Trigger thumb

I had an opportunity to see a patient who presented ‘trigger thumb’.
On the initial evaluation, this patient presented c/o discomfort when heard the ‘clicking’ sound. Sometimes the thumb got stuck in one position and nothing could be done to release discomfort beside wait till resolved itself. There was no pain association with this condition at all.

In PE, there were no activities or any thumb movements which could possibly bring up the Sx such as ‘clicking’ sound or stuck the thumb in certain position. NAD on other exams, eg. AROM, PROM, PAMs, sensation and no patient’s discomfort at all. Basically I was treating this patient with no S & S of ‘Trigger thumb’ on the day. There was not much physio contribution in terms of intervention according to the literature and books, thus STM, gentle stretching and US were my first choice for this condition.

After each Rx component, clicking the thumb became visible more and more with thumb flexion. By the end of US, the thumb was clicking all the time. At that point, I felt very terrible because all what I did made the patient worse. Before the Rx started this patient was instructed there was limited what we could do to this condition and the Rx may or may not contribute to release the S & S, and this patient understood well. But even so, I did not expect the S & S would get worse.

On the 2nd visit, the patient reported there was still ‘clicking’ sound in occasion, but no ‘stuck in one position’ of the thumb since last Rx. The patient thought the previous Rx did help some and was happy to do the same thing again. I was not 100% sure the previous Rx did help or not, but the patient was happy to proceed the same Rx so the same procedure was conducted.

Again, no S&S pre Rx and S&S was brought up post Rx with every thumb movements. At that stage, I was thinking any of my intervention was some how triggering the ‘trigger thumb’, even though the patient reported it helped some.

I need to come up any other techniques in terms of physio intervention which at least do not increase S&S for this patient’s next visit. Does anyone have any idea? I searched in several books, but no luck.

There is most common Rx used for non-surgical Rx that is corticosteroid injection to the tendon sheath or mid-axial area, but this is not conducted by physio. Taking NSAID is another way to reduce inflammation. If the conventional Rx failed, surgical procedure would be the option to release the narrowed tendon sheath. Percutaneous procedure is getting popular recently, over open-cut procedure, which is releasing A1 pulley and very safe, effective, and quick procedure (takes 15 mins under local anesthesia in Dr’s office) without any complications. Again, this is not done by physio. So anyone has any idea?