Trigger finger doesn’t get better on its own
BY KEITH ROACH, M.D.
DEAR DR. ROACH: My left thumb has been “clicking” and locking in position for the past five months. Moving it from one position (straight) to another position (bent) can be done with the help of my other hand. Trying to move it without the other hand’s assistance can be quite painful. It’s an acceptable level of pain during daytime, but it is unbearable during the night. I took to wearing a thumb splint, which helps, but the base of my thumb gets sore overnight. It clears up during the day. This cycle has been going at a steady level for the past four months.
Is there a better way to treat this, short of surgery? Will this get any better over time, or am I destined to have the trigger thumb for the rest of my life? I’m almost 61 and in excellent health, at least relative to my peers. I work out daily and have no plans to retire. I have yet to see my doctor about this, but I will mention it at my next annual checkup. — S.K.
ANSWER: Trigger finger is quite common, with 2% of the population suffering from it at some point in their life. It is most common in a person’s 60s and somewhat more common in women. It is caused by a tight pulley system in the hand — the tendon gets stuck inside the pulley. Without treatment, the muscle can shorten (called a contracture), so it’s best to get these treated promptly.
Initial treatment may consist of activity modification (stopping whatever seems to cause it to stick) or splinting. A trial of anti-inflammatory medicine for a few weeks is reasonable. If this doesn’t help, or if symptoms are worse at the time of presentation, the physician will usually do a steroid injection into the pulley. Some family doctors will do it, but often patients are referred to a hand surgeon. The steroid injection can be repeated up to a total of three injections, and is usually effective. About half of people will have relief lasting at least 10 years. If injection fails, surgical release is the next treatment. Surgery is effective for over 95% of people, but the results aren’t as good in people with diabetes.
DEAR DR. ROACH: I’m 69. Two and a half years ago, I had a double lumbar fusion and a laminectomy that left me with some mild back pain and stiffness. Exercise and stretching has helped, but not to the degree I had hoped. Recently I started doing planks and bridges to build core muscles. They are difficult exercises, especially the planks. It has been helping, but I wonder if I am risking harm to the four titanium posts or lumbar fusions in my back. — M.W.
ANSWER: Exercise after back surgery is generally safe. The surgical changes are very stable, and it is quite unlikely you could damage them. In fact, exercise tends to strengthen the back muscles and surgical site. I recommend a physical therapist to help guide exercise immediately after surgery, but after two and a half years, you can certainly do exercise on your own.