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Explanation, Treatment, and Prevention of Trigger
Dr. Timothy Jameson
This brilliant article by
Dr. Timothy Jameson discusses a common affliction
amongst guitarists and musicians - trigger finger.
Finger movement is
facilitated by spaghetti like tendons that extend from
the muscles in the forearms to various attachment points
along the front and back of the fingers. Along their
route to the fingers, these tendons must pass under a
band of tough fibrous material called retinaculums.
A retinaculum helps to guide
the tendon to its insertion point, and acts