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  1. #1

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    Just hoping to connect with anyone who has had or knows about this condition. Apparently it’s common for guitar players. Symptoms are stiffness in one or more fingers or thumb of either hand such that, when you bend your finger there is a pronounced click or hitch in the movement.

    I’ve got it in the middle finger of my left hand. It started last year, I went to a hand specialist and he gave me a cortisone shot in the finger but the relief only lasted about 6 months. It came back a few weeks ago, but I haven’t wanted to go back to the Dr because the next step is surgery, and I would like to avoid that if possible.

    So I bought a splint about a week ago and have been wearing it nearly 24/7 (I take it off to bathe and wash my hands obviously). If anything the condition seems worse now. Before I started using the splint I could still play guitar, now it’s too stiff and painful to play anything. That’s a problem because I have a band, we have rehearsal Sunday and a gig in about a month so I’m starting to get concerned. That’s why I’m reaching out. Anybody else experience this problem? What have you done that’s worked (or didn’t?)

    Thanks.

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  3. #2

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    I've got one of those (not from the guitar). Ring finger, right hand. More I used it, worse it got. Luckily it seems to have eased up lately. Never had treatment and certainly not a splint.

    But if you're right handed then one on your left hand might be tricky. But does it actually click when you're just fingering the neck? I have to firmly close my hand before it seizes up. Normal gripping doesn't do it.

    That's all I've got on that. Yours is possibly worse than mine, I don't know.

  4. #3

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    I have had mild forms of that from time to time. Not a problem right now though.

    You can google it to get a bit more info on what it is and how it happens...

    Trigger finger - Symptoms and causes - Mayo Clinic

    A cortisone injection is the right fix for it--I did one of these myself (on someone else) last month. Personally I would recommend finding a reputable hand surgeon. There is a surgical fix, but that's not something you would want to pursue unless absolutely necessary.

  5. #4
    Thanks guys, at this point I can't make a fist or even close to it. It's much worse than it was last year when I got the injection.

    Thing about cortisone is you can only do it a couple of times. Apparently it can cause permanent damage to the tendon if you keep doing it. I'm going to see my new primary care doc on Wednesday, hopefully he'll have something for me, though I doubt it. My last doc sent me to the hand specialist who gave me the cortisone shot, maybe this guy can refer me to a different hand specialist.

    Like you I've had mild cases over the years, I always thought it was a curiosity. I didn't know what it was but it didn't hurt, didn't get in my way really and always went away after a few weeks. This time has been different.

    The other aspect of this that is relevant to this board is the fact that I bought my first good quality archtop about a year ago, a 1958 Gibson L-4C. I never could get comfortable with that neck and it was only a few months after I got that guitar that my hand started acting up. A few weeks ago I decided the guitar may have caused this condition so I replaced it with a 1967 L-7C, which has that nice thin neck Gibson put on all their guitars in the late 60s. This is really my dream guitar, basically a less fancy version of an L-5 (all hand carved wood). I used it at a gig 2 weeks ago and it was a dream, so easy to play and such a great tone. Unfortunately I haven't been able to play it since.

    Hopefully when I recover this time I won't get a recurrence because I won't be pushing myself to play a guitar that hurts my hand. I thought I was being a tough guy, now I see I was just being a dummy. And Jim Soloway even warned me about playing a guitar that wasn't comfortable for me -- on this board, in my NGD thread. Ugh! I don't listen for s**t, I spent a lot of money fixing up that L-4C and I'll lose most of that. We need a facepalm emoji...

  6. #5

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    Well, I'd bow to Doctor Jeff's expertise first.

    However, I knew all about the cortisone etc but I realised it was getting worse because I wasn't helping matters by using it all the time. I thought, probably, that it needed a bit of activity coupled with rest, rather like a pulled muscle, but I'm not sure I was right. I simply stopped using it for hard gripping - or very, very little - and it seems to have settled down.

    I would have thought a thicker neck would be better, simply because it lessened the distance and pressure needed to press on the string.

    I also think that if it's so painful you can't even make a fist then you must stop. Actually I can't completely make a tight fist either, but then I haven't needed to. Haven't hit anybody in ages... (joke).

    But I sympathise completely if it's stopping you playing, must be awful. On the other hand (no joke intended) it might recover quicker if you have a rest. But whether it will ever completely go away, I don't know. Let's hope.

  7. #6

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    The German federal law doesn't allow doctors to make an individual diagnosis on a online basis - and, as a matter of principal, without having an exact, individual diagnosis an expedient therapeutical suggestion is impossible.

