Dr. Roach: How to handle a trigger finger diagnosis

ANSWER: Stenosing flexor tenosynovitis, more commonly known as “trigger finger,” is a common issue, especially for people in their 40s and 50s, somewhat more common in women. (It’s called trigger finger because the finger gets stuck in the flexed position, and when it is straightened out, it snaps like a trigger being pulled and released.) The condition often starts out painless, but may progress to painful episodes, or even being unable to “unlock” the finger. Some people have more than one finger affected.

There are many strategies for conservative management. One that has data behind it is splinting the affected finger, which is effective in many people, but it may take 6 to 10 weeks. Avoiding activities that have caused the condition (pinching the fingers is a common one) may help. I have had readers write in to tell me that moving the finger (one person said underwater) helped, and quite a few have written me to say that the condition just went away after a year or two.

I refer people who continue to have symptoms despite conservative management to a hand surgeon, who can inject an anti-inflammatory steroid into the sheath the tendon goes through to try to keep the tendon from getting stuck. Although hand surgeons can treat this surgically, I have not had a patient have to go through the operation very often, as most people will get better by the third injection.

DEAR DR ROACH: I read your recent response to the 79-year-old woman with spinal stenosis. I am an 80-year-old woman with a similar diagnosis (spinal stenosis along with slight herniations at L4, L5 and S1 vertebras). However, I do not have the pain typically described. For several years, my legs have gotten weaker and weaker, and at this point, my legs feel like lead. I need to take Tramadol to be able to walk.

Have you seen these particular symptoms, i.e., weakness in legs or feeling generally achy, with spinal stenosis?

ANSWER: Compression on a nerve, due to any factor, most typically first causes sensory changes, especially pain or numbness, followed by loss of reflexes (you probably wouldn’t notice this because most people don’t check their reflexes). Last of all usually comes weakness. Progressive weakness is one indication to relieve the nerve compression, usually by surgery. However, as we say, not everybody’s body reads the textbooks, and nerve compression can sometimes cause weakness without pain.

It sounds like you have had advanced imaging, such as an MRI, to make an exact diagnosis of the cause, and I hope you have had evaluation by an expert to see whether surgery would be appropriate in your case. It often is not the appropriate choice, and many surgeons are reluctant to operate on people in their 80s. Still, I refer every patient I see with weakness due to spinal stenosis so that they can have an evaluation by a surgeon, as only the surgeon has the experience to recommend for, or against, surgery.