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Rest is particularly important, because continued use of the thumb will continue to stimulate inflammation. One way to rest the thumb and wrist is to use a splint that extends over the thumb and wrist see the photograph. Clinicians don't agree about the best use of the splint; some think it should be worn continually for four to six weeks; others recommend wearing it only as needed for pain. A splint that immobilizes the thumb and wrist may be recommended for de Quervain's tenosynovitis.

For the pain, apply an ice pack to your wrist for 15 minutes every four to six hours and take a nonsteroidal anti-inflammatory drug NSAID such as ibuprofen or naproxen ask your doctor about the dose and how often you should take it. If your pain hasn't subsided after three weeks with these therapies, your clinician may recommend a steroid injection into the tendon sheath. If all of these measures fail, the next step may be surgery to open the sheath and make more room for the tendons.

Once the pain and swelling have calmed down, simple stretching exercises such as the one shown below can help you restore normal movement in your thumb and wrist. Massage the base of the thumb and palm of the hand before you start stretching. Stretch the thumb back with gentle pressure, and hold for five seconds.

Perform several sets of 20 stretches per day. Trigger finger is a painful condition in which a finger or thumb catches or becomes locked when you try to straighten or bend it. It gets its name from the trigger-like snap that occurs when the finger suddenly releases. Trigger finger is most likely to develop in a person's 40s and 50s, and it's about six times more common in women than in men.

What are the symptoms of trigger finger? The first symptom may be pain and a slight thickening at the base of the finger or thumb. The characteristic snapping sensation can develop gradually or start suddenly, and the pain may radiate to the palm or toward the end of the finger or thumb. You may find that the finger or thumb is locked toward the palm when you wake up and gradually releases over the course of the day.

The problem may seem to be at the middle knuckle of the finger or the top knuckle of the thumb, but it's actually at the base of the affected digit. Sometimes you can release a locked digit by massaging it at its base. Trigger finger can develop when the tendon is swollen or nodular and cannot move smoothly through the sheath that surrounds it. What causes trigger finger? Job-related repetitive movements may be a cause of trigger finger, but the research on this connection is conflicting.

Trigger finger is also associated with rheumatoid arthritis and diabetes. People with diabetes have an almost fourfold increased risk of developing trigger finger. Sometimes a cause for trigger finger can't be found. The problem arises when the tendon develops a knot nodule , or its lining synovial membrane becomes swollen.

As a result, instead of traveling smoothly through the fibrous sheath through which it passes, the tendon gets stuck see the illustration , causing pain and catching. Trigger finger can also occur because of inflammation or narrowing of the sheath. Either way, a vicious cycle develops: the more often the tendon catches, the greater the swelling and irritation, and the greater the swelling and irritation, the more the tendon catches. How is trigger finger diagnosed and treated? The main symptom of trigger finger is a history of locking or snapping while bending or extending the affected finger or thumb.

X-rays are unnecessary.

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Your clinician will check for pain and swelling at the base of the finger or thumb as you open and close your hand and perform other hand movements. Another condition, Dupuytren's contracture, can also cause difficulty straightening a finger, but it's usually painless. The first step in trigger finger treatment is to stop doing anything that aggravates the condition.

The second step is to immobilize the affected finger or thumb, either by taping it to an adjacent finger or by using a splint see the photograph. Splinting at night can be especially helpful in preventing the thumb or finger from becoming locked. If you still have severe locking or other symptoms after four to six weeks of immobilization, your doctor may recommend a steroid injection into the base of the affected finger or thumb. If the trigger finger symptoms still don't improve after another six weeks, she or he may recommend a second injection.

Nonsurgical treatment of trigger finger and de Quervain's is usually effective if begun early on and you discontinue any repetitive motions that caused or contributed to the problem in the first place. But when locking and pain persist, surgery may be recommended. Like the surgical procedure for de Quervain's tenosynovitis, surgery for trigger finger opens the sheath, which allows the tendon to glide through it more easily.

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