trigger finger release

[dan in va]

Has anyone in the cafe ever had a trigger finger develop in the fretting hand and had the surgery done to release it? If so, how does it feel now?

It seems my left index tendon is developing a knot (I'm right handed).

[Ivan Kelsall]

Dan - I had an op.on my left hand ring finger & thumb 9 years back to stop them from 'triggering'. The op.is very minor & usually very quickly performed unded a local anaesthetic. The main problem is that it usually takes 2 - 3 months before your hand is back to 100%. So that's the time it needs before you can get back to playing.
The big PLUS,is that the problem is permanently sorted. Local steroid injections can be used successfully in around 65% of cases,but triggering can re-occur.Further injections can be given,but that's IT. If further triggering occurs,then it's the knife !!,
Ivan

[bratsche]

My left index finger has been triggering every morning when I first wake up for the past several years. For a while, I had to do rubber ball squeezes to make it go away; at present, it goes away on its own in 15-30 minutes. Even if it were to get worse, and I could afford it (which I can't), I wouldn't have it either operated on or injected with anything. I just have no confidence whatsoever in those methods. That's just me. YMMV.

bratsche

[Mandoist]

Has anyone in the cafe ever had a trigger finger develop in the fretting hand and had the surgery done to release it? If so, how does it feel now?
It seems my left index tendon is developing a knot (I'm right handed).

I began my trip with TF about 5 years ago. First, in the right (picking) hand. Now , in the past year, a very severe case on my middle finger / left (fretting) hand. It gets seemingly worse lately with every passing month.

At a workshop I was conducting at the Gettysburg Bg Fest about 4 years ago, a hand therapist happened to be in the audience when I was preaching about warm-up excercises before kicking into your session, practice or whatever. Truth is, very few players take the precaution of warming-up.

The therapist offered to show me a series of excercises after the workshop. Needless to say, I immediately invited her to share her knowledge to the everyone in the tent! Her 5-position excercise eliminated all complications in my right hand. I would say, I was 99% "cured". I have no trigger finger in the right hand, but do occasionally have the slightest 'resistence' in the two previously affected fingers (middle and third digits).

Unfortunately this amazing excercise has not done the trick for my left hand TF symptoms. Every morning is a total drag. It locks, but will release with an effort...and some minor pain when it clicks back to an extended position. At the moment, it gets much better after opening & closing the hand (making a fist for a minute or two). Then I can play with little difficulty, and after three or four tunes, I don't think about it and rarely have any resistence while playing. BUT -- that is slowly getting worse, more noticable and with more resistence. I am predicting a course of action in the near future.

I have done extensive research on the subject in the past 5 years. On the Internet, phone calls and face-to-face with some of the best surgeons in the world (including Scandinavia, Asia and -- my choice -- the Cleveland Clinic where they are familiar with, and sympathetic to, musician's surgical procedures. I used to be in the same camp as "bratsche" -- but those notions of not ever giving-in to injections or surgery changed with the severity of TF symptoms.

For me...first, it will be an unintrusive cortizone injection. Last resort will be the minor walk-in/walk-out surgery. It is a very quick and fairly painless surgery...with an amazingly high success rate!! Out of my conversations with 4 experienced TF surgeons, I gathered the average number of complications is approximately 3 cases in 20 years per doctor. Most of those "complications" were due to the patient's fault (falling on the hand, not following orders re: useage, etc).

There is a technique in Denmark, using injections to dissolve the problematic tissue...but it is too new and undecidely effective for me to take the risk.

Here are three links for detailed info. One is for an effective excercise, another contains a very detailed group of diagrams which will show you exactly what TF looks like...although the surgeon's text is somewhat over-simplifying the surgery and results (a bit of a hype, I think)? The last is for the Cleveland Clinic, with an excellent TF summary.

1) This is a commercial site for an excercise product. You don't need the product!! You can do these tension excercises using a large 1/2" wide rubber band. It does not need to be a high tension band...just enough to offer resistence to the finger(s). This is a great excercise, and has been very successful for TF sufferers. Check out all 3 videos -- ignore the hype for the product and do the excercises shown in the video once or twice a day, for no more than 3-5 minutes per session. TF Excercises (http://www.repetitive-strain.com/TreatmentInfo/trigger.htm)

2) TF Diagrams (http://www.davidlnelson.md/Trigger_Finger.htm) (Dr. Nelson is a bit unobjective in his text re: surgery, but the explanation and diagrams are tremendously detailed. An excellent perspective and easy-to-grasp understanding of TF.)

3) Cleveland Clinic (http://my.clevelandclinic.org/disorders/trigger_finger/or_overview.aspx)= an excellent summary of TF and surgical informations.

The one thing EVERY SINGLE SURGEON and non-partisan therapist agreed upon was that delaying medical help, if excercise is not effective within a three month period, is a bad choice. It makes things worse for you, and perhaps more difficult for them to help you regain your mobility pain-free.

[Patrick Hull]

Very good discussion of the problem. I have had trigger finger (on my picking hand) and also the surgery. If you really have trigger finger it isn't going to get better with exercise and you are not going to keep picking if you have it on your fretting hand. I, too, would eschew surgery, but finally got to where it was so problematic, I had it done. To not do otherwise would have been to accept a severely limiting disability that can be simply and virtually painlessly resolved. I had to quit mandolin and concentrate on fiddle. Let me caution that the steroid injections are quite painful....but surgery is a 15 minute piece of cake. At this point, I can hardly remember which hand the surgery was on.

