Updated: Jan 21
In my 15+ year career as a hand therapist, I have worked with a multitude of patients with trigger fingers and trigger thumbs. I have helped many patients with mild symptoms improve with conservative hand therapy treatments, however, moderate cases are typically given a corticosteroid injection and severe cases may need a surgical release. In the medical books & journals I’ve read and hand therapy courses that I’ve taken, the focus has been on the biomechanical causes of trigger finger and the relationship of trigger finger to other conditions, like diabetes. “Several causes of trigger finger have been proposed, though the precise etiology has not been elucidated.” (1) I’ve noticed that most articles, like the one just quoted, do not include the word nutrition within them.
In my recent studies about Nutritional Therapy, I’ve learned how dietary habits and nutritional deficiencies can impact common inflammatory hand conditions, like tendinitis and trigger finger/thumb. It is my personal quest to educate my patients and clients, fellow hand therapists and other health professionals about the important role of nutrition in conjunction with traditional hand therapy. Within this post, I will describe the incidence, etiology, and presentation of trigger finger and then focus on the nutritional issues that can impact the development and resolution of trigger finger.
Trigger finger/thumb is one of the most common causes of hand pain in adults. The reported prevalence is 2-3 % of the general population and most often appears in the middle 5th and 6th decades of life (2). It occurs up to 6 times more frequently in women (1). The risk of developing trigger finger increases up to 10% in diabetics. There also appears to be a higher risk in patients with carpal tunnel syndrome, de Quervain’s disease (thumb abductor tendinitis), hypothyroidism, rheumatoid arthritis, renal disease and amyloidosis (abnormal proteins deposited into organs and tissues). The ring finger is most commonly affected, followed by the thumb (1). The long, index and small fingers can also be affected and some people develop multiple trigger digits.
Trigger finger earns its name from the painful popping or clicking sound when the involved digit is bent and straightened. It was first described in 1850 by Notta (1). It is caused by a difference in the diameter of a flexor tendon and its retinacular sheath, due to thickening and narrowing of the sheath (1). Repetitive finger movements and local trauma to the base of the finger/thumb are proposed causes. There are reports linking trigger finger to occupations requiring extensive gripping and finger flexion, such as the use of shears or hand held tools. However, this relationship is questionable, with studies finding no association between trigger finger and the workplace. “In reality the causes of trigger finger are multiple and in each individual often multifactorial” (1).
The symptoms of trigger finger may begin as a painless clicking with finger motion. Further development can cause painful catching or popping and progress into the finger “locking” up. A painful nodule (firm bump) may be felt at the base of the finger on the palm side. The nodule is a thickened area that typically occurs where the finger flexor tendons enter the synovial sheath (a tube enclosing the tendons) and glide under the A1 ligament. Each finger and thumb have a flexor pulley system made up of a series of fibrous bands called annular ligaments and cruciate pulleys (as well as an oblique pulley in the thumb). These bands keep the tendons gliding close to the bones to prevent “bowstringing” which is likened to trying to reel in a fish on a fishing pole with no eyelets. The first A1 ligament, located at the base of finger/thumb, receives the most friction. With repetitive stress (and poor recovery from poor nutrition) the ligament can become inflamed. The body thickens the pulley to "strengthen" it to better withstand the stress but this becomes a problem because the increased thickness puts pressure on the tendons which creates a negative reinforcement loop. The tendons themselves can develop a thickened lump as they try to adapt to the increased stress. The "trigger" begins when the lump begins to catch on the thickened pulley. As you can see in the simplified image below, the lump gets stuck as it tries to glide under the pulley and the finger gets locked into flexion or extension, but flexion (being bent) is most commonly seen.
Some patients notice a feeling of stiffness and then a progressive loss of full flexion or extension without ever developing the catching and locking of a “typical” trigger finger. Some patients report stiffness or swelling in the morning or that they wake up with the digit locked and then it loosens during the day. Initially, the locking can be released with active extension (attempting to straighten the finger). Since the flexors of the hand are 3-4 times stronger than the extensors, overtime the finger can lock up so firmly that it requires a manual release from the other hand. Because this manipulation is very painful, patients tend to try to avoid the triggering and reduce that finger's motion, which then creates secondary stiffness and the development of PIP joint contractures (limited motion of middle knuckle).
Working for many years as a hand therapist, the treatments that I commonly provide for trigger finger and trigger thumb are as follows:
1) Splinting to limit full flexion (bending) to prevent catching/locking.
2) Passive exercises, using the other hand, to move the affected finger into full flexion and extension in order to decrease stiffness and prevent joint contractures. If the finger remains relaxed, it can be moved by the other hand without catching because the tendon inside is not being pulled by an active muscle contraction.
3) Stretching the flexor muscles of the fingers (located in the forearm) to decrease tightness.
4) Ice massage to the inflamed nodule 2-3 times a day for 2 weeks.
