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, which can be pretty scary given that music is my life.
I have “stenosing tenosynovitis” or “trigger finger.” If you’re a musician and have 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 have a genetic predisposition to trigger finger, but certain activities bring the body out of balance and worsen it. 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 doing too many yoga poses on my hands. Once I adjusted my gym routine, things became a lot more manageable. Now I can play my guitar, just not at total 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 friction creates more irritation, increasing swelling, scar tissue at the pulley, adding more pressure on the tendon, and so on. Eventually, you get a knot in your tendon that catches against the pulley and slips through, closing like a “trigger.” I’ve been dealing with this for years now.
- 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 tremendous research on the condition. Treatments are straightforward 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 about 6-8 weeks apart. The steroid helps to calm down the inflammation and gives the body time to remove the scar tissue around the area, restoring the balance between the tendon and the 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 in November when I return from the Bay Area. 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.
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