    So it may not be helpful for you, but I checked the actual wikipedia listing on the trigger finger (TF), and, IMO, it's basically ok:


    1. The cause of trigger finger is unclear but several causes have been proposed. It has also been called stenosing tenosynovitis(specifically digital tenosynovitis stenosans), but this may be a misnomer, as inflammation is not a predominant feature ... The relationship of trigger finger to work activities is debatable and scientific evidence for and against hand use as a cause exist.

    This could show that the cause of the TF is related to the genetic disposition, or a metabolic or autoimmune disease. Since inflammation is not a predominant feature, why then multiple injections of corticosteroids? Steroids are one of the most effective anti-inflammatory drugs (it's their main effect), but repeated doses (at least, in a limited period of time) can lead to serious side effects to the tendon and the surrounding soft tissue.



    2. When corticosteroid injection fails, the problem is predictably resolved by a relatively simple surgical procedure (usually outpatient, under local anesthesia). The surgeon will cut the sheath that is restricting the tendon ... More recently, a randomized controlled trial comparing corticosteroid injection with needle release and open release of the A1 pulley reported that only 57% of patients responded to corticosteroid injection (defined as being free of triggering symptoms for greater than six months). This is compared to a percutaneous needle release (100% success rate) and open release (100% success rate). This is somewhat consistent with the most recent Cochrane Systematic Review of corticosteroid injection for trigger finger which found only two pseudo-randomized controlled trials for a total pooled success rate of only 37%. However, this systematic review has not been updated since 2009. [We all knew that doctors are lazy bones ...]
    There is a theoretical greater risk of nerve damage associated with the percutaneous needle release as the technique is performed without seeing the A1 pulley.

    A mechanical problem, here the affected digital flexor tendon and the A1 pulley, IMO, usually asks for a mechanical intervention to be eradicated. The outpatient surgery of the TF is a minimal intervention, the follow-up without a big fuss.
    The main problem, as always, will be to find a trustworthy, capable and affordable doctor, here a hand surgeon.

    Good luck - and enjoy your L-7C! Which guitar neck best to use is a completely individual thing, personally, I like to reach the middle of that road. I certainly play instruments of all periods, some of them with extreme necks - though not on a daily basis. And, no, it doesn't seem that violin or mandolin players do have more finger disorders than upright bass players. Just listen a bit more to your body, guys, it will tell you what's good for you, and what not! In other respects we also listen to it, don't we?




  8. #7

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    Just a few comments to consider:

    The risk of steroid injection for a local problem is extremely small ( whether it be infection, tendon rupture etc ). They are commonly used in medicine for a variety of issues ( arthritic joints, carpal tunnel syndrome, herniated discs etc ) Multiple injections to an area may be not warranted because you're getting diminishing returns/results, more so than the overall risk, which will also worsen the risk benefit assessment of any treatment . As the OP had benefit from a prior injection in the distant past, a repeat injection would be reasonable. Having said that, as this is a recurrent problem, the benefit may be limited from injection, MAY being the operative word. Much may be placed on the exam by the surgeon in assessing the tendon itself ( i.e. is there a palpable nodule/area of induration that would be less likely to respond to conservative therapy ) From a surgical standpoint the last thing a surgeon wishes to see is a complication from a procedure that could have been managed conservatively ( i.e. explain that one away in court! )

    Best of luck with your hand.

  9. #8

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    I've had relief from joint problems after visiting a Doctor of Osteopathic medicine (DO) who practices prolotherapy. I highly suggest checking it out. What is Prolotherapy? Biocellular Regenerative Medicine

  10. #9
    Wow, thanks for all the responses guys, I’m always amazed at how generous people can be on these discussion boards.

    So I had a huge breakthrough in the past 48 hours. When I got the splint I took off one of the Velcro straps because I didn’t think there was room for it. But when my finger got worse I decided to try it. Huge difference. The finger has been completely immobilized since Friday (it had a lot of wiggle room before I put this other strap on) and it feels so much better I was able to play my guitar for a while this morning.

    It’s still sore and there’s still some discomfort, but where I couldn’t bend it more than about halfway before I can almost make a fist now, say 80-90% of the way. After I played for a while I put the splint back on. I plan to be very conservative with this problem until it clears up completely. I know you guys think surgery on your left hand is no big deal, but it is to me. I don’t play guitar professionally but my whole life revolves around music, I don’t know what I would do if I couldn’t play anymore.

    I have an appointment to see my primary care doc on Wednesday so I’ll talk to him about it and see what he suggests, but I’m feeling much less anxious now. Thanks again for your support and suggestions.

