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- - - - - tendonitis trigger finger

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#1
condensr

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I've had a mild/moderate case of trigger finger (catching/locking of the finger in a bent position, esp. in the morning) in my left ring finger for a couple of years now - it comes and goes though. Currently, it has 'flared up' though and getting up in the morning knowing that I'm going to have to straighten my hand, and that it will hurt, is much less pleasant because of it.

I know there are the two options of local steroid injection and release surgery, but I am hesitant to pursue them as of yet.

Has anyone with this problem had any luck with other treatments? (e.g. splinting at night, NSAIDs, cold packs.) What kind of doc does one see for this? A rheumatologist? Ortho?

Thanks in advance for any tips.
-Shane
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#2
plattb1

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I've had a mild/moderate case of trigger finger (catching/locking of the finger in a bent position, esp. in the morning) in my left ring finger for a couple of years now - it comes and goes though. Currently, it has 'flared up' though and getting up in the morning knowing that I'm going to have to straighten my hand, and that it will hurt, is much less pleasant because of it.

I know there are the two options of local steroid injection and release surgery, but I am hesitant to pursue them as of yet.

Has anyone with this problem had any luck with other treatments? (e.g. splinting at night, NSAIDs, cold packs.) What kind of doc does one see for this? A rheumatologist? Ortho?

Thanks in advance for any tips.
-Shane


I had this problem with my thumb - when it's your thumb, it has a different name, but it's the same condition. Essentially, it's tendonitis of the fingers.

I tried a splint pretty much 24/7 - not just nights. Also tried the NSAIDS & cold packs. All helped for a time.

But, eventually, it got bad enough I had to choose between steroid injection & surgery. I decided to have the steroid injection & so far, so good. They warned me that it might spike my BG up to 50 points for two-three days, but it didn't. It took seconds, wasn't too painful, & wasn't expensive at all with my insurance. I saw an ortho doc.

Good luck. Let us know what you decide!
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#3
Jan B

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Yuk. I went through a few months of my thumbs and fingers all triggering. They seemed to take turns until it all quit. I sometimes forget it completely until I see it mentioned. I know a lot of people choose surgery, but I never wanted to do that. My intuition turned out right, in just leaving it alone.

Use caution with NSAIDS. At least do not take more than the RDA. Those things finally tore up my half my stomach, literally. When I see that commercial about only two Aleve vs. eight Tylenol . . . well . . . Aleve are not harmless!
Jan

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#4
dlmoak

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I had severe trigger finger that would come and go for about 15 years. I used to be a classical guitarist and was concerned about the effects of either a shot or surgery on my career. One of my doctors recommended a hand specialist to me and thought I really should check her out. I relayed my fears to her and she said that she had never had a complaint from any of the musicians she had treated. She said that since my problem had gone on so long, injections may not take care of it to my satisfaction, but that we would start with that and see what happened. I wound up having two injections, about a month apart. The first one was excruciating to have done, but very little pain afterwards. I did keep it on ice for an afternoon. The second shot was not very painful because the first shot had helped so much.

After a year or so, I opted for surgery because, although my hand was light-years better, I was still aware of the finger when I played. The surgery was out patient. I had no problems. I did physical therapy afterwards (which I highly recommend). I can now play with no sense that I ever had a problem and it has been a couple of years since the surgery.

I recommend the injection as it my prevent more problems down the road. My surgeon said that it was very very common for diabetics to have this problem, but she was not sure what elevated blood sugars had to do with it. She also pointed out that I had nodules on all of my fingers!

#5
holler1

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I've had a condition with my right index finger that was diagnosed as trigger finger by an orthopedic doctor about 7 or 8 years ago. However, it isn't a classic trigger finger as it doesn't stick and release. It just stays a little bent and doesn't move very well either to straighten or bend. The knuckles are a little callused too. I had two injections a couple of years apart, and both helped only temporarily. I would say that the finger has been somewhat improved since I've begun to get tighter control on my BG. Some days it seems almost normal and straighter, but not entirely straight.

With more reading (Bernstein's book and some online references), I've begun to wonder if it isn't a mild case of Dupeytren's Contracture. In any case, it is a tendon problem and I'm pretty sure is it a diabetic complication. I also had a frozen shoulder a few years ago which has now gone away.
Age 69,male,BMI~22, current FBG 110-120, FBG~120-130 since 2002,1/2009 A1c 6.7,1/2010 A1c 7.2, started lower carb diet, 10/15/2010 A1c 5.8 (lab),1/29/2011 A1c 5.9 (home), , A1c creeping up to 6.2 11/2011, tried met late 2011-digestive issues, omeprazole 20mg for GERD, tamsulosin (alpha blocker), exercise 5+hrs/wk, vit D, super B complex.
-----------------------------
Science: it's what works.

#6
notme

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I had this in my thumb on my left hand. I tried splinting and it didn't do anything. My doctor said the injection was a long shot for me because of the severity. I opted for the surgery. I was awake and could have cared less if they cut my hand off. It was painless and easy and it never returned. Took about two weeks to heal completely.
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#7
gettingby

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I have dealt with this for many years. My ortho doc told me the last time that I have had the maximum shots that I can have. The shots usually last a long time. I've not had to have one for the "catching" in both of my middle fingers in at least 3 years because they haven't flared up. Now it seems that the thumb on my right hand is acting up. Not very bad but I can feel it "pop" when I straighten it. Problem with surgery for me is that I now work on a computer every day and I've not built up much time off so I'm afraid of missing work but I need my hands to do my job. I know surgery is my next step but I'm delaying it until I can build up more time. I just see a regular orthopedic surgeon for my shots.
Good luck in whatever you decide to do about it. I know the splinting only works temporarily.
BTW, welcome back Shane!!:) It's great to see you back around.

