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  1. #1

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    Hi,

    Can anyone who has had cortisone / steroid injections for trigger finger or similar, advise on how long it took for the shot to begin working? or did it not work for you?

    I had a cortisone shot in the base of my left hand index finger about 2 1/2 weeks ago by a hand surgeon, and my finger is in a worse state than it was before the injection - painful, cannot flex the finger very far, and slightly worse swelling at the lower joint.

    I had read lots about the time frame of when these shots stop working for some people, but not much how long it took to start working.

    I am age 41. My problem started back in January, with sudden swelling and pain, and not being able to curl the finger into a fist - it stopped me playing guitar completely. After about 8-10 weeks it cleared up and I gradually returned to careful guitar playing.
    Unfortunately in July it came back - similar to before, no warning aches or pains - just sudden swelling of the whole finger, restricted movement, sore at the base of the finger on the palm - had to completely stop guitar playing or putting weight on the finger at all. I saw my Doctor and was sent for X ray/Ultrasound and referred to a hand surgeon.
    The X-ray result came back normal. After some weeks wait I saw the hand surgeon who suspected trigger finger (But - my finger has never locked once, it's just tight/restricted) so he referred me for Ultrasound guided steroid injection if needed.
    In the meantime I was sent for a basic ultrasound scan only (shorter wait) by this time my finger had changed, in that I could curl it slightly better, but now I could feel the tendon sheath at the base of my finger felt pronounced/firm/swollen to the touch, and if I tried to fret a note it would result in a lot of pain. Frustratingly the Ultrasound operator didn't find any problems - no enlargement of the A1 pulley, no fluid around the tendon etc.

    Some weeks later I had a follow up appointment with the hand surgeon, by this time the swelling at the base of the finger was even worse, and I could detect a tiny lump on the tendon when I flexed my finger and pressed by palm slightly away from the joint. The surgeon said the A1 pulley must be enlarged (thereby squashing the tendon sheath and tendons), and decided he should do the steroid injection there and then, instead of waiting weeks longer for the ultrasound guided injection appointment, so it was done over the desk - not pleasant and really hurt for a few hours afterward.

    So that was 2 1/2 weeks ago, and although the increased swelling from the injection has gone down, the pain/discomfort and restriction is worse than before, it's difficult to use my other left hand fingers at all without it seeming to irritate the index finger. I am wondering if he actually 'hit the target' as it was not done with real time ultrasound guidance.

    I'm trying to stay positive about the situation, anyone's experience with cortisone shots good or bad and the time frames in particular would be really appreciated.

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  3. #2

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    Sorry to hear about this. It must be frustrating.

    I had a similar problem with my right thumb when I was younger and played in bars every night.
    There was no swelling but the thumb only had 2 positions and made a clicking noise when I moved it.

    Two weeks of therapy did nothing so I opted for the cortisone injection.
    By the next day the thumb was back to normal.

    Maybe a second or third opinion is in order.

  4. #3

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    Quote Originally Posted by AndyTT
    Hi,

    Can anyone who has had cortisone / steroid injections for trigger finger or similar, advise on how long it took for the shot to begin working? or did it not work for you?

    I had a cortisone shot in the base of my left hand index finger about 2 1/2 weeks ago by a hand surgeon, and my finger is in a worse state than it was before the injection - painful, cannot flex the finger very far, and slightly worse swelling at the lower joint.

    I had read lots about the time frame of when these shots stop working for some people, but not much how long it took to start working.

    I am age 41. My problem started back in January, with sudden swelling and pain, and not being able to curl the finger into a fist - it stopped me playing guitar completely. After about 8-10 weeks it cleared up and I gradually returned to careful guitar playing.
    Unfortunately in July it came back - similar to before, no warning aches or pains - just sudden swelling of the whole finger, restricted movement, sore at the base of the finger on the palm - had to completely stop guitar playing or putting weight on the finger at all. I saw my Doctor and was sent for X ray/Ultrasound and referred to a hand surgeon.
    The X-ray result came back normal. After some weeks wait I saw the hand surgeon who suspected trigger finger (But - my finger has never locked once, it's just tight/restricted) so he referred me for Ultrasound guided steroid injection if needed.
    In the meantime I was sent for a basic ultrasound scan only (shorter wait) by this time my finger had changed, in that I could curl it slightly better, but now I could feel the tendon sheath at the base of my finger felt pronounced/firm/swollen to the touch, and if I tried to fret a note it would result in a lot of pain. Frustratingly the Ultrasound operator didn't find any problems - no enlargement of the A1 pulley, no fluid around the tendon etc.

