Cortisone injection for trigger finger

[jazzkritter]

Hi AndyTT
IIRC, my cortisone shot was pure hell for 24-36 hours and then it was like a curtain lifted, birds sang, and all was good. for about six months. That was after my first surgery which at that time we didn’t know was royally effed up by the surgeon. It took two more surgeries by the top hand guy at Jefferson in Philly to correct what that =/;(&+ did.

Probably recall from my comments earlier, Im not a doctor I’ve just gone through three surgeries to correct De Quervain's tenosynovitis. DeQ happens at the base of the thumb (sorta) whereas Trigger Finger presents in the finger(s). Check the Mayo Clinic site for excellent reference data.
Certainly look it up, but DeQ in advanced state doesn’t just heal itself. As the tendons in the sheath inflame, rubbing on each other it just builds more scar tissue. At its worst for me, my thumbs (both were damaged) would stick straight out and be very painfully stuck.
Anyone facing this has my empathy sympathy and prayers.
There is a test for DeQ, you can do yourself, the Finklestein Test. Rather than describing it here’s a link with a good video to help:
Finkelstein Test - Physiopedia

Very much a gold standard to determine real DeQ vs other fleshy stuff.
Best of luck there and feel free to PM.
I will spout no voodoo. Just clinically verified data.
jk

[AndyTT]

This may not directly address the OP, but may be helpful to someone.

I've had multiple injections in finger joints.
At Kaiser, they just plunged in. Eye popping pain for a few seconds until the anesthetic (mixed with the steroid) kicks in.
Outside of Kaiser, they prepped it with something that feels cold and makes the injection a little less painful.
Iirc, I was told that injecting the anesthetic would hurt as much as injecting the steroid, so there was no point in it.
I never had anything guided by ultrasound ... maybe that takes longer, so you need the anesthetic.
I had one trigger finger resolve on its own.
I've had one well known hand surgeon inject a steroid into a finger joint and another well known hand surgeon recommend against it. I've had two rheumatologists inject joints.
I also tried the usual supplements, fish oil, and some other things. No improvement from any of them.

One thing seems to help, but it should be done with blood work and ongoing medical supervision. It's Vitamin D3. One of the hand surgeons said that his musician patients do best with the D level in the bloodstream at 50 to 60 of whatever unit they use in the measurement. He recommended a level of D3 intake that my PCP didn't like.
To explore this, first you have to have your blood level of D measured. If it's low, you supplement and have it checked again after a suitable time period. Reportedly, there are hazards in taking too much. There are well documented hazards to not having enough D.
Even though I get some daily sun, the D3 supplement seems to help.

Good luck.

Thanks, interesting stuff. Yes it felt like there was a lot of poking around in different areas with the anesthetic needle (uncomfortable, but not painful) then by the time the steroid needle went in I couldn't feel a thing.

A blood test last winter found I was slightly low on Vitamin D, my GP recommended a specific dose of D3 to take so I've been taking that ever since, even through the summer, as it's not a particularly high dose (but it's larger than you normally find in supermarket multivitamins). I've had various blood tests since and my vitamin D level has not been mentioned again ( I normally get my blood test results via a letter rather than a consultation, so not easy to ask) so presumably it is in the normal range. It would be good to know the specific level though. As you do I try to get some daily sun even when working.

[AndyTT]

Hi AndyTT
IIRC, my cortisone shot was pure hell for 24-36 hours and then it was like a curtain lifted, birds sang, and all was good. for about six months. That was after my first surgery which at that time we didn’t know was royally effed up by the surgeon. It took two more surgeries by the top hand guy at Jefferson in Philly to correct what that =/;(&+ did.

Probably recall from my comments earlier, Im not a doctor I’ve just gone through three surgeries to correct De Quervain's tenosynovitis. DeQ happens at the base of the thumb (sorta) whereas Trigger Finger presents in the finger(s). Check the Mayo Clinic site for excellent reference data.
Certainly look it up, but DeQ in advanced state doesn’t just heal itself. As the tendons in the sheath inflame, rubbing on each other it just builds more scar tissue. At its worst for me, my thumbs (both were damaged) would stick straight out and be very painfully stuck.
Anyone facing this has my empathy sympathy and prayers.
There is a test for DeQ, you can do yourself, the Finklestein Test. Rather than describing it here’s a link with a good video to help:
Finkelstein Test - Physiopedia

Very much a gold standard to determine real DeQ vs other fleshy stuff.
Best of luck there and feel free to PM.
I will spout no voodoo. Just clinically verified data.
jk

Hi jk,

Thanks, it's useful to know that your shot gave you problems for 36 hours. My swelling has come down somewhat, but I still have some anesthetic numbness in the end of my finger after 24hours.

