Editor’s note: This is the second of two articles on Dupuytren’s disease and trigger finger, two common hand disorders. Last week’s article explored surgical options for both, while today’s story explains how hand therapy can prevent surgery in some cases, as well as assist with healing after treatment.

Therapy provided by a certified hand therapist is an important component for patients recovering from certain hand surgeries. In some circumstances, it can even play a role in avoiding surgery altogether.

“There are definitely treatments to improve the condition of your hand,” said Emily Tjosvold, a certified hand therapist with UCHealth SportsMed Clinics in Steamboat Springs. “You don’t have to suffer with fingers and hands that give you pain or are negatively affecting your lifestyle.”

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She treats patients with trigger finger who have sought help early so they hopefully avoid surgery. She also works with those who have had surgery for both trigger finger and Dupuytren’s disease so they gain full range of motion in their fingers and hands as they recover.

Dupuytren’s disease is a disorder of the hand’s fascia, a tough substance that protects skin, tendons and blood vessels in the palm. It causes the fascia to gradually thicken and then contract, creating nodules and cords, some of which can be painful. Males of northern European descent are the most likely to suffer from this affliction.

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Trigger finger occurs when a finger becomes stuck or locked in a flexed position as a person tries to bend or stretch their fingers. Other symptoms include pain and stiffness in the fingers and thumb. Tjosvold said women are more at risk for trigger finger, which is usually worse in the morning.

When it comes to prevention, while there is not hand therapy available for Dupuytren’s disease, there are steps people can take if they suspect trigger finger.

“If you catch trigger finger early enough, there are things you can do to avoid surgery,” saidTjosvold. “If you experience if a few times, it’s a good idea to see to a hand therapist. Typically, once it starts, it gets worse with repetitive activity, and it can get worse quickly.”

Steps before surgery for trigger finger

There are a number of non-surgical steps a person with trigger finger may consider, including:

• Splinting, where a custom splint is made that keeps fingers straight at night to prevent inflammation and provide relief for the affected tendon.

• Exercises to reduce inflammation. 

• Education to understand what exacerbates your trigger finger, such as repetitive activities that strain the hand or excessive squeezing or gripping. 

• Modification of tasks. If you have repetitive work activities, modify them, if possible, and wear a splint.

• Practicing a natural sleeping posture. Don’t curl your hands in a ball or bend your fingers when sleeping.

• Cold laser treatments that use low-infrared light to decrease inflammation and promote healing of cells.

If non-invasive treatments don’t work, Tjosvold said it may be necessary to discuss cortisone injections or a procedure with a hand surgeon.

After surgery for trigger finger and Dupuytren’s disease

If surgery is necessary, every person is referred for therapy and a care plan is created based on the severity of disorder. A patient might need to meet once or twice with a hand therapist like Tjosvold, while others may need a few months of rehab to restore range of motion and decrease inflammation. Post-surgery care includes exercises and progressive splinting.

“Trigger finger is very simple until you wait too long, and then it’s not,” said Tjosvold. “When you have a finger that is so swollen that it can’t be straightened, it be can quite debilitating for patients and more challenging for us to treat.”  

As there is no therapy to prevent Dupuytren’s disease, Tjosvold treats patients who have had surgery for that condition in a similar manner as those who she sees for trigger finger, customizing splints and specific exercises to each patient’s needs.

“Everyone is different,” she said. “Some people don’t need much therapy after surgery, and others develop thicker scar tissue that we need to address. We cater our treatment to their needs to restore a full range of motion and get them back to their lives.”

Mary Gay Broderick writes for UCHealth. She can be reached at marygaybroderick@comcast.net.