    Some weeks later I had a follow up appointment with the hand surgeon, by this time the swelling at the base of the finger was even worse, and I could detect a tiny lump on the tendon when I flexed my finger and pressed by palm slightly away from the joint. The surgeon said the A1 pulley must be enlarged (thereby squashing the tendon sheath and tendons), and decided he should do the steroid injection there and then, instead of waiting weeks longer for the ultrasound guided injection appointment, so it was done over the desk - not pleasant and really hurt for a few hours afterward.

    So that was 2 1/2 weeks ago, and although the increased swelling from the injection has gone down, the pain/discomfort and restriction is worse than before, it's difficult to use my other left hand fingers at all without it seeming to irritate the index finger. I am wondering if he actually 'hit the target' as it was not done with real time ultrasound guidance.

    I'm trying to stay positive about the situation, anyone's experience with cortisone shots good or bad and the time frames in particular would be really appreciated.
    Very sorry to hear about your hand. I think WG's advice on second and third opinions is sound.

    You should get a number of responses with people who have had similar experiences. Good luck!

  5. #4

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    I'm 63 and went through a very similar experience. Quite painful to get a cortisone injection in your fingers. Mine worked for the trigger finger and hasn't been back since 2 years now.
    I would imagine most of this is due to genetics in my case. But maybe some form of calisthenics might be helpful. Howard Roberts Jazz Guitarist had some excersice in his teaching books

  6. #5

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    I had a similar problem with the index on my right hand. Could have been due to mouse use, gardening, DIY and less likely from gripping the pick in one position for up to one hour at a time. First injection two years ago - worked fine for 12 months and then the problem returned when I found myself gripping/turning a large diameter plastic washer on the pvc plumbing under the kitchen sink. So far, the second jab seems to be working, but have tightened up (!) on the range of manual diy tasks and warm up much more pre-practice and break in the middle to do a range of exercises.

    Your point about a specialist not placing the jab accurately could be a valid one. A friend recently had a cortisone injection in his shoulder and the 'specialist' hit a nerve.........................

    Good luck,

    David

  7. #6

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    I had multiple injections in several fingers maybe 5-10 years ago. Done by rheumatologists.

    One by a hand surgeon.

    Another hand surgeon, with excellent credentials, advised against them.

    These injections were all for pain. I did have a trigger finger episode, but that cleared without treatment.

    Everyone of the shots worked, only hurt for the first few seconds, did not hurt afterward and lasted at least for months.

    Eventually, again with doctor's recommendation and monitoring with blood work, vitamin D seemed to work and I haven't had any more shots.
    When my fingers start to hurt, I up the Vitamin D. So far, so good.

    You can overdo it with Vitamin D, so you have to be monitored to make sure your levels are safe.

  8. #7

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    Andytt,

    I had cortisone injections in my picking hand as an experiment by the hand surgeon to determine the likelihood of surgery being successful. I had developed three trigger fingers. I think the surgery would have involved cutting the bands so the nodules on the tendons would no longer catch on them. The cortisone injections did not improve the trigger fingers so I elected to forgo the surgery. This all happened about 20 years ago; I was a little older than you are now.

    I still have the trigger fingers. They're worst upon waking but I massage the affected hand and gently manually push/pull the fingers into flexing/extending completely. I also have a heated vibrating massager that makes my hand feel better.

    Good luck!!!

