence to:

Nishitha Jasti

Department of Psychiatry

Integrated Centre for Yoga

National Institute of Mental Health and Neuro Sciences

Hosur Road

Bangaluru 560029, Karnataka

India

nishitha.jasti910@gmail.com

For the trigger finger cases that present to our clinics, we use a neuroanatomical approach for acupuncture-point section. Specifically, the evaluation and resulting acupuncture treatment target the motor points of both the agonist and antagonist muscles that contribute toward wrist and finger flexion. Trigger finger is a condition that manifests itself when the A1 pulley becomes inflamed and thickened. This physiologic change prevents the flexor tendon from passing smoothly through the tendon sheath. Clinically, this presents as clicking or snapping of the flexor tendon along the affected phalange. Although trigger finger affects an isolated tendon, the effect on the finger's primary muscle (the flexor digitorum profundus) and its antagonist (the extensor digitorum communis) can cause motor muscle inhibition of one or both muscles. By targeting the motor points of the agonist and antagonist muscles of the forearm and finger flexors, the treatment goal is to both (1) correct alpha motor nerve inhibition and (2) reduce neurogenic inflammation. In turn, by correcting both the levels of neurogenic inflammation and the motor nerve inhibition, the patient's pain will be reduced.1,2

The alpha motor neuron is the most powerful influence on both muscle tone and activation. Multiple sources of neural input, both excitatory and inhibitory, are required for normal functioning of the alpha motor neurons. The sum of all these inputs determines the amount of muscle tone and activation. When pathology or injury affects alpha motor neurons, their innervated muscles, or their complete motor units, clinically, there might be abnormalities in muscle tone and activation.3 In the case of trigger finger, the muscle tone and activation of the forearm and wrist flexors (the flexor digitorum profundus and extensor digitorum communis) are affected. Clinically, the patient will complain of muscle weakness or immobility.

Neurogenic inflammation—which is present in the A1 pulley region of the trigger finger—is generated by nerve impulses and the release of inflammatory substances from the sensory axon (1 or more cutaneous nerves of the forearm) at the site of the original injury. These substances are typically, but not limited to, substance P (SP), calcitonin gene-related peptide (CGRP), and neurokinin-A (NKA). The innervating nerves involved with trigger finger are the anterior interosseous nerve (a branch of the median nerve) and the posterior interosseous nerve (a deep branch of the radial nerve). Prolonged inflammation and pain can lead to protective muscle spasm, accumulation of fibrous tissue, and muscle shortening. Muscle spasm and shortening led to nociception, compression of blood vessels, and decreased joint mobility. Within the fibrous tissue are palpable taut muscle bands and trigger points.4

Assessment

Clinical evaluation of these above structures is both a combination of range of motion (ROM) testing, observational inspection, and palpatory examination. We assess the primary muscle (the flexor digitorum profundus) and its antagonist (the extensor digitorum communis), using a combination of manual palpation and ROM examination.

The patient rests the forearm, wrist, and hand in a neutral position on the examination table. ROM testing of both the flexor digitorum profundus (SI 7) and the extensor digitorum communis (LI 10) is performed to determine the extent of passive and active mobilization of these structures. Restrictions and inhibitions are noted. Deep palpation is used to check for myotomal trigger points. The palpatory examination should include the region of the upper arm and shoulder, particularly those that are innervated by the lower trunk of the brachial plexus (anconeus [TH 10], triceps [SI 9], latissimus dorsi [GB 22], pectoralis major [LU 1], and pectoralis minor [Lu 1′]).

We assess the corresponding spinal segmental levels via palpatory examination for any spinal segmental changes. Palpation is performed both at the somatic spinal levels (C-7 to T-1) and the sympathetic spinal levels (T-1 to T-5). The location is at the multifidi muscles. The assessment is performed as follows:

  • (1)

    A skin pinch and roll to test for allodynia

  • (2)

    A scratch test to check for hyperalgesia

  • (3)

    Deep palpation of the paraspinal muscles to check for myotome trigger points.