  11. #10

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    Take this as advice from a stranger on the Internet.

    I had trigger finger in my pinkie some years back. Cleared up on it's own.

    I have had multiple injections in fingers because of arthritic pain. They were helpful.

    BUT

    1. One injection permanently bent my thumb. The joint works fine, but the thumb is not longer straight. Cortisone can damage tendons. Shot was administered by a hand surgeon.

    2. My current hand surgeon believes that the cortisone shots speed the deterioration of the joint and should be avoided.

    3. My finger pain eventually subsided. I believe that was because I had a previously undiagnosed Vitamin D deficiency, which was then properly treated. I could be wrong about that. I am advised that you shouldn't mess with Vitamin D on your own. Rather, you get the blood work, find out if you actually need it and follow the doctor's advice, with monitoring of the level.

    4. I have been told that trigger finger is the simplest hand surgery.

    5. My hand surgeon has spoken against general orthopedic surgeons doing hand surgery. He believes that hand surgery is different and requires a specially trained surgeon to have a high probability of a good outcome. Sounds self serving, but I strongly suspect he's exactly right.

    6. Symphony string players usually know which hand surgeon is good in the area.

    7. It's a joint issue, and rheumatologists sp? treat joint disease. It's another specialty worth considering, since they might be able to rule out other problems which could affect joints.

  12. #11

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    Quote Originally Posted by ragman1
    I simply stopped using it for hard gripping - or very, very little - and it seems to have settled down.
    A couple of years ago I had trigger finger issues in the left hand that caused me to cut back on practice time for a few weeks. It wasn’t extremely painful, but took some joy out of playing. I wondered if I was bending my fingertip too far and putting strain on the joint, so I tried to be conscious of that when playing. I’m old enough that it could be a first sign of arthritis. It finally cleared up though.

  13. #12

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    I'm another one who's been through the trigger finger situation.

    Mine was in my LH pinky. It manifested when lifting the finger after playing a note.

    I use the classical oriented curved LH finger technique and on lifting off there was a definite "click" feeling
    in the palm side. Didn't hurt in the slightest, but caused a definite lack of enjoyment of playing.....it was like waiting
    for it to click again. The whole thing got to where I was getting disturbed about what was going on and would it get worse etc.

    Luckily I had a great physiotherapist who used acupuncture as an adjunct to her other mainstream physical therapy.
    I went for about half a dozen appointments and as well as vigorous massage she would end each session with about
    a 15 minute period of acupuncture with an electrical current passed through as well.

    Nothing seemed to be improving with the finger and it was costing me practice time and some gigs.
    Then I went to what turned out to be the last session where she used an acupuncture needle and probed into the
    actual tendon ....quite an unnerving feeling and not entirely comfortable...in fact it hurt.
    I could feel that something was being prodded ....inside the finger and she probed like this for a few minutes.
    There was no anesthetic used .....but it was not too painful...I was wondering WTF she was doing in there and she said
    that on the previous sessions she'd felt the nodule on the tendon and had been breaking it down gradually with the electric
    acupuncture.
    What she achieved on that session was to break off what remained of the nodule.....she said to give her a ring in a couple
    of days to see if the situation had changed.

    Well, when I walked out of there I was flexing my LH into a gentle fist and opening the fingers .....the pinky was fine.
    All the way home I flexed the hand.....weeks and weeks of discomfort and concern....gone.

    Never have experienced a recurrence in that finger, or any of the others.
    That was about 25 years ago ....have just turned a number that begins with a 7 .....still playing ....no problems.

    And that is my story.....make of it what you will....
    I suppose in retrospect, my physio carried out a minor surgery in a very natural way....there was a lot of trust on my part.
    I knew her work well and also she was well known to the national symphony orchestra people in our town who sought her treatment.

    I wish the OP every success in getting a favorable outcome to what is a serious issue for us small muscle athletes.

  14. #13

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    Anatomically all humans show a constriction in the area of the first annular (A1) pulley on the palm close to the finger base joints. Initially, pathophysiologically, it's the flexor tendon sheath (connected to the annular ligaments) that starts with swelling and increasing constriction. Like with every tendovaginitis you can feel a "rubbing" or hitching, when strongly flexing the concerned finger. This is the most successful time frame for doing injections.

    Later on, if the disorder would worsen, a thickening of the tendon itself can lead to the known snap phenomenon, when the thickened part of the tendon is pulled through the constricted part of the tendon sheath (A1 pulley). If the thickened tendon part remains proximal of the constriction, the finger is blocked in flexion and can only slip back with a snap that can even get painful, or must even be reached out by help of the healthy hand.
    The watching of anatomical illustrations could be helpful for understanding how this works ... all of that stuff seems to have a copy right.