  9. #8

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    DE QUERVAINS TENOSYNOVITIS...PLEASE BE CAREFUL...SAY NO TO EXERCISE OF THE FINGER! Essex If it is truly De Quervains and not ‘normal’ tendonitis (in DeQ the tendons being jammed in the sheath due to a build up of scar tissue) I believe you will find literature Saying no exercise.
    I was advised by the first surgeon who did my releases (both wrists) to physical therapy. Within a week or two I was in worse pain than before. It took three surgeries to undo the damage exercise did.
    I did receive a cortisone injection to the base of the thumb joint once. Got great effect with two weeks. I have never done it again due to the incredible pain I experienced with them pulling the joint apart to inject. No thank you.
    within ten years of the injury and final surgeries I was able to play no problem. I play thumb over and really require a thin neck (hence being an Ibanez fanboy). Classical is actually easier to play due to the different thumb motion.
    I followed the device of Mrs JazzKritter whose career has been in catastrophic workers comp cases. Get thee not just a hand surgeon, but a hand surgeon specializing in work related injuries. That will take you out of the Tendonitis ambulance chasers and get you with someone who knows this stuff.
    Good luck, I know the pain you’ve experienced.
    d

  10. #9

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    As it turns out I had surgery about two months ago for my middle finger on my right hand. I searched for the best guy in town (Tulsa, a medium sized city) by asking music professors that were string players and teachers. As luck would have it, their guy retired a year or two ago. So I approached my heart doctor and asked who the heart surgeons and neurosurgeons go to for hand problems and found THE GUY...a guy that only does hands and micro surgery--most guys in that catagory do shoulders and elbows as well as hands. This guy was highly credentialed, early 40's, and impressive in every way.

    The doctor examines my hand and says my trigger finger was pretty typical example and said he starts conservatively and says a single steroid shot resolves the issue in about 60% of cases like mine. So, I opted for the shot after being told I would see some results immediately and would continue to see steady improvement over the next 2 to 3 weeks and would then have a tele-health appointment to check on me. (Covid19 is raging here in Tulsa.) Aside from there actual shot itself ("this will sting a bit"--it was the most painful shot I ever remember) in the upper palm and inch from the base of the finger, the scenario played out exactly as described. I did see immediate improvement that continued for two or three weeks.

    Unfortunately for me the improvement stopped at about 80%, which for real life was probably sufficient and I could/would have lived with, but for something as important to me as guitar playing, the remaining 20% I needed still involved a "hitch" that was exactly in the wrong location for playing jazz with classical technique, and the hybrid country picking I do.

    It turns out for my case there wasn't another intermediate step before surgery. A second shot, according to the doctor, is only about 20% effective for most folks, so I scheduled the surgery. It was an outpatient procedure performed in a hospital. I received a pain-block in the shoulder and was under light sedation. It was about a 30 minute procedure and I was surprised it was over so quickly. I had a 3/4" slit in my upper palm beneath the finger and 5 stitches. The hand was bandaged and required me to keep it dry for a few days. Stitches were removed a week later. But relief was immediate! I played guitar (carefully) the next day and have had a complete recovery. Mild scaring in my hand but less noticeable every day.

    I am back to playing guitar normally (poorly) with no residual effects...like it never happened. I still can't play the violin, but I never could. (By the way, being a headstrong, macho male bad-ass, I first tried all the internet suggested exercises and treatments to no avail, of course, before I called a professional.)

    That's my story and I'm sticking to it.

    Samuel




  11. #10

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    Very glad to hear of your good outcome, Onlyserious! Keep the faith, Baby!

  12. #11

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    I have never had issues with trigger finger, but have had experience with cortisone shots into my knee and meniscus.
    If I am reading your story right its not that it wore off but that you never felt the effect of the shot? I echo what others say here and say get a second or third opinion. I remember feeling the benefits of the shot the afternoon after I got it, and it lasted for weeks. I would make sure the procedure was done correctly.

  13. #12

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    I'm old.

    Got the cortisone jab in the knee 20 years ago.

    Wow, that hurt.

    It worked for me in a within days, say, five or six.

    For you, additional professional attention is probably in order.

    I wish you the best.