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#8
condensr

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Thanks Cin, and everyone else who has replied!

I'm hesitant to get the shots because it sounds somewhat painful.. You'd think I wouldn't worry about that after jabbing myself with needles for 14+ years, but.. I once had to have a local anesthetic shot straight in my big toe after dropping a gym bench on it, and the dang shot hurt more than the injury itself.

As for the surgery part, I'm in the same boat as you, Cin. I type for a living and not having one hand for a couple weeks would be a huge drag.

The last couple nights I have loosely taped/wrapped the affected finger to the one next to it, enough to keep it from bending past the catch point. So far, yesterday and today, things definitely feel better. A downward spiral starts once the symptoms start to flare up, because I tend to habitually stretch/work the hand in some strange attempt to improve things. That only makes things worse, which makes me want to do it more, which .... you get the point. Long story short, immobilizing has helped for now, but I still need to do something about it. Maybe I'll try and find an ortho doc in the area soon.
-Shane
T1 ~14 yrs
Levemir / Humalog via Luxura HD pen
Minimed 522 w/ CGMS - On vacation
Contour USB / SoftClix

#9
shades_of_idaho

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I have had trouble with trigger thumb. I did splint it to control pain and finally was able to go with out the splint. Thumb was in straight position. Then I started pushing a bend in my thumb with other hand when ever I thought about it until I could get it all the way bent. Took me a couple months. Now my thumb is almost normal again. It is swollen and painful in the end joint in the morning but loosens up. I continue to make sure I do the bending exercises. I am pretty sure this will avoid having to have surgery.I have no insurance. I considered the shot but with no insurance well it was almost impossible to get into any one to just do the shot and be done with it. Happy camper for sure now.

Chris

#10
holler1

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I'm hesitant to get the shots because it sounds somewhat painful..


For me the shots were less painful than a novocain shot for dental work.
Age 69,male,BMI~22, current FBG 110-120, FBG~120-130 since 2002,1/2009 A1c 6.7,1/2010 A1c 7.2, started lower carb diet, 10/15/2010 A1c 5.8 (lab),1/29/2011 A1c 5.9 (home), , A1c creeping up to 6.2 11/2011, tried met late 2011-digestive issues, omeprazole 20mg for GERD, tamsulosin (alpha blocker), exercise 5+hrs/wk, vit D, super B complex.
-----------------------------
Science: it's what works.

#11
Daisy London

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There is an alternative to surgery, but a study is needed to maximise the potential.

Here's my experience with series of trigger fingers. I'm a type one diabetic and as usual apparently once you get one the other come to the party so now I have 3 more. The first one I ignored for too long thinking it was funny and would pass. then it got so bad that even after injections it would not open anymore, with help even. So my left middle finger was operated on Dec '08. It took 5 months of vigorous fysio afterwards before it would open, not a few weeks like they promised. And I lost my job. And by the way it triggered as a result of an injury, lifting heavy boxes that got out of had, not that any doctor will admit to that.

Then in Dec '09 my right hand (dominant) thumb got inflamed and sticky, but not triggering as such. But apparently it is a trigger too. It was painful and swollen and hand surgeon and rheumatologist said it had to be operated on, that there was no other way or it would at best remain the same but most likely get worse. They injected it with cortisol, but it only helped for about a month, no movement returned and then the pain and swelling came back gradually.

I didn't fancy becoming disabled - the prognosis after surgery was "no guarantees" and that it could get even worse. Taking my healing time last time into consideration I descided to go back to Bowen Technique - the Bowen therapists had been able to help me when I got chronic RSI from Photoshop retouching when nothing else worked. There is data about Bowen being effective on RSI, but I'm no sure there are yet any studies about it working for trigger fingers.

The bowen therapist I went to told me she had been able to manage her sister's (type 1 diabetic too and young like me) serial trigger fingers and that she had not realised there is not supposed to be fysio that actually works for this.

I didn't expect much from the first appointment, maybe just some pain relief. But the most amazing thing happened only hours after the first treatment - the swelling went down, the pain was hardly there and most of all the thumb had more mobility! I couldn't believe it. I went back (usually 3-4 sessions in about a month is all that's needed) and it got better every consecutive treatment.

Now my thumb is still slowly gaining movement, the inflammation and pain were gone by the end of the Bowen treatment. I have also used 2 teaspoons of organic apple cider vinegar in a glass of water twice a day to keep inflammation down and it has worked much better than the anti-inflammatories that started to burn a hole in my stomach. I also wore a splint (comfy neoprene coated one from Oppo) at night over the worst of the time to prevent it from contracting or me sleeping on it.

Since then I've hand my right index and ring finger and left index triggering. But I go to Bowen and take the vinegar and they settle. But has been important tackle them right away when the trigger appears, because it seems the sooner it's treated the less severe it becomes and therefore caught early recovers faster. A small "crunch" is left in them, but it doesn't affect them in any way. Inflammation can try to creep back in if I forget the daily vinegar.

I have also learned to avoid the movements that clearly cause triggers. Doctor's saying otherwise is again just lack of up-to-date research and they are not allowed to express their clinical personal opinion which I think is not conductive to medical profession. So I avoid hard twists with just fingers, pulling anything with one finger, excessive force when pushing with one finger and any RSI causing activities like computer games, mobiles texting with thumbs, retouching (although sometimes I have to do it as I'm a photographer). In my opinion trigger fingers can be a form of RSI in some cases and the whole RSI relative to how we use our hands these days requires more research. We were not built to be machines or to operate them.

I live in the UK and now the NHS surgical team has asked for a presentation from my Bowen therapist, so I'll keep you posted.

Edited by Daisy London, 02 December 2010 - 06:14 AM.
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