We assess the anterior interosseous nerve (PC 4) and posterior interosseous nerve (TH 5) via manual palpation and observation. These three nerves are evaluated manually via the skin pinch and roll test and the scratch test. These tests are used to assess for tissue trophic changes, which are signs of neurogenic inflammation. Examining the surrounding areas of these nerves is performed to check for edema and redness.

Finally, assessment of the A1 pulley and the neighboring tendons is performed via manual palpation. Palpation of the affected tendon is compared to the neighboring tendons to assess the integrity of the tissue and to check for signs of trophic changes.

Determining Needle Location

The following helps us determine the locations for needling:

  • Flexor digitorum superficialis motor point location: We bisect the anterior wrist crease and the cubital fossa, insert the needle ulnarly 1–2 cm, and use a Pointer Plus stimulation unit is to confirm point location.

  • Flexor digitorum profundus (SI 7) motor point location: We place the tip of the little finger on the olecranon and place remaining fingers along the shaft of the ulna. We insert the needle just beyond the tip of the index finger. The ulnar innervated portion is 2–3 cm deep.5 The Pointer Plus stimulation unit is used to confirm point location.

  • • Extensor digitorum communis (LI 10) motor point location: This is 8 cun distal from the lateral epicondyle. We insert the needle 1–2 cm. The Pointer Plus stimulation unit is used to confirm point location.

  • Multifidus motor point (Hua tuo jiaji line) motor point location: We locate the spinous process of the corresponding somatic (C-7 to T-1) and sympathetic (T-1 to T-5) vertebral level and then move 0.5 cun lateral. We insert the needle 2–3 cm.

  • Anterior interosseous nerve (deep branch of median nerve; PC4) nerve location: This is in the anterior antebrachial region, 5 cun proximal to the anterior crease of the wrist on the ulnar side of the flexor carpi radialis muscle. We insert the needle 1–2 cm. The Pointer Plus stimulation unit is used to confirm point location.

  • • Posterior interosseous nerve (deep branch of radial nerve; TH 5) nerve location: This is in the posterior antebrachial region, 2 cun proximal to the dorsal crease of the wrist on the line connecting TH 4 and the tip of the olecranon. We insert the needle 1–2 cm. The Pointer Plus stimulation unit is used to confirm point location.

  • A1 pulley location: This is at a site proximal to the metacarpal of the fourth digit, which holds the flexor tendon to the bone tightly. Three different points are used: (1) the AhShi point at the A1 pulley; and (2) 2 BaXie points (2 needles) at approximately the fourth digit.

Treatment

After locating the motor points of the flexor digitorum profundus and extensor digitorum, we insert 2 needles should in each motor point. Using two separate Ito-ES-130 mA stimulation units (or comparable models), we attach alligator clips to each muscle (with 1 lead on the flexor side and 1 lead on the extensor side).

We start at the extensor side first at 100 Hz; this puts the hand into extension causing the trigger finger to come out of flexion. The extensor compartment remains in tetany resulting in the fingers being extended. Then, we start at the flexor side at 1 Hz; this stimulation causes flexion of the phalanges while the phalanges remain in tetanic extension. This off-setting stimulation treatment lasts 20 minutes.

Depending on the abnormalities found during the evaluation of the other structures, the other needles are placed into their respective points. The points corresponding to the agonist and antagonist nerves are linked together via alligator clips and stimulated at 100 Hz. The patient should feel the nerve stimulation as a nonnoxious sensation. The points corresponding to the A1 pulley and the BaXie points are linked together via alligator clips and stimulated at 100 Hz. Finally, the spinal segmental points are placed and linked together via alligator clips. The spinal segmental points are stimulated at 1 Hz. These points are treated, also for 20 minutes, at the same time as the above motor points.

Case Study

A 35-year-old male presented with right, fourth-digit trigger finger of 1 year's duration. He noted that this finger would “stick” when he awoke in the morning and that this limited his ability to do fine manipulation and motor tasks, such as buttoning clothes and typing. He had not had treatment for this condition.

