Handling a trigger finger diagnosis
Dear Dr. Roach: My healthy 91-year-old mother recently discovered that she has a diagnosis of trigger finger. She is hesitant to do surgery, but is hoping for more mobility. What are some of the best options?
M.B.
Answer: Stenosing flexor tenosynovitis, more commonly known as “trigger finger,” is a common issue, especially for people in their 40s and 50s, somewhat more common in women. (It’s called trigger finger because the finger gets stuck in the flexed position, and when it is straightened out, it snaps like a trigger being pulled and released.) The condition often starts out painless, but may progress to painful episodes, or even being unable to “unlock” the finger.
There are many strategies for conservative management. One that has data behind it is splinting the affected finger, which is effective in many people, but may take 6 to 10 weeks. Avoiding activities that have caused the condition may help. I have had readers write in to tell me that moving the finger (one person said underwater) helped, and quite a few have written me to say that the condition just went away.
I refer people who continue to have symptoms despite conservative management to a hand surgeon, who can inject an anti-inflammatory steroid into the sheath the tendon goes through to try to keep the tendon from getting stuck. Most people get better by the third injection.
Dear Dr Roach:
I read your recent response to the woman with spinal stenosis. I am an 80-year-old woman with a similar diagnosis (spinal stenosis along with slight herniations at L4, L5 and S1 vertebras). However, I do not have the pain typically described. For several years, my legs have gotten weaker, and at this point, feel like lead. I need to take Tramadol to be able to walk. Have you seen these particular symptom?
Answer: Progressive weakness is one indication to relieve the nerve compression, usually by surgery. It sounds like you have had advanced imaging, and I hope you have had evaluation by an expert to see whether surgery would be appropriate. It often is not the appropriate choice. Still, I refer every patient I see with weakness due to spinal stenosis so that they can have an evaluation by a surgeon, as only the surgeon has the experience.