  14. #13

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    Quote Originally Posted by jazzkritter
    DE QUERVAINS TENOSYNOVITIS...PLEASE BE CAREFUL...SAY NO TO EXERCISE OF THE FINGER! Essex If it is truly De Quervains and not ‘normal’ tendonitis (in DeQ the tendons being jammed in the sheath due to a build up of scar tissue) I believe you will find literature Saying no exercise.
    I was advised by the first surgeon who did my releases (both wrists) to physical therapy. Within a week or two I was in worse pain than before. It took three surgeries to undo the damage exercise did.
    I did receive a cortisone injection to the base of the thumb joint once. Got great effect with two weeks. I have never done it again due to the incredible pain I experienced with them pulling the joint apart to inject. No thank you.
    within ten years of the injury and final surgeries I was able to play no problem. I play thumb over and really require a thin neck (hence being an Ibanez fanboy). Classical is actually easier to play due to the different thumb motion.
    I followed the device of Mrs JazzKritter whose career has been in catastrophic workers comp cases. Get thee not just a hand surgeon, but a hand surgeon specializing in work related injuries. That will take you out of the Tendonitis ambulance chasers and get you with someone who knows this stuff.
    Good luck, I know the pain you’ve experienced.
    d
    thanks for your reply, I have looked up De Quervains before and it seems to be a condition that affects the thumb only, I will ask the surgeon about it though, as my case doesn’t seem to be classic trigger finger - I had restricted finger movements (but no locking) well before there was a noticeable lump on the tendon, and the sheath has been swollen up for some time (like being able to feel a cylinder shape under the skin , from the base of the finger going towards the middle of the palm)

  15. #14

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    Quote Originally Posted by rabbit
    I'm old.

    Got the cortisone jab in the knee 20 years ago.

    Wow, that hurt.

    It worked for me in a within days, say, five or six.

    For you, additional professional attention is probably in order.

    I wish you the best.
    Thanks, that’s exactly what I was looking for. It does seem that the improvement should be felt within a few days or a week, and if not , it has no effect at all.

  16. #15

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    Thanks everyone for all the replies. Good to hear what worked for you, be it the shot or the surgery.

    It does seem that for others it is almost always the right hand that is affected, which makes me think that these problems may be caused by work/gripping other than playing the guitar, given that most people are right handed.

    I am left handed but play right handed, so my affected left index finger has not only had to most of the lifting/DIY/hand tool work over the years , but also gripping on the guitar for barre chords and partial barres as well, maybe not a good combination.

    It has really been painful the last couple of days and affecting my sleep, I managed to get in
    touch with hospital and ask if I could see the surgeon asap, so they are fitting me in later today.

  17. #16

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    I guess I'm in the lucky camp. After a couple of cortisone injections, I've never had it return. But everyone is different and as stated make sure you talk with someone who's an expert in the feild.

  18. #17

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    Quote Originally Posted by jads57
    I guess I'm in the lucky camp. After a couple of cortisone injections, I've never had it return. But everyone is different and as stated make sure you talk with someone who's an expert in the feild.
    That's right - same here ( two jabs and so far, no recurrence ). What I didn't say in my earlier reply was that the surgeon I saw here in France was heavy on 'no DIY/gripping' advice coupled with a recommended exercise/stretching routine. I believe that Bireli Lagrene had a tendonitis problem with his right hand at one point and I saw a clip where he demonstrated closing down ( fist-like) his two middle fingers whilst waggling the index and pinky independently for 10x etc. Many possibilities I guess.

    Good luck.

    David

  19. #18

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    I saw the surgeon again on Tuesday. He examined my finger and he thought that there was a bit of improvement, and said that the additional swelling/pain was due the volume of the steroid solution still being present in the enclosed space of the tendon sheath, and that I needed to get the finger ‘moving’ to help clear the inflammation. So, I have to move/flex the finger joints using the assistance of my other hand, then go back in six weeks time. I wasn’t told any of this when I had the shot, so I’m glad I went back.
    So far it does seem to be moving a little better and less painful. Fingers crosssed!

  20. #19

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    I hope your surgeon is correct.

    You might look into the business of dietary oxalates aggravating your connective. tissue & joints.

    I'm basically an advocate of 'fruit & veg' but it turns out the a lot of "healthy" foods contain
    more oxalates than a particular individual can tolerate.

    I am one of those individuals and a low-oxalate diet has helped me with other (not like yours)
    painful, 'refractory' problems. Don't get bogged down in the seemingly 'pyramid power-crystal energy'
    woo-woo aspect, this is real enough if it is pertinent in your case.

    Best of luck!

  21. #20

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    Well shortly after my last post, my surgeon organised a physiotherapist for the affected finger. I was given ‘tendon glide’ exercises to be done after applying a heat pack and massaging the inflamed area - this was pretty uncomfortable for the first week, it got easier but didn’t make any improvement to the finger. On the follow up the physio decided that restricted exercises would be better, and made a short splint for me to wear that only allows the finger to bend at the two end joints (then removing the splint 3 times a day to do the exercises). This made no difference either.

