Trigger Trouble

I woke up one morning this past December and noticed an odd sensation in my left hand. The 4th finger — the ring finger — hurt a little, plus, when I tried to flex my hand or make a fist, that finger had a sort of “catch” to it, as if it was coming up to a gate that it had to push open in order to get through.  Yup, I recognized the symptoms of a trigger finger.

What were fairly mild symptoms that first morning proceeded to get gradually more severe in the days and weeks that followed.  And, of course, I increasingly had difficulty carrying out my usual everyday occupationsgripping the steering wheel in the car, opening jars, wringing out the dish cloth, pulling up the quilt that had slipped in the night, tearing open the sealed bag inside the cereal box.  Eventually, even the light typing on the computer keypad was uncomfortable.

All this time, I felt relieved that the finger problem did not seem to interfere significantly with my piano playing.  But the possibility of having to cut back on my time at the piano every day, perhaps permanently, was definitely a worry.

After about a month, I finally gave up on the hope that the problem would just go away and I arranged for an appointment with an orthopedic surgeon.

My first visit to the orthopedic clinic was interesting and a little puzzling.  I did indeed have a trigger finger.  A handout with an anatomical diagram of the finger including the muscles, tendons, and pulleys was used to help me visualize what was going on. Two possible procedures were explained to me, i.e. injection and surgery.  The upshot of the conversation was that it was up to me — totally, as far as I could tell — to decide which I wanted to have done.

orig_finger_anatomy

I have long supported the concept of client-centered care, or, the term I like even better, family-centered care.  Yet I found myself wanting to at least get a recommendation regarding the options that were described.  But no specific recommendations one way or the other were forthcoming.  Up to me.

At about midpoint in the office visit, the surgeon asked me if I was able to remove my rings from the trigger finger.  “No.”  I had not been able to remove them for years and years.  He replied that I would need to have the rings cut off before he could go forward with either procedure.  He also wrote out a prescription for an oral steroid 6-day “pak” to take in the meantime while we sorted things out.

I left that first visit mulling over what I had learned about treatment for a trigger finger, and I started to swing into action.  I went downtown to a trusty jeweler and had my engagement and wedding rings cut off (the jeweler used an impressive little tool that he slipped under the rings and then cut upward, away from the finger). Next, I picked up the oral steroid “pak.”  The pharmacist told me the steroid would “mess up” my sleep and have me talking “a mile a minute” — in other words, I would be totally revved up. Not good, as I had a big weekend coming up with our daughter and son-in-law arriving to celebrate my 75th birthday.  So — I made the decision not to take the steroid yet — maybe after the weekend — or maybe not.  “Maybe not” won out.

Coincidentally, I discovered that two of my friends had histories of trigger fingers.  I listened to their stories and comments about injection/surgery options and success or lack of success.  Even though these women were not totally in agreement with each other, their ideas helped me to keep thinking things through and to appreciate that the choices I had been given were not so easy to deal with.

Back to the orthopedic surgeon two weeks later for follow-up and a decision. This time I was assigned to a physician assistant.  I reported that I had not taken the oral steroid and was still on the fence about which way to proceed.  He repeated the options and shared his own past experience with a trigger finger, i.e. two trials with injections brought no improvement and he ultimately had surgery, which was 100% successful.  Me:  “Okay, I’ll have the surgery.”  PA:  “Okay,we’ll set that up.  Let us know if you change your mind.” Holy cow!  This thing really was totally up to me!

Surgery was scheduled.

In the days that followed this decision, doubts about the wisdom of going ahead with surgery persisted.  And then I began to wonder why I could not come to terms with this situation. Good grief!  Why was I so undecided?  Ed finally chimed in with what suddenly seemed like good advice.  Why not start with the prednisone pak, then, if no relief, move on to the injections, and leave the surgery option for last?  Aha!  I finally felt like the eagle had landed.

So, I called the clinic to cancel the surgery.  I would take the oral steroid.  Another appointment was set up for three weeks hence, when I would report on the results.  As it turned out, the prednisone did not interfere with my sleep, I did not talk a mile a minute.  However, I also did not experience any improvement in my trigger finger.  None.

At the next clinic appointment, we went ahead with the injection. By the following day, my trigger finger had improved immensely.  It has continued to get better and better, and I am now, five weeks later, virtually symptom-free.

So that is the mini-saga of my trigger finger.  Along the way, after my rings had been cut off, I was surprised to find that I apparently had a habit of sort of “fiddling” with the rings on and off all day long.  I kept reaching for the rings, only to find the empty space where the rings had been.  I had been totally unaware that such a habit existed throughout my daily occupations.  Also, I realize now that family, friends and health professionals all contributed to my thinking in an ultimately helpful way.  It really does “take a village” to care for ourselves and to get through daily life.

10 thoughts on “Trigger Trouble

  1. I am surprised that splinting was never suggested as an option to you. I made my own trigger splint and wore it on and off until the symptoms subsided. I also used a neoprene one on and off. That was well over two years ago and symptoms have not returned.
    Theresa Smith

    Like

  2. Theresa: You’ve brought up an interesting point. Splint possibilities were never in the discussion. My trigger was in the MCP joint of the 4th finger. Not sure if a splint could be used to rest that joint or not. Was your trigger in the PIP or PDP joint? Anyway, glad to get your input. Thank you. Betty

    Like

    • Hi Betty,
      I am surprised a hand therapist hasn’t chimed in here. A trigger finger is caused by inflammation of the A 1 pulley which is located at the MCP. I do not know of any metal splints preventing full flexion of the MCP but they are ring splints to prevent Boutonniere deformities secondary to arthritis. A Boutonniere can result in a flexed PIP and hyperextended DIP. Flexion of the DIP is secondary to either a dorsal bony fragment or tendon avulsion and is called a mallet finger. In the case of a mallet injury the DIP is not stuck in flexion it cannot be extended secondary to the avulsion. I hope a hand therapist near you can educate the healthcare providers of the wonders OTs can do with splinting!
      Theresa

      Like

      • I am definitely showing my ignorance here! Thanks, Theresa, for your follow-up. So trigger finger is by definition due to inflammation of the pulley at the MCP joint, but finger ring splints are use to prevent other finger joint deformities? I’d love to have a hand therapist enter the discussion! I’ll keep an eye on this. Betty

        Like

      • Hi Betty,
        I decided on OT school after receiving hand therapy from Rosalyn Evan. Although I began my career as a hand therapist my road went in a different direction. I cited your letter to the editor of Unspeakable Occupations in an article I wrote on Hurricane Ike. But my favorite piece is Habits of the Heart.
        Thanks for all you have done!
        Theresa

        Like

  3. So happy to hear that you went through the non-invasive process first–what wisdom! And yes, I’ve known individuals who’ve worn the beautiful ring splints (if cosmesis is important) for years to manage their symptoms.

    Like

  4. Hello Betty. I was particularly interested in your reference to “client-centred care” in your description of your experiences with professionals and the lack of ‘collaborative’ dialogue to alert you to options. Your story would be a great ‘trigger’ (please excuse the pun) for you or someone to write a critique of “client-centred occupational therapy’ for SJOT, Special Issue, manuscripts due October 31. Gudrun Palmadottir and I will be special guest editors. We are keen to invite lots of submissions and will try to include letters, short reports and other submissions as well as full length academic manuscripts. Hopefully you or readers of this site will take up the opportunity! With good wishes to you Betty from Prince Edward Island, Liz Townsend. Here’s the SJOT site with info: http://informahealthcare.msgfocus.com/q/1fqSMbuh4Td8p21hGbkgsYE/wv

    Like

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s