Patients who are persistent with these treatments and avoid catching/locking for 6-8 weeks have the best outcomes, however, all hand therapists know that trigger fingers often reoccur. I now believe that this is likely due to underlying nutritional issues not being addressed. Providing education about proper hydration and nutrition, along with traditional treatments, can be effective in reducing and preventing reoccurrence of trigger finger and thumb.
Common Nutritional Issues that relate to Trigger Finger/Thumb:
1) Dehydration: There is increasing evidence that even mild dehydration plays a role in the development of chronic diseases (3). To learn the ideal amount to drink for your body weight, please read my first blog post titled the #1 Ingredient for Healthy & Flexible Joints: https://www.holistichandhealth.com/blog-1
2) Lack of Magnesium: Magnesium is a mineral that helps muscles relax and allows the body to utilize calcium optimally. 50% of Americans are deficient in magnesium which worsens with age (as evidenced in 80% of the elderly). Lack of magnesium causes muscles to get tight and stay tight. As noted above, when a muscle contracts and compresses it's tendon against the A1 ligament, the body tries to make the ligament “stronger” by building up tough connective tissue to help withstand the compression (4). Supplementing with Magnesium Glycinate, Mag L-Threonate or Magnesium Citrate (note the citrate form has a laxative effect) can be helpful. A standard dosage of 250-300 mg before bed is recommended, however, some people may need higher doses. As a Nutritional Therapist, I tailor the dosage and form of Magnesium to fit each client’s needs.
3) Lack of Vitamin B6 and B12: These B vitamins impact the ability of the body to utilize magnesium so supplementing with magnesium alone is often not enough. A B6 deficiency is linked to increased pain perception and since the body/mind doesn’t like pain, it will react in ways to try to reduce pain = a thickened A1 ligament = which paradoxically causes more pain.
Supplementation of B6 (Pyridoxine) is recommended at 50 mg (once daily) or 20 mg taken 3 times daily (5). It is important to choose a supplement with activated P-5-P form of B6.
When it comes to B12 supplementation, there is a wide range of recommended dosage. I hesitate to recommend a specific dosage without an individual evaluation. Patients can boost the amount of vitamin B12 in their diets by eating more meat (beef), fish (salmon and cod), eggs and dairy products (if lactose tolerant).
4) Gluten Intolerance: This is a HUGE player in many chronic health conditions. Gluten intolerance creates Leaky Gut, nutritional deficiencies and inflammation. Gluten intolerance in a major factor in Rheumatoid Arthritis and other auto-immune conditions that affect the joints. There are many methods for testing gluten intolerance but currently there is no “gold standard”. A simple blood test can screen people for celiac disease but they must be currently eating a diet that includes gluten for it to be accurate. You can learn more about testing options in this Healthline article:
5) Vitamin D: People living in northern/southern latitudes more than 37 degrees from the equator are at high risk for Vitamin D deficiency. It is very common and most people are unaware of it. The symptoms are often subtle and non-specific, but they can include muscle weakness/aches/cramps, pain, fatigue and depression. A general guideline for supplementation is to take the D3 form at 2000 IUs during the summer and 5000 IUs during the winter. However, it is important to have vitamin D levels checked once a year with dosages tailored to each client’s current level.
6) High sugar/carb diet: Modern research has repeatedly shown that high sugar diets create inflammation in the body, which is an underlying cause of diabetes, obesity and many other chronic health conditions. It is important to encourage patients/clients to cut out soda and other sugary drinks including fruit juice (it’s much better to eat the whole piece of fruit) and decrease their consumption of processed/packaged foods (which often contain High Fructose Corn Syrup). It is also important to stress the importance of eating enough high-quality protein and healthy fats. I have written about these topics in other blog posts for reference.
I enjoy working with individual patients/clients as a OT Hand Therapist and Nutritional Therapist to blend traditional and holistic therapies. I have learned the importance of addressing the root nutritional issues behind symptoms and conditions. I provide comprehensive evaluations and treatment plans with tailored recommendations. I approach each person as a unique bio-individual and include both dietary and lifestyle encouragement. The next time you hear of someone complaining of a trigger finger or thumb, please refer them to me for holistic care. I appreciate your support!
1) Makkouk, A, Oetgen, M, Swigart C, Dodds, S. Trigger finger: etiology, evaluation, and treatment. Cur Rev Musculoskelet Med. 2008 Jun; 1(2): 92-96. Published online 2007 Nov 27. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2684207/
2) Blazar P.E., Aggarwal, R. Trigger finger (stenosing flexor tenosynovitis). 2019. UpToDate. com https://www.uptodate.com/contents/trigger-finger-stenosing-flexor-tenosynovitis
3) Manz F, Wentz A. The importance of good hydration for the prevention of chronic diseases. Nutr Rev. 2005; 63(6 Pt 2): S2-S5.
4) Tucker, J. The Trigger Thumb Tendonitis Dynamic. 2018. Tendonitisexpert.com https://www.tendonitisexpert.com/trigger-thumb.html
5) Dach, J. Vitamin B6, Pyridoxine for Trigger Finger and Carpal Tunnel. 2014. Drdach.com http://www.drdach.com/Vitamin_B6_TriggerFinger.html