Does Trigger Finger Mean I have Arthritis?

The short answer is, No! In addition,  A trigger finger is also not a dislocating finger or a knuckle being ‘cracked’. But that doesn’t mean that the a trigger finger is trivial – your trigger finger can be annoying, painful and progressive.

What is a Trigger Finger?

A Trigger finger is a finger that gets stuck in a flexed position, taking some force to extend the finger past a particular position.  Usually a click or a pop can be felt at the base of the finger when the finger is extended past the trigger point. Most often, the triggering does not cause pain at first, but progresses over time to cause pain and a stiff finger that often won’t fully extend.

Symptomatic triggering usually occurs in the index, middle or ring finger, but can also occur in the thumb or small finger.  Triggering is inflammation in the finger’s flexor tendon and pulley, analagous to  having a knot in your shoelaces – with some force the knot can be pulled through the shoe, but in the finger, each time the enlarged tendon tries to go through the inflamed pulley, the inflammation is exacerbated. The official name for the condition is called Stenosing Flexor Tenosynovitis, but is commonly referred to as a trigger finger.

Trigger Fingers and Thumbs in Children

Triggering in children is quite different. Young children can have triggering of their thumb that does not allow any extension of their thumb and is usually best treated surgically. Alternatively, triggering in the rest of the fingers of children is usually a separate anatomic anomaly, but still most often requires surgery for correction.

Who Gets Trigger Fingers?

Adult trigger fingers usually occur in those age 40-60 and does not  automatically require treatment. Diabetics and Rheumatoids tend to get triggering at a higher rate, but other causes of triggering include partial tendon laceration and cysts in the tendon sheath. Most triggering, however, occurs in healthy individuals.

What Can Be Done?
Many trigger fingers cause minimal symptoms. When symptoms progress to pain, stiffness and functional difficulties I recommend a steroid injection which quite successful in soften the tendon and pulley due to inflammation. I do not advocate splinting or physical therapy as these are proven to be rarely effective. Injections decrease the symptoms and inflammation in the majority of patients.  However, the symptomatic relief remains long lasting in only about half of patients.

When the triggering returns I offer another injection (no sooner than three months after the first injection) or surgical release of the pulley. This surgery is a simple and highly effective surgery that simply involves longitudinal release of the restrictive pulley.

The outpatient surgical release is nearly always successful and permanent, and many of my patients can return to work the next day. Long term relief is the rule, though other fingers occasionally independently may develop triggering.

If you have questions about this condition or you would like a consultation, contact my office at 206-633-8100 or submit a question that I will answer here. I make it my goal to fit you in promptly so as to get you back to full function and trigger free!

Common Winter Fractures and Ice Safety

FractuWalking in Winterres (or broken bones) of the ankle and wrist are common injuriesduring the winter months. We thought it might be useful to review some of the common injuries that often require urgent treatment.

Wrist (Distal Radius)Fracture
A “Colles” (distal radius) fracture is a particular type of wrist fracture involving the distal radius. This very common fracture occurs with a fall on an outstretched hand, often breaking a fall. Diatal radial fractures also occur during skiing, snowboarding or other falls . This particular fracture type is relatively common and can often be treated in a cast. In our clinic, we can usually treat these with waterproof Goretex casting that allows the cast to get wet during the treatment process However, some cases of Colles’ fractures require surgical intervention when proper alignment is necessary. … read more

Does Your Shoulder Hurt at Night? It could be a Rotator Cuff Tear

Shoulder pain is common, but it is not normal.  Perhaps you have a rotator cuff tear?  How would you know? 

Here are a few questions may highlight common symptoms that are common to those with rotator cuff tears –

Have you recently injured your shoulder?
Do you have pain with overhead activities? 
Do you have shoulder pain at night? 
Does your shoulder feel weak?

Don’t worry, not all rotator cuff tears need surgery, but it is important to identify the particular source of your shoulder painbecause the particular treatment and rehabilitation can drastically reduce your suffering.

One note – there is no anatomic structure called the “Rotatory Cup”!  You are right, the spherical end of the humerus does rotate in the glenoid (cup), and is actually the most mobile joint in the body. However, the “Rotator Cuff” is not directly involved with the joint surface, so problems with your rotator cuff do not necessarily mean that you have shoulder arthritis.

Common demographics of a patient with a rotator cuff tear include age 30-60, a specific traumatic episode or chronic heavy use of the shoulder, specifically difficulty with overhead activity. Symptoms include pain and weakness with initiating activities about the shoulder, night pain, pain on the side of the shoulder radiating down the arm.  Symptoms that suggest another disorder include grinding shoulder or popping shoulder, shoulder dislocation, pain in the front of the shoulder, stiff shouder, numbness, neck pain.

Once again, shoulder pain is common, but not normal. Proper systematic evaluation is critical identify your particular diagnosis to lead you down a rational treatment pathway with maximal chance of success.

For an appointment, call 206-633-8100 or you can submit a question that I will answer here.

Finger Numbness at Night

Many people experience numbness that occurs at night or even persists throughout the day. There are many causes of such symptoms and if the problem is consistent and persistent, it is important to undergo an evaluation by someone trained in such conditions such as an upper extremity specialist. Usually, with a simple exam and occasionally an electrical study, the problem can be identified and often corrected.

One of the most common causes for such numbness the hand is Carpal Tunnel Syndrome. There is a wealth of information available on the subject, but not all is necessarily reputable or helpful. As carpal tunnel syndrome is one of the most frequent conditions that I see, I thought it would be worth preparing an informative article on the subject that can help my patients start the process of learning about Carpal Tunnel Syndrome here.

In short, Carpal Tunnel syndrome is a progressive compression of one of the major nerves of the hand that causes numbness in the thumb, index, middle, and half of the ring finger, along with weakness and clumsiness in hand function. The compression on the nerve starts out initially as a transient and reversible condition, but reliably progresses to permanent and irreversible nerve damage if left untreated for years.

Treatment starts with education and interventions such as splinting or injections, but if the compression persists and progresses, so far the only reliable way to relieve pressure permanently is to surgically release the Carpal Tunnel in a relatively minor day procedure that takes less than a half an hour. Patients can often work the next day if their work allows a soft dressing.

If you have Carpal Tunnel Syndrome or are simply interested in learning more, please contact me – I would consider it a privilege to help you learn more and will take the time necessary to help you understand your options. You can contact me by email here or by contacting my office at 206-633-8100.

Orthopedic Specialists of Seattle’s New Ballard Location: Grand Opening January 3, 2012

After 40 years of service and the addition of expert surgeons, Orthopedic Specialists of Seattle has outgrown its NW Market Street Ballard location. It has now moved to a new Ballard location at 5350 Tallman Avenue NW, Suite 500. This office is located in the same building as the Swedish Hospital/Ballard emergency room.

The new Ballard location serves as an orthopedic clinic, while also offering same day emergency appointments. This clinic is using new, state-of-the-art X-ray equipment and offers a full scope of orthopedic services. Along with these services, this location gives access to all of its orthopedic surgeons.

All surgeons working at the Ballad location, Dr. Downer, Franklin, Ruhlman, Shapiro, Weil, Peterson, and Watt are experts in many orthopedic problems including sports injuries, total joint replacements, hand surgery and pediatric orthopedic care. To make an appointment with an orthopedic surgeon please call (206) 784-8833.

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