The medical term for trigger finger is “stenosing tenosynovitis.” This is a form of tendonitis that affects the tendons in the hand that flex the fingers.
The tendons work like long ropes connecting the muscles of the forearm with the bones of the fingers and thumb. The tendons travel through sheaths lined with synovium, the same tissue that lines joints. The tendons and the sheaths have a lubricated lining that allows easy gliding inside the pulleys.
Trigger finger/thumb occurs when the tendon develops a nodule or swelling of its lining. When the tendon swells, it must squeeze through the opening of the tunnel (known as the flexor sheath). This causes pain, popping, or a catching feeling in the finger or thumb. When the tendon catches, it produces inflammation and more swelling. Sometimes the finger becomes stuck (locked) and is hard to straighten or bend.
Causes for this condition are not always clear. Some medical conditions such as rheumatoid arthritis, gout, and diabetes may be associated with trigger finger symptoms.
Trigger finger may start with discomfort felt at the base of the finger or thumb. A thickening may be found in this area.
The goal of treatment in trigger finger is to eliminate the catching or locking and allow full movement of the finger or thumb without discomfort. Swelling around the flexor tendon and tendon sheath must be reduced to allow smooth gliding of the tendon. The wearing of a splint, taking anti-inflammatory medication by mouth, and an steroid injection into the area around the tendon may be recommended to reduce swelling. Treatment may also include changing activities to reduce swelling.
If non-surgical forms of treatment do not improve symptoms, surgery may be recommended. This surgery is performed as an outpatient. The goal of surgery is to open the first pulley so the tendon will glide more freely. Normal use of the hand can usually be resumed once comfort permits. Some patients may feel tenderness, discomfort, and swelling around the area of their surgery. Hand therapy is often recommended after surgery to improve use.
A more recent development is the use of percutaneous hydrodissection release. In this procedure, ultrasound guidance is used to introduce a small needle into the tendon sheath. A large amount of fluid is then injected to open the tendon sheath… similar to how an angioplasty opens a coronary artery. This hydrodissection procedure is much less invasive than the standard surgical procedures used for trigger finger.
For more information about this procedure, go to:
Arthritis Treatment Center
The shoulder is a complex joint consisting of three bones (the scapula, the humerus, and the clavicle) and held together by an arrangement of ligaments, tendons, muscles, and bursae. Shoulder pain is a common complaint. It’s important to separate shoulder pain from referred pain coming from the neck. Most primary shoulder pain is due to degeneration occurring in the rotator cuff or biceps tendons. The term tendonitis is incorrect since there is very little inflammation. The problem is tendon degeneration. Accurate diagnosis is important. Examination with history, physical, and imaging procedures can establish the correct diagnosis. Treatment involves the use of rest, ice, physical therapy, stretching and strengthening exercises. More aggressive measures include steroid injection, needle tenotomy with platelet rich plasma, and Tenex.
Computer-Controlled Cadaver Gives Researchers Insight Into Causes Of Shoulder Injuries.
Kay Lazar writing in the Boston Globe, “Using a computer-controlled cadaver to emulate a pitcher on the mound, Boston researchers are gaining insights into the causes of baseball shoulder problems.” The researchers “found that when the scapula was out of line, it increased the stress on the shoulder joint, where the arm joins the shoulder. This can impinge the movement of the rotator cuff, which is the group of muscles, tendons, and ligaments that connect the upper arm bone with the shoulder blade, and is pivotal to shoulder mobility.”
Susan Birk writing in Rheumatology News reported a study from the Royal National Orthopedic Hospital in London. Investigators used ultrasound guided dry needling and autologous blood injection to treat hamstring tendonitis. The 42 patients, all athletes, were randomized into one of three treatment groups. One group received steroid injections, another group received autologous blood – about 2-3 cc’s, and the third received both. The injections were ultrasound guided. All the patients then underwent physical therapy for six weeks three weeks after the treatment. Significant reductions in pain and improved function scores were seen in the steroid plus blood group followed by the blood only group. The steroid patients were better at 6 weeks but then declined thereafter. Ultrasound evaluation at 3 months showed healing in both blood groups and persistent micro-tearing in the steroid only group. More ammunition for PRP use!
PRP Not Effective For Recovery From Tendon Injuries.
As you know I’m an advocate of regenerative medicine techniques using platelet-rich plasma and adult stem cells. I still think it’s important to be balanced in my reporting.
John Gever writing in MedPage Today reported, “Platelet-rich plasma (PRP), whether injected or incorporated into fibrin matrix implants, did not promote recovery from tendon injuries,” according to several studies presented at the American Academy of Orthopaedic Surgeons meeting. “In two randomized trials of platelet-rich fibrin matrix (PRFM) implants to augment arthroscopic repair of rotator cuff tears, no benefit from the treatment could be discerned in clinical or imaging-based evaluations.” A third study of five National Football League players with “hamstring injuries who were treated with PRP injections plus standard rehabilitation with those in five matched players who only
underwent rehab” found that the median time to “being cleared to play was 20 days for those receiving PRP (range 16 to 30) versus 17 days in the control group (range 8 to 81).”
I don’t know the details of how the athletes were treated but I’m surprised by the results since that has not been our experience.