I have read about De Quervain's previously, it sounds awful so you have my sympathy. Have you now recovered, or still recovering? are you able to play guitar again?

I have had some thumb pain and stiffness on and off, but it seems to be either deep in middle of the fleshy part of the thumb, or in the end joint, and seems to be aggravated by being in warm/hot situations where there is more blood flow to my hands.

I will certainly have a go at the Finklestein Test though. When you say base of the thumb, do you mean near the wrist? I've not had any pain there.

[RJVB]

I have a trigger finger in my right annular, fortunately with the trigger point in a position where it rarely affects my guitar playing.

The origin is probably arthritic: the base joint of the finger in question is one of those where I'm hyperlax so it's easy to make that joint crack by just making a tight fist. I'm still thinking the TF syndrome was triggered by playing too roughly with my dog, esp. using a ball launcher with a shitty grip that presses into my tendon right where the nodule is now.

It's been almost 1.5y now, with some ups and downs but never bad enough to go find someone trustworthy enough to get a cortisone injection. I do massage the spot regularly, and do daily exercises that involve "rolling" my fingers with hands and arms in different positions so all the mechanical parts involved get warmed up gently and the muscles stretched (these are actually part of anti tennis-elbow exercises). I've also become more mindful of my playing technique, avoiding to curl the 3rd and 4th fingers up too tightly when I don't need them while playing, and using the 3rd less when playing on the high E.
The past few months I've noticed less and less triggering, and I'm convinced that the nodule has shrunk. Good to know about the vit. D; I have a running prescription for regular "shots" (15000-or-so unit vials) which is due for about now (according to my doctor there are also indications that vit. D boosts antiviral resistance).

Shortly before last summer I read (on the AGF I think) about acupuncture which can apparently be very beneficial for this. I haven't yet tried (few in my region, expensive without a prescription, and my housedoctor only wanted to give me a prescription to get an opinion before prescribing the treatment). There's a specific name for the intervention (or rather the places where to put the needles), I've been meaning to relocate the exchange to write it down somewhere...

[maco]

Hi, sorry to hear about your painful finger. awhile back I was doing a lot of repetitive work with hand tools and paint brushes. It was too much for an old guy. symptoms like yours crept in and effected my lousy guitar playing. finally went to a Plastic surgeon who was a hand surgeon. we did 4 or five steroid injections that eliminated problems in some of my fingers on the left hand. Pian and difficulty flexing the ring finger kept returning. So, after 3 times with steroids we talked about surgery. That took care of the pain and intermittent trigger finger in that ring finger. I never had problems with the steroid injections themselves, but everyone is different and reacts differently to meds. When all this is resolved, you might talk to a good surgeon and just get the surgery. Just get all the info and weigh it up.

[RJVB]

I see several people who got the surgery, so I'd like to ask them a question.

From what I understand, the surgery cuts the tendon sheath so that the nodule on the tendon can no longer catch. Now that sheath is there for a reason: to guide the tendon so it keeps flush to the joint when you flex your fingers. If you cut it open completely, you can/should get what I think is called "rubber banding", where the tendon lifts off the bones when you flex your finger, as far as your skin will let it go.

Does anyone notice something like this?

I just remember I had some similar nodule(s) on the thumb-side of my left index finger when I was in my early 20s; not hindering me but I could sometimes feel them when playing baroque violin. Talked about it with a teacher who told me it'd go away ... and it did.

[Drumbler]

I see several people who got the surgery, so I'd like to ask them a question.

From what I understand, the surgery cuts the tendon sheath so that the nodule on the tendon can no longer catch. Now that sheath is there for a reason: to guide the tendon so it keeps flush to the joint when you flex your fingers. If you cut it open completely, you can/should get what I think is called "rubber banding", where the tendon lifts off the bones when you flex your finger, as far as your skin will let it go.

Does anyone notice something like this?

I just remember I had some similar nodule(s) on the thumb-side of my left index finger when I was in my early 20s; not hindering me but I could sometimes feel them when playing baroque violin. Talked about it with a teacher who told me it'd go away ... and it did.

I had trigger finger in my right ring finger about ten years + ago.

