Trigger Finger (Diabetic cheiroarthropathy)

P.Bamila

SeenaRajsekar

Dept. of Podiatry

Trigger finger or the stiff hand syndrome, is a frequent occurrence in people with diabetes.

Diabetes can affect the musculoskeletal system in a variety of ways. The metabolic changes in diabetes such as  glycosylation of proteins; microvascular abnormalities with damage to blood vessels and nerves; and collagen accumulation in skin and periarticular structures result in changes in the connective tissue.

Hands are a target for several diabetes-related complications. Diabetic cheiroarthropathy, also known as diabetic stiff hand syndrome or limited joint mobility syndrome, is found in 40–50% of all patients with type 1 diabetes and is also seen in people with type 2 diabetes. The longer the duration of diabetes, the greater is the occurrence.

 This condition is related to and predictive of other diabetic complications.

Contractures of the fingers known as flexion, may develop when the problem reaches advanced stages.

One of the most noticeable signs of trigger finger is the formation of the prayer sign. This is when the person is unable to completely close the gap between palms together and is an indicator of stiff-hand syndrome. 

Also, many people complain of a locking or catching sensation accompanied by pain in the fingers.

Cause and Risk factors for developing trigger finger:

• Trigger finger is more common in women than in men. 
• It occurs most frequently in people who are between the ages of 40 and 60 years of age. 
• Trigger finger is more common in people with certain medical problems, such as diabetes because of increased glycosylation of collagen in the skin and periarticular tissue, decreased collagen degradation, diabetic microangiopathy, and possibly diabetic neuropathy and rheumatoid arthritis. 
• Trigger finger may occur after activities that strain the hand. 

Symptoms

• Symptoms of trigger finger usually start without any injury, although they may follow a period of heavy hand use. Symptoms may include:
• A tender lump in the palm 
• Swelling 
• Catching or popping sensation in finger or thumb joints 
• Pain when bending or straightening the finger 

Stiffness and catching are likely to be worse after periods of inactivity, such as when you wake up in the morning. The fingers will often loosen up after some movement.

Examination:

• Trigger finger is usually diagnosed through X-rays.
• On examination a palpable nodule, usually in the area overlying the metacarpophalangeal joint, and thickening along the affected flexor tendon sheath on the palmar aspect of the finger and hand.
• The locking phenomenon may be reproduced with either active or passive finger flexion.
• Prayer sign of trigger finger.

Treatment:

• Rest. 
• Splinting. Wearing  a splint to keep the affected finger in an extended position for up to six weeks ,helps to rest the joint,
• Physical therapy-Exercises to improve motion, strength, and endurance in the wrist and hand are recommended.

• Avoiding repetitive gripping.
• Soaking in warm water/ice
• Soft tissue mobilization/massage /wax therapy
• Ultrasound therapy
• Phonophoresis
• Stretching-As the pain and irritation begin to ease, the muscles and other soft tissue can be gently stretched to allow the finger or thumb to bend without clicking or catching.
• Isometrics/ergonomics 
• Nonsteroidal anti-inflammatory drugs (NSAIDs).
• Steroids.
• Percutaneous trigger finger release.
• Surgery 
• Good glycemic control