    As mentioned there can be underlying metabolic and auto-immune diseases that have to be cured.
    A ganglion cyst, a fluid filled lump associated with a joint or tendon sheath, can in the initial stage imitate the symptoms of a trigger finger. They're very frequently found among active musicians, more often around the back of the wrist, but also near all finger joints.
    In my youth, I had a ganglion cyst at my left wrist on the palm side that was definitely caused by my efforts to become a class violinist (ha - darn that dream!). Recently, my body dared to develop a small and amazingly unelastic tendon sheath cyst dorsally near the left middle finger PIP (proximal interphalangeal joint), without previous injury or inflammation signs. No, it wasn't one of these frequent arthrotic osteophytes. It developed over the course of weeks/months after a major endeavour to pile up fire wood.
    In both cases the self-treatment was - watchful waiting ...with success. Ok, I admit that my mind has developed some own procedures to put my body under pressure. So far it has always helped - the mind is king! Django Reinhardt, and many others, knew about that!

    In cases where joint-related ganglions or tendon sheath cysts are intractable, a percutaneous "needling" of these structures could help. In old times they took the hammer. Boy, my respect for good physiotherapists is almost endless, but I'd never let them perform such a needling deeper than the cutis! The risk for provoking a tendon rupture (ugly aftercare!) is not zero, especially if the tissue has undergone a pre-existing, unrecognized defect, or there are some other disorders like, for instance, the giant-cell tumor, growing benign though locally aggressive - the second most common tumor of the fingers and hands.

    Folks, please, in your own interest get as soon as possible rid of all sorts of joint splints that your specialist has not prescribed: their damage is often greater than their benefit! A much better alternative is simple watchful waiting, though it doesn't hurt if you ask someone who could be a bit more knowledgeable in this field.







    Life continues to dance, sometimes on crutches! - Robert Frank, photographer


    Last edited by Ol' Fret; 02-26-2018 at 08:28 AM.

  15. #14

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    I'll repeat this one again: It's not the same as a pulled muscle where the best self-treatment is a combination of rest and mobility. Fact is, more you irritate a trigger finger the worse it gets. It needs rest. Not complete rest, you can carry on doing things, but nothing damaging. Then it may ease up to quite a tolerable degree.

    The problem, of course, is playing guitar and I have no clever answers for that. However, the OP's problem is on his fingering hand. Mine (on the right hand) is always stiff but doesn't really seize up and click unless the finger is fully compressed and there aren't too many chords that require that. Like I said, a thicker neck is ungainly but it means there's less distance to cover and less pressure required. Trying it left-handed, I can certainly put considerable pressure on from above. Eventually, though, I'll begin to feel it.

    I don't know what other work the OP does with the hand. Hopefully not too manual. I certainly wouldn't resort to splints, cortisone or surgery unless it seemed absolutely necessary.

    Sorry to repeat. Easy to write this, of course - I'm not the OP and his case may not be the same.

  16. #15
    OP here. As so often happens with these threads, it's a confusing melange of advice, but I am grateful nonetheless. I'm not sure if the splint is helping or not. I'm not wearing it at work now, I'm thinking I might limit it to nighttime just to protect it from accidental damage in my sleep. As I said I'm going to see my GP Wednesday so I'll report back after that.

    FWIW I'm a SQL database programmer at work so my job involves some typing but I don't think that's affecting it. The job requires more thinking than typing, plus a lot of copying and pasting. We even have a piece of software that predicts what command we're typing so you only have to type the first couple of letters and it fills in the rest. Soon they won't need me at all, but that's a topic for another thread. Anyway, thanks again guys.

  17. #16

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    I once got a cortisone injection in my left hand. The surgeon had the needle in his hand when I walked in the room and pretty much he wanted to get paid so I was getting it no matter what after the cursory examination. The hand hurt for about a week real bad and then was the same as before for another few weeks, after the cortasone wore off the hand was much much more painful and tender than before.

    I spent a long time trying to get to improve my technique to get rid of the pain. Unfortunately I focused on my hands when I should have been paying attention to my whole body. Nobody wants to hear this but if you slouch or are stiff in your body then your hands are going to suffer. Playing in front of a mirror is good, taking the weight of your upper torso off of the guitar is good, noticing that your LH wrist is bent and stiff is good.