It was bad so had the surgery you referred to.

The results were very good. I have not noticed any rubber banding.

I now have mild trigger finger in my right hand middle finger but am hoping to resolve it with rest, stretching, etc. We'll see.

[jazzkritter]

I had three releases, two left one right, about 15 years ago. The first “surgeon” did not entirely clean the scar tissue out of the sheath. Found that out several weeks later when my thumb froze out at 90 degrees. Needless to say got a referral to an occupational hand surgery specialist who fixed that and did the right hand.

Mine were due to a bicycle accident. So although I’ve been pain free in all honesty the permanent damage from the accident stopped my public playing both guitar and classical organ. Again due to accident damage not the D’Querrvaines Release.
Just don’t use that jackaxx I first did at Southern ocean County Hospital NJ.
jk

[Yanduna]

I had trigger finger a while back, and the cortisone shot helped, but only for a few months. It eventually came back, and I had to explore other options. Surgery was a last resort, so I looked into different steroid sources. I found https://steroidscanada.is/ helpful for researching alternatives before making a decision. Sometimes, a mix of treatments works best, depending on how stubborn the issue is.

[Tom Karol]

Had the same issue and tried a cortisone shot—worked for a while but the problem came back. Ended up doing the release surgery, and recovery was quicker than expected. No regrets.

Same here, and the scar is hardly noticeable.

[rpjazzguitar]

Some orthopedic surgeons do hands, even though they don't have the sort of specialized training that board certified hand surgeons do. No special license is required by law.

A hand surgeon who was chief of service at a teaching hospital told me that the extra training is important and to always go to a properly trained hand surgeon. Self serving? Perhaps, but I'm thinking he's right.

[Eugle]

The same for me. The cortisone shot helped only for a few months. I'm thinking about the surgery. Glad that I've found people here who did it and were lucky to solve the problem. Thanks for sharing your experiences! I also came across a Canadian Pharmacy B2B Partner site for affordable meds, which might be helpful post-surgery. Btw, how was your recovery? Any advice?

[nyc chaz]

You might want to try Dr Fredericks Original Trigger Finger Splints as sold on Amazon. Two years ago my ring finger was totally locking up on me. Wore these splints every night for awhile and during the day as much as possible.Finger is back to normal.The splints were the best money i ever spent.Playing an instrument requires touch and feel,surgery sometimes takes that away.

[Heybopper]

I have had loads of steroid shots. 3 in one finger, 2 in another and one in my first finger all of these on my fretting hand and then one in my picking hand.
Im 49. I first had trouble in about 2010 up till then no issues, did a degree in Jazz and was practicing all the time. When I finished uni I had more time to practice but the trouble started when I was working on pull offs like methany. I was doing it on single strings up and down the different scales and after about 6 weeks I was getting the trigger at nights. I ignored it as it wasn't painful and carried on.
Anyway one morning I picked up the guitar and as soon as I put the finger down on the string, a shooting pain went up my whole arm. I was terrified, it went away after about 20 mins but I went to the doctor.
Im in the UK so the doctor has to approve the injection and then book it so it was 3 weeks of worry. There was an online book for guitarists with this problem I bought it it was like $40 said you had to put your hand in freezing water for 5 mins then out for 10 mins and do it 5 times every couple of hours. I tried this but it didnt work.
The injection worked straight away but I was told to rest for two weeks. I managed to wait just a week.
It came back about 8 months later, then had an ultrasound injection, that cured it for about a year. Then it started coming in other fingers.
I think if you catch it early its not to bad. There is always swelling after the injection so I always rest for at least three days, The doctor says you can have one once a year but there are more risks if it keeps going in the same finger.
My fretting hand has been fine for a couple of years now. and the picking hand has been ok for a year. I massage the tendons now every few days when I can feel an ache.
There is a YouTube video of a guitarist recovering from surgery. Surgery was discussed for me. One doctor said it would be fine nothing to worry about, then when I went for the second appointment and saw a different doctor at the same hospital he told me all the risks, including loosing all feeling in the tip of finger or not being able to play at all.
It was really very worrying.
I dont do pull offs at all now and cant click my fingers anymore to count in tunes but everything is fine playing wise.
my advice is to make sure the swelling has gone down before you start playing.
Im sure in the states you will be faced with lots of different doctors saying all sorts of things but here with the NHS there are rules to follow and the guidelines are the same across the country.
I also prayed a lot and I mean A lot : )