Assessment

A visual inspection of the trigger finger, compared to all of the other phalanges, revealed that the affected phalange was locked in a flexed position at the proximal interphalangeal joint. Palpation revealed a thickening of the “triggering” A1 pulley tendon and trophic changes around the surrounding tissues, including the forearm flexor compartment (the flexor digitorum profundus and superficialis). Palpation of the anterior and posterior interosseous nerves revealed tenderness. Palpation of the spinal segmental levels of C-7 to T-1 and T-1 to T-5 revealed trophic changes. On a visual analogue scale (VAS), this patient reported pain a level of 8/10.

Treatment

The needle combination of SI 7 to LI 10 was linked via alligator clips and stimulated via the abovementioned off-setting stimulation treatment (1 Hz and 100 Hz). The A1 pulley and the BaXie points were needled, linked together via alligator clips, and stimulated at 100 Hz. Finally, the spinal segmental points of C-7 to T-1 and T-1 to T-5 were needled, linked together via alligator clips, and stimulated at 1 Hz. The treatment lasted 20 minutes. Treatment was repeated once per week for 3 weeks. After his first visit, the patient was fitted with a generic trigger finger split that could be found readily at a pharmacy.

Outcome

The patient was symptom-free for 4 weeks following the final third visit. He patient reported a pain level of 1/10 on the VAS.

References
  • 1.Lund JP, Donga R, Widmer CG, Stohler CS. The pain-adaptation model: A discussion of the relationship between chronic musculoskeletal pain and motor activity. Can J Physiol Pharmacol. 1991;69(5):683–694 [DOI] [PubMed] [Google Scholar]
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Joseph Walker III, MD1

and Anthony Lombardi, DC2

1University of Connecticut, Farmington, CT

2Hamilton, Ontario Canada

Address correspondence to:

Joseph Walker III, MD

University of Connecticut

263 Farmington Avenue

Farmington, CT 06030

jwalker@uchc.edu

Trigger finger or stenosing tenosynovitis is a medicosurgical condition that causes pain, stiffness (particularly in the morning), and a sensation of locking or catching when the affected finger is bent or straightened. Trigger finger, a form of tendinopathy,1 can affect any finger, including the thumb of 1 or both hands. The condition often develops in patients with diabetes mellitus, gout, or rheumatoid arthritis. Predictive risk factors for trigger finger include—but are not limited to—female sex, age (50–70), repeated traumas, overuse (repeated gripping), and farmer or dental hygienist occupations. Trigger finger could be idiopathic, characterized by a “dark tendon sign” on sonography.2 This condition is caused by local swelling from inflammation (tenosynovitis) or thickening or scarring of the protective fibrous sheath around the superficial and deep flexor tendons that normally flex the affected digit inward toward the palm. Increased stiffness and thickening of the A1 pulley are considered to be the main causes for snapping symptoms in trigger digits.3,4

Patients with trigger finger need careful assessment—including complete history taking along with physical and systemic examinations—to make a precise diagnosis not only of trigger finger but also other associated physical diseases, such as carpal tunnel syndrome, degenerative joint diseases, de Quervain's syndrome, Dupuytren's contracture, and diabetes mellitus.5 This assessment is used to choose appropriate treatment interventions. In addition to histopathologic, sonographic, and imaging findings,6,7 sonoelastography also helps in quantitative assessment of the stiffness involved in the patient's trigger finger.3 The patient should be advised to seek consultation if the trigger finger joint is hot and inflamed (these are signs of infection) along with stiffness, catching, numbness, pain, and difficulty in straightening or bending the finger. Management of trigger finger varies, depending on its severity, duration, previous treatments received, and comorbid conditions. Pharmacologic and nonpharmacologic treatments, including surgery, benefit patients with trigger finger.1,8,9