    What's happening with your thumb ? Is it by any chance clamped on the side of the neck most of the time ? What are you doing with your pinkie when not using it, does it happen to be tightening up. You might need to work on training your hand to support the pinkie stability by noticing that it curls when not in use and allowing that to stop happening.

    The hand is connected to the wrist forearm and ultimately through the spine and neck to the brain, there is a lot that can go wrong in terms of tension on that route, the symptoms might be localised in the hand but that in no way means that the problem starts there, usually things start with a clenched jaw and neck.


    Splints are a bad idea because they build in weakness, the body responds to stress by getting stronger, splinting stops the stress during an activity but that in turn allows the hand to weaken. The other problem with splints, or neck braces or whatever is that they give us something to tense onto and a tension habit is often the source of hand problems.

    Anyway, sorry if this is confusing but I was kinda surprised that this thread seems kinda fatalistic, like things happen for no reason and the player cannot help themselves.

    I don't have any problems at all with my hands any more, it is a long journey to fix these things by taking responsibility for your body use but it will make you a better musician and technician and maybe less likely to have other aches and pains (back, neck, knees) that are a consequence of playing in a constricting way but which you might not relate to guitar.

    All the best.

    D.

  18. #17

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    Consider the surgery.

    I had it in my right thumb. Got the cortisone shot, worked for a while. It would bother me off and on. It got to the point where it was very painful and a lot of swelling.

    Went to a plastic surgeon who specializes in hands. A very simple out patient operation. Hand bandaged up for a couple weeks, this is maybe 10 years ago, no problems since. I know other people who have had the surgery, no problems.

    Rick

  19. #18

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    Quote Originally Posted by tonyp145
    OP here. As so often happens with these threads, it's a confusing melange of advice, but I am grateful nonetheless. I'm not sure if the splint is helping or not. I'm not wearing it at work now, I'm thinking I might limit it to nighttime just to protect it from accidental damage in my sleep. As I said I'm going to see my GP Wednesday so I'll report back after that.

    FWIW I'm a SQL database programmer at work so my job involves some typing but I don't think that's affecting it. The job requires more thinking than typing, plus a lot of copying and pasting. We even have a piece of software that predicts what command we're typing so you only have to type the first couple of letters and it fills in the rest. Soon they won't need me at all, but that's a topic for another thread. Anyway, thanks again guys.
    Sorry, OP!

    I don't think being a developer is a great strain. More likely to be the back, elbow, tendons, and BRAIN :-)

    And, in some instances, sanity

  20. #19

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    In 2001 I discovered a small bump in the palm of my hand about an inch south of my left ring finger. Under it was a hard growth like a tiny ball bearing. I knew what it was and that it spelled doom for my playing. Saw a GP, she agreed it was a ganglion cyst, suggested I do nothing for awhile and see what happens. What happened was it got bigger and bigger and more painful.

    I finally went to a well-regarded hand surgeon, who aspirated it. That worked really well for a month, but then it came back. Next two tries, spaced out about four months each, didn’t work at all—he said the cyst was so tough the needle wouldn’t penetrate it.

    In late 2004 I had a trigger-finger operation to remove the cyst and clean up what could be cleaned. Surgeon said he could hardly cut the cyst with a scalpel. He declared the operation a success, but I know from sad experience that that just means the patient didn’t die in his surgery and all the surgical tools were accounted for at the end. :-)

    Had to wear a hard cast for ten days, then a removable splint for another ten, then had stitches removed. No restrictions after that—in fact, I did an unplanned gig the next day. It hurt and was very stiff, but it worked. About two months later, after the incision had healed, I noticed that there was still a hard lump there. Saw the surgeon again; he said it’s scar tissue and nothing to be done about it. More surgery would mean more scar tissue. Five years later I saw another hand surgeon at the Mayo—he said the same thing.

    So fourteen years later it still hurts, my ring finger is still slow and unresponsive, and my playing is greatly diminished. I have other hand problems too—can’t blame it all on the cyst, but a big part anyway.
    Can’t really blame the surgeon either; I’ve had scar tissue problems with other surgeries too. It’s just the hand I was dealt, pun intended. If there’s a moral here I don’t know what it is, other than everyone is different.

    Danny W.

    Health problem: trigger finger-cast-jpg

  21. #20

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    I've dealt with "trigger thumb" on both hands for about a year. I finally decided to get the shots, rather than simply just deal with the pain. So far, the shots have really helped but it has only been about a month. Coincidentally, my wife who is a nurse (and non-guitar player) is also dealing with a more severe case of "trigger thumb". The shots have been less successful for her. As Danny W said "everyone is different." Good luck in your recovery.