    I was due to see the surgeon again 2 weeks ago, but this is delayed due the Covid situation.

    I’ve also had pain in my feet that has returned, and some soreness in my other hand, at the base of at least three fingers. To top it off at the weekend, the day after some pretty relaxed playing, the index finger on my right (picking) hand started getting stiff and would not bend past half way, it seems it is going the same way as my left hand.

    I spoke with with my doctor about these events, and he sent me to have a series of blood tests today to check for RA, diabetes, gout, vitamin D levels and various other things, so waiting for the results.

  22. #21

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    Quote Originally Posted by AndyTT
    Well shortly after my last post, my surgeon organised a physiotherapist for the affected finger. I was given ‘tendon glide’ exercises to be done after applying a heat pack and massaging the inflamed area - this was pretty uncomfortable for the first week, it got easier but didn’t make any improvement to the finger. On the follow up the physio decided that restricted exercises would be better, and made a short splint for me to wear that only allows the finger to bend at the two end joints (then removing the splint 3 times a day to do the exercises). This made no difference either.

    I was due to see the surgeon again 2 weeks ago, but this is delayed due the Covid situation.

    I’ve also had pain in my feet that has returned, and some soreness in my other hand, at the base of at least three fingers. To top it off at the weekend, the day after some pretty relaxed playing, the index finger on my right (picking) hand started getting stiff and would not bend past half way, it seems it is going the same way as my left hand.

    I spoke with with my doctor about these events, and he sent me to have a series of blood tests today to check for RA, diabetes, gout, vitamin D levels and various other things, so waiting for the results.
    Best of luck! I hope you can get some progress on this!

  23. #22

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    Quote Originally Posted by rpjazzguitar
    I had multiple injections in several fingers maybe 5-10 years ago. Done by rheumatologists.

    One by a hand surgeon.

    Another hand surgeon, with excellent credentials, advised against them.

    These injections were all for pain. I did have a trigger finger episode, but that cleared without treatment.

    Everyone of the shots worked, only hurt for the first few seconds, did not hurt afterward and lasted at least for months.

    Eventually, again with doctor's recommendation and monitoring with blood work, vitamin D seemed to work and I haven't had any more shots.
    When my fingers start to hurt, I up the Vitamin D. So far, so good.

    You can overdo it with Vitamin D, so you have to be monitored to make sure your levels are safe.
    I’ve just had my blood test results back, my Doctor says my Vitamin D level is slightly low (perhaps not surprising for the time of year) and has recommended I take a specific daily dose of D3 - hopefully it will help.

  24. #23

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    Quote Originally Posted by blackcat
    I had a similar problem with the index on my right hand. Could have been due to mouse use, gardening, DIY and less likely from gripping the pick in one position for up to one hour at a time. First injection two years ago - worked fine for 12 months and then the problem returned when I found myself gripping/turning a large diameter plastic washer on the pvc plumbing under the kitchen sink. So far, the second jab seems to be working, but have tightened up (!) on the range of manual diy tasks and warm up much more pre-practice and break in the middle to do a range of exercises.

    Your point about a specialist not placing the jab accurately could be a valid one. A friend recently had a cortisone injection in his shoulder and the 'specialist' hit a nerve.........................

    Good luck,

    David
    On the occasion of the second jab I should point out that the specialist gave zero advice on exercises or offsetting the problem for the future, just seemed keen to operate if it occurred again. Meanwhile, I have adopted a policy of only gripping the pick for 60 mins maximum in practice and even breaking that down into 20 min slots. No gripping of UPVC plumbing fittings or opening bottle tops in the kitchen. Have adopted maximum use of touchpad and if using the mouse have now switched to LH ( easier than you might think ). Use alternate hands to grip and steer the lawnmower.

    Birelli (Lagrene) once illustrated ( on YT somewhere ) how he formed a fist of his right hand and then let go with thumb, index and pinkie and waggled those repeatedly whilst inwardly gripping the second and third fingers tight in fist fashion. Have found these to be really useful ( used variously across the week): 11 Trigger Finger Exercises for Pain, Stiffness, and More Otherwise, policy is to keep all fingers of the RH constantly on the move!

    Bonne chance,
    David