In light of what is going on in the world right now, Austin hand surgeon Dr. Alton Barron has been holding a weekly “Musician Monday” livestream with the goal to offer musicians a virtual avenue to ask health-related questions that they may normally ask a doctor in-person. This blog serves as a recap of the questions asked by musicians around the world and Dr. Alton Barron’s responses.
Today we’ll focus on a few of the hand and wrist related questions!
Is there a permanent fix for “trigger finger”? I.e. the finger sticks closed, and must be forced open with the other hand.
Trigger fingers are a relatively minor anatomic physiologic problem, but it has major repercussions for a professional musician. You need your fingers desperately to be fluid, and so, what is a trigger finger?
In our fingers, we have one tendon to the thumb and we have two long tendons to each of the other four fingers. One is the superficialis, the other is the profundus. Now, those travel through a tight sheath and they glide very well, lubricated by a little bit of tissue called tenosynovium… With overuse, you can develop inflammation of that sheath, and the sheath will actually thicken. There’s not very much space for those tendons to glide through anyway, and when they swell from the inflammation, they can develop a nodularity… When it gets really bad, they will lockdown, but when they’re milder, it makes the fingers sluggish, so you can’t play fluidly and well.
The good news is that if you have a mild case, it’s actually usually better when you’re playing because it is lubricated by the movement, but then you go to bed, and the fluid that’s been building up in your legs redistributes to our hands and arms and an area that’s inflamed gets more fluid, because that’s the concept of inflammation. Then, you wake up with your fingers stuck down and they’re much worse and you have to get them going by putting them under hot water to loosen them up and so forth.
So, the treatment for a very early one is rest, anti-inflammatory medication, and sometimes a little splint or some taping to keep you from curling your fingers when you sleep. Secondarily, many musicians can’t even afford to have that kind of a delay, so they want a cortisone shot. A cortisone shot into that sheath is very safe. It’s a small amount of cortisone, it doesn’t affect your whole body, and it bathes that tendon and reduces the inflammation. Cortisone is the strongest anti-inflammatory we have, we produce it naturally in our bodies. It’s super safe, but if it’s used in high doses or injected repeatedly to the same spot, then it can start to have untoward effects… We use a rule of thumb that applies to all the fingers, which is three injections max to one area. Now, if you’ve gotten really good relief for a year, and it comes back, then of course come back in and we’ll give you another injection. If you only got three weeks of relief, and then it starts triggering again, that portends poorly for you to be able to get over it with just injections.
The worst-case scenario is a super minor procedure. It’s a little one-centimeter incision to release the critical pulley in that area, the one where all the triggering and catching happens. It takes 15 minutes under local anesthesia and most musicians I treat, if they just have one, get back to playing within a week at the most. I encourage them to get back early, and you can move your fingers right away after the surgery. So, that’s the worst-case scenario – yes there’s a cure, it’s essentially 100% curative unless it’s just very chronic.
Dr. Barron is a board-certified, fellowship-trained shoulder, elbow, and hand surgeon who has been operating out of New York City and Austin, TX since 1996. He's here to answer your orthopedic questions – ask away in the comments!
Posted by Dr. Alton Barron on Monday, April 20, 2020
We hope these virtual Q & A’s with Dr. Alton Barron are helpful, especially during this time. We will continue to share the results of these livestreams in hopes that it will help musicians stay healthy and keep the music playing!