[JFDilmando]

I have just had the surgical procedure done... three weeks ago. I intially tried corizone shot in the tendon. I thought that I had known pain before... but I was wrong. This had to be the MOST painful thing that I have ever experienced. The Doc tried to warn me, and said that it had been described as "thinking that the top of your finger was about to explode". Indeed, if felt that way !
it worked though, for about two months. Then triggering started again, and slowing got worse. I never even thought of another shot, although statistics say that a second cortizone treatment sometimes works where only one fails. Didn't care. Do the OP.

So far so good... but it is a bit slow going on recovery. I can play and do lots of good, but some chords are tough on the streatch, and simple chop "d" is a grim reminder that I am not recovered . Stiff in the morning, and working it out is a bit uncomfortable... but at the very least, I can play again... and things are getting better by the week.

Good luck... it CAN be fixed... but it ain't fun. not terrible, but not fun.

[Mandoist]

Very good discussion of the problem. I have had trigger finger (on my picking hand) and also the surgery. If you really have trigger finger it isn't going to get better with exercise and you are not going to keep picking if you have it on your fretting hand.

Actually, in its early stages, excercise can indeed help. Although in many cases it is only delaying the inevitable. I had minor symptoms in my right (strumming) hand and CORRECT excercises made it disappear completely, at least so far, over the past three years.

One thing all specialists agree on...if your condition is bad enough to consider cortizone shots, most of the time the cortizone is surely delaying the inevitable.

My left (fretting) hand is a severe case..and I can't do the exercises even if I wanted to. My time has come. This winter I will take the plunge, and hope like hell that the surgery is successful. :(

[JFDilmando]

When considering all the options I investigated the %'s of success and failure with cortizone and surgery. Most of the informatioin I found, as well discussions with Dr's, put the cortizone in the 20-40% success range with up to two treatments... surgery, close to 100% success rate. It is a simple proceedure, with few complications llikey. Recovery will vary in length but all likeyhood points to excellent mobility with minimal discomfort...
So far so good with me... I am still stiff and somewhat sore, with some problems with streatch chords, but getting better... Good luck to all that need to deal with this.

It is VERY common.

JohnD

[Ivan Kelsall]

The Steroid injections 'can' work very well,but have different outcomes for different people. A musician friend of mine had injections over 6 years ago,& has been TF free since then.I didn't know re.injections when i had my op.,if i had,maybe i'd have gone down that route.But,the op.worked. Another op.only daunts me because of the recovery time i'd have to spend not playing.
I currently have slight triggering in my left hand middle finger & index finger first knuckle. I've partially overcome the problem by using an Anti-inflammatory steroid Gel (Piroxicam), which has reduced the swelling in the tendons causing the TF quite a bit.
After my 1st TF op.,one of the things my Physio.told me to do,was to soak my hand in hot water for 5 minutes,then to get a face cloth,soak it & wring it out a few times. The tension & release of tension in doing that,frees up the tendon - i still do it & it does,
Ivan

[Patrick Hull]

I didn't mean to suggest that exercise has no place in TF treatment. Perhaps I should have typed, "When you REALLY, REALLY" have Tf it doesn't seem likely that exercise is going to cure it. There is a physiological problem that surgery can cure. Mine was so bad that even using the picking hand was problematic. I can't imagine trying to fret with a bad case. Trying to straighten my middle finger was very painful. I got a big click and a lot of pain. I changed to playing violin because I could use the bow. I thought about trying acupuncture but just went ahead with surgery, and I'm very glad I did.

[Raymando7]

Timely thread ! I have a hospital appointment on Monday about TF in my left pinkey finger. Useful to know about the limitation of steroids and the pain involved.

I have to do some sort of warm up before playing otherwise that finger is too slow. After a few minutes doing chromatic stuff things start to get better.

I like the idea of surgery to fix the problem but I don't think I could live with no 'mando fret action' !

I've had Carpel Tunnel operations on both hands in the past so I guess this is an area of weakness for me.

[tree]

Had the injection this morning, left hand middle finger. The hand surgeon told me it should be much better within about 3 weeks, but said to use it as normal, no restrictions.

Right now it's a little tight, since the "sleeve" area is slap full of corticostearoid (oddly enough, the symptoms were quite mild when I went in and became more noticeable with the injection). If this doesn't pan out, I may try the surgery. Whatever it takes to maintain my mandolin habit . . .

[mugbucket]

Dan,

Add me as another vote for the operation. I've had three - index & middle on the picking hand, and middle on the fretting hand. Also a carpal tunnel op on the picking hand. I got to the point where mega doses of vitamin B6 and anti-inflammatories were having zero effect, and I couldn't even make a fist.

All better now - just stiffness in the morning until the hot water & stretches take effect...

Ski

[robert.najlis]

I would try acupuncture before surgery. If the acupuncture does not work, not big deal, but if the surgery does not work, then you might be in worse shape...

feel free to ask your question on Mediyak.com if you like. you might get some useful information...