Rhythmic Physician: Treating Trigger Finger

Rhythmic Physician: Trigger Finger

By Luga Podesta, MD

Published in DRUM! Magazine's May 2009 Issue

Ever experienced pain in one or more fingers after a grueling practice? Or lost the ability to bend or straighten a finger after an intense gig? If so, you could be experiencing what’s known as “trigger finger.” Trigger finger, or stenosing tenosynovitis, is a condition in which one of our fingers catches in a bent position. The finger may straighten with a snap, like a trigger being pulled and released.

Trigger finger results from a narrowing of the sheath that surrounds the tendon in the affected finger and is often quite painful. Tendons are the fibrous bands of issue that connect muscles to bone. Each tendon is surrounded by a protective sheath, which in turn is lined with a substance called tenosynovium, which releases a lubricating fluid that allows the tendon to glide smoothly within its protective sheath.

If the tenosynovium becomes inflamed from a repetitive-strain injury or overuse, the space within the tendon sheath can become constricted and the tendon can’t glide through the sheath easily, resulting in the finger catching in a bent position before popping straight again. With each catch, the tendon becomes more irritated and inflamed, worsening the problem. With prolonged inflammation, scarring and thickening can occur and bumps or nodules can develop.

Trigger finger can result from repetitive gripping for extended periods of time, or certain medical conditions, including diabetes. Trigger finger is also more common in women than in men. Symptoms may first present when the affected finger stiffens and may click when you bend or straighten. A painful bump or nodule may develop at the base of the affected finger in your palm and is the spot where the tendon is likely catching. As the problem worsens, your finger may catch at times in a bent position and then suddenly pop straight. Eventually, the finger may not fully straighten.

Trigger finger more commonly occurs in your dominant hand, and most often affects your thumb, middle, or ring fingers. More than one finger, and either or both hands may be affected at a time. Triggering is more pronounced in the morning while grasping an object or when straightening your finger.

Treatment varies depending on severity and duration. Mild cases can be treated with rest, splinting the finger, using nonsteroidal anti-inflammatory medication (NSAIDs), performing finger exercises, avoiding repetitive gripping, message, or soaking in ice water.

Treatment of more serious cases can include NSAIDs, an injection of a steroid medication into the tendon sheath, or in the case of recalcitrant locking that doesn't respond to other treatments surgical release of the tendon may be necessary.

The prolonged gripping on a daily basis that drummers take for granted can subject us to a number of soft-tissue injuries. We need to take care of our hands and seek medical care at the first signs of trouble.

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