Acupuncture is an ancient traditional Chinese modality used effectively in patients with trigger finger and involves the application of fine disposable needles, heat, or acupressure to the affected finger. The traditional mechanism of medical acupuncture is through distribution of Qi energy along the meridian energy channels to balance the Yin (negative) and Yang (positive) forces and unblocking Stagnation from the affected finger. Manual or electroacupuncture (EA) helps improve Blood flow to the affected finger, decrease inflammation through humoral factors, and reduce pain by stimulating multiple neuroreceptors in the spinal cord and up in the brain to produce endorphins (i.e., enkephalin and dynorphin).10,11 Furthermore release of adenosine—which acts on adenosine A1 receptors in interstitial fluid—by traditional acupuncture has also been reported to reduce pain in human subjects.12 Most importantly, the acupuncturist should rotate the needles inserted into the Zusanli point (ST 36), which is the most frequently used acupuncture point.

Following diagnosis, a typical case of trigger finger needs a treatment plan that, depending on multiple socioclinical factors, may include biomedical interventions—such as rest, special hand exercises, soaking and massage, splinting, short-term use of nonsteroidal anti-inflammatory drugs, steroid injections, and surgery (percutaneous release of the tendon). Complementary therapies—such as medical acupuncture, cupping (Hijamah) therapy, and medicinal herbs used mainly in Traditional Chinese Medicine—may also be used.

In the clinical setting, acupuncture needling details for trigger finger in 1 session are as follows: 4–5 needle insertions; several acupuncture points related to trigger finger (Archi or Arshi along the bumpy nodule) are used (361 points have been identified in the body); BaXie acupoints (8 points) on the dorsi of both hands (i.e., the creases between 2 fingers); Jing Well acupoints on the tips of fingers; acupoints on the sides of the fingers; and 10 Lung meridian (LU1–LU11) points on the thumb (between the A1 pulley and the midline of Interphalangeal crease). Acupoints are chosen according to the affected finger in 1 (unilateral) or both hands (bilateral). The depth of needle insertion needs to be 3 to ∼5 mm. The needle insertion time should be 25 to ∼30 minutes. The needles should be 0.25 × 30 mm, stainless-steel, disposable filiform acupuncture needles. The number of treatment sessions varies and may be up to 18 times; thus, frequency and duration of treatment sessions can be up to 2–3 times per week. The needles need to be manually rotated or stimulated by electrical means for achieving the De Qi sensation.

This acupuncture therapy procedure for trigger finger might not work for every patient. Notably, with an integrative medicine model that includes acupuncture combined with other complementary and alternative medicine (CAM) and Non-CAM approaches, most patients with trigger finger tend to recover completely without any complications.

There are many scientific studies, including case reports, that support the efficacy of several types of acupuncture (traditional/manual, burning, EA, laser, bee venom, clinical, and medical) used to treat trigger finger. Effective rates vary from 90.5% to 100%.13–17 Notably, acupuncture performed with filiform needles (once per week, each session with 5 treatments, and each treatment lasting 20–30 minutes) and using traditional techniques in light of acupotomology principles was shown to be effective for treating stenosing tenosynovitis and produced improvement in 94.44% patients with stenosing tenosynovitis. Acupuncture is often combined with other modalities—such as acupoints massage, acupressure, osteopathic manipulations, and analgesics—for better therapeutic effects not only in patients with trigger finger18–21 but also in patients with many other conditions.

Trigger finger is a common condition in women that needs correct diagnosing by using advanced investigation tools and proper management by acupuncture, either alone or combined with other therapies, to achieve better outcomes. Acupuncturists should conduct randomized clinical studies; these are globally lacking especially trials for trigger finger.

