Pulling the Trigger: hand struggles of a musician

I’ve been dealing with a pretty scary tendon issue with the middle finger of my fretting hand for a few years now, probably even longer. Sometimes it will just lock-up half open, caught on something. Then my finger snaps closed, pulling through the catch-point and causing a nice blend of pain and cracking. This all happens in a moment, and it can be pretty scary given that music is my life.

Apparently I have what is called “stenosing tenosynovitis”, or “trigger finger”. If you’re a musician and had this experience, please get set-up with a hand therapist ASAP. It’s always better to be safe than sorry, and with Covid destroying the healthcare system in the U.S., the hand guys around here are pretty backed-up. It took me four months to get my appointment.

How did I get this way? 

According to my therapist, some people are genetically predisposed to trigger finger, but certain activities bring the body out of balance and make it worse. Doing any repetitive, intense stress on the flexor or extensor tendons can aggravate it. For me, it was gripping a lat pulldown and row machine, doing farmer carries, and too many yoga poses on my hands. Once I changed my gym routine things got a lot more manageable. Now I can play my guitar, just not at full capacity, which is better than not at all, but still pretty frustrating.

What causes trigger finger?

Your finger has a tendon and a sheath, or pulley. This pulley material is incredibly tough, and encloses your tendon while attaching to the bones of your finger (much like an eyelet on a fishing rod). The pulley keeps your tendon controlled as it opens and closes your finger. Just think about how random your finger’s trajectory would be without a pulley around it! Trigger finger happens when the pulley gets aggravated and swells, compressing your tendon. This pressure creates abnormal forces on the tendon, and over time these forces distort the tendon creating a bulbous area that rubs against the swollen pulley. This creates more irritation, which then creates more swelling and scar tissue at the pulley, which adds more pressure on the tendon, and so on. Eventually you get a knot in your tendon that catches against the pulley and then slips through, closing like a “trigger”. This is what I’ve been dealing with for years now.

Treatments

  • Night splints
  • Anti-inflammatory medication
  • Changing your activity
  • Steroid injection

The good news is that, according to my doctor, this is the most common hand problem today, and there has been a tremendous amount of research on the condition. Treatments are very simple and effective (at least when considering the complexity of the hand). About 80% of people can resolve trigger finger without surgery by getting two steroid injections spaced about 6-8 weeks apart. The steriod helps to calm down the inflammation and give the body time to remove the scar tissue around the area, thus restoring the balance of tendon and sheath.

I had my first injection yesterday and it was pretty scary, to be honest, but not all that painful. I’ll get the second shot when I get back from the bay area in November. Hopefully this is all it takes! If surgery is required, the procedure is so simple it can be performed in the clinic, although hearing about it almost made me faint; musicians would understand.

Find me here in the real world: https://walkerguitarlessons.com

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