I woke up one morning a few years back with the middle finger of my right hand contracted as if I was going to fling a spitball. I thought I must have been dreaming and my body was simply carrying out the action I was performing in the dream. When I tried to move my finger back into the open position I couldn’t. I felt that I had control over the finger – I could contract the muscles – yet I could not open my hand completely no matter how hard I tried. I had to use my left hand to pry the finger from its flexed position. Strangely, it took some force to get it passed a threshold, after which it released with a pop and opened to its full range. As a chiropractor, I am used to releasing joints, so it felt as if the pop was all it needed to work again properly. Naturally, I felt immediately compelled to test it, so I closed my hand into a fist again and then tried to reopen it. The middle finger stayed flexed exactly as it had before. I could not open it solely with strength of the hand itself; I needed help from the other hand to pull it open. Again, I felt a snap and then the freedom of movement.
What I experienced was a conditioned called trigger finger: a tenosynovitis, or inflammation of the finger’s tendon and its sheath. The sheath opening narrowed, preventing the swollen tendon from sliding through freely. In trigger finger, a nodule can form locking the tendon in place and causing it to snap when forced open. The snap comes from pulling the nodule forcibly through the swollen sheath.
Trigger finger occurs most often in people who use their hands to grip or flex often. In that regard, it is a repetitive use injury. Some common activities which could lead to tenosynovitis are gardening, tennis, lifting heavy weights, playing guitar, auto mechanics, and giving massages. Women are more commonly affected, and it could even be a symptom following carpal tunnel surgery. Twenty percent of people receiving a carpal tunnel release surgery developed trigger finger in one study. The average time post-operatively to develop a trigger finger was five to eight months. And a trigger finger left untreated can become permanently locked in place – definitely not ideal for gardening, tennis, playing guitar, and so forth. My profession as a chiropractor is all hands, so naturally I am at risk for developing the condition.
The inflammation caused pain along the entire tendon of my middle finger with the nodule at the base (essentially what we call the knuckle but on the palmar surface) being especially sensitive. With a tenosynovitis, the forearm might also feel tight and sore, especially first thing in the morning. I was, indeed, having all these symptoms, and so along with my general fascination, I took to treating the forearm and hand immediately to relieve the pain.
I tried a number of things, such as icing, massage, and exercise, yet nothing seemed to help the situation. It took three months of hand pain before I consulted with my friend, a surgeon. He suggested platelet-rich plasma (PRP) injections, which is taking blood from a patient, concentrating the blood cells through centrifuge, and reinjecting them into the site of inflammation to assist in the healing of the injured tissue. I agreed to the procedure and underwent three treatments. The first began with a Lidocaine/steroid injection at the nodule point to reduce inflammation and numb the hand for the upcoming injections. I then received 3-5 shots of my own concentrated plasma all around the affected tendon. It is no secret that I hate needles; and as a chiropractor, my hands are extremely sensitive, so shots in the hand are my worst nightmare. But my hand hurt so badly from the trigger finger that this first treatment actually was somewhat of a cinch for me. You can watch the procedure and listen to the doctor explain how PRP works here:
My hand got significantly better almost immediately. In fact, I was able to work that day after the procedure. The pain was pretty much gone by the following day and the snapping was minimal. I did wake up with snapping the next morning but the pain was almost nothing. Frankly I would have been happy to stop there, as the difference was night and day, but my friend said two more treatments were imperative for complete healing. OK I was sold.
The next two treatments were not as easy. Because the pain felt 90% better, I was more sensitive to the discomfort of the needles. However, my friend was right: Within days of the third and final treatment, my hand was both 100% pain free and fully mobile. I never again developed trigger finger in my right hand.
Fast forward three years later when I awoke one morning to find my left hand in the trigger finger position: It hurt the same way the right one had three years before, and the middle finger was locked into a flexed position. I was playing the guitar and piano quite a bit at that time and the combination along with my work caught up with me. Because of the success I had with PRP the last time, I called my friend and asked if he could give me another round of injections into my left hand. He agreed and we went through three treatments, one a week. Like last time, the pain went away immediately; however, this time the snapping never fully left. It did reduce, perhaps by seventy five percent or more, never getting worse than that, but I continued to snap regularly on opening my hand. The pain did gradually return; however, because I had a much harder time with this round of injections, whether it was psychological or due to hypersensitivity, I don’t know, but I was afraid to tell my friend, because I just couldn’t take another round of those thin, small needles. I have to admit I WAS being a pussy, but I figured it would be better if I could find another way to treat this condition, through rehab and chiropractic principles. If I failed, I could always get another round of shots later.
I set out to address the pain and tightness with stretching and massage, which I had definitely done the first time around, but what I had discovered this time was a unique approach to systematically reducing the pain, swelling and locking finger of tenosynovitis. Trigger finger is not fun. It can put a real damper on the things you love to do. It might even keep you out of work if your job requires lots of hand use. The persistent nature of this condition makes leaving trigger finger to get better on its own a poor option. It is pretty hard to ignore a flexed and locked finger. Further, it can permanently lock, so getting it treated rapidly is the wisest approach and surest way to minimizing lost time from work or hobbies. Platelet-rich plasma injections are a definite option. They work but do not come cheap. Treating trigger finger conservatively, then, might be more attractive, but it does take a little longer. It certainly won’t dent the bank account as much. If you are a Beverly, Hills, Los Angeles, or West Hollywood massage therapist, musician, nurse, or anybody with hand pain who finds their finger(s) stuck in a contracted position, please call my office so we can get you healing quickly and back to doing the things you love. Don’t stick out trigger finger hoping it will go away on its own. Get your trigger finger hand pain fixed today.