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Naseem Akhtar Qureshi MD, PhD,1,2

and Saud Mohammed Alsanad, PhD1,3

1National Center for Complementary and Alternative Medicine

2Ministry of Health, and 3College of Medicine

Imam Mohammad Ibn Saud Islamic University (IMSIU)

Riyadh, Saudi Arabia

Address correspondence to:

Naseem Akhtar Qureshi MD, PhD

National Center of Complementary and Alternative Medicine

Almizan Street

AlFalah Block

Riyadh 11662

Saudi Arabia

qureshinaseem@live.com

Only limited research has been done to evaluate the effectiveness of acupuncture for treatment of trigger finger,1 and patients or medical practitioners rarely consider acupuncture as a viable treatment option for the condition.2,3 From my personal experience, trigger finger can be treated effectively with acupuncture, but, for best results, the exact location of points needs to be identified specifically for each individual patient and modified for each individual treatment session. Without modifications, using classical acupuncture points and treatment according to Traditional Chinese Medicine's differential diagnosis, I was rarely successful, but, with modifications, about half of my patients reported complete or significant relief of their symptoms. It is highly probable that further, similar modifications of acupuncture treatment can lead to higher success rates.

Two important factors need to be considered when treating trigger finger with acupuncture: (1) the nodule on the tendon that causes the condition needs to be identified; and (2) acupuncture needles need to penetrate the surface of the nodule. Let me consider the treatment in more detail.

Typically, there is only 1 nodule on a tendon of a flexor muscle located on a finger, but, in some instances, there can be more than 1 nodule, possibly as a result of repeated injuries to the same finger. In any case, different aspects on different nodule(s) produce different degrees of the symptoms of trigger finger. Only one aspect of 1 nodule—or, on rare occasions, 2 nodules—however, produces most of the symptoms. The correct place on the nodule can be located in the following way: (1) as the patient reports which finger has this issue, I palpate the flexor tendons around the joint that locks until the nodule on the tendon is identified; and (2) while holding the palpating finger on the nodule, I have the patient flex and extend the finger. With every next flexion/extension, I press gently on the nodule at one specific angle per the patient's flexions and extensions. The pressure from one angle only decreases the locking effect significantly—and that is the aspect of the nodule that is needed for a successful treatment outcome.

In order to avoid recurrence of trigger finger, it is imperative to ensure that the symptom-producing nodule on the flexor tendon dissipates completely. While different patients react differently to acupuncture treatment, most of the symptoms of trigger finger usually resolve after 3 or 4 sessions. For the fastest relief, acupuncture needles should be inserted in the aspect of the nodule where mild pressure on which reduces the symptoms of trigger finger more than any other areas on the nodule. More often than not, that area on the nodule feels the firmest. Usually, with each treatment, the intensity of trigger-finger symptoms diminishes, and finding the firmest, most effective points becomes increasingly more challenging. At the same time, the area of the nodule that is the most effective in treatment of a particular trigger finger can migrate to different areas of the nodules with each passing treatment. That is why careful palpation is crucial. In addition, the effective points tend to become smaller, which justifies using thinner needles (38 or 40 gauges) and inserting them in 2 steps: (1) After the nodule is identified through palpation, 3 or 4 needles are inserted in the direction of the nodule; then, (2) I identify the active area of the nodule, again, through palpation, and insert each needle in that area's surface. I leave the needles in for 20 minutes, rotating the needles gently every 5 minutes.

References

  • 1.Inoue M, Nakajima M, Hojo T, Itoi M, Kitakoji H. Acupuncture for the treatment of trigger finger in adults: A prospective case series. Acupunct Med. 2016;34(5):392–397 [DOI] [PubMed] [Google Scholar]
  • 2.Amirfeyz R, McNinch R, Watts A, et al. Evidence-based management of adult trigger digits. J Hand Surg Eur Vol. 2017;42(5):473–480 [DOI] [PubMed] [Google Scholar]
  • 3.Nikolaou VS, Malahias MA, Kaseta MK, Sourlas I, Babis GC. Comparative clinical study of ultrasound-guided A1 pulley release vs open surgical intervention in the treatment of trigger finger. World J Orthop. 2017;8(2):163–169 [DOI] [PMC free article] [PubMed] [Google Scholar]

Address correspondence to:

Vladislav Korostyshevskiy, MS, LAc

2678 Ocean Avenue, Apartment # 2-E

Brooklyn, NY 11229

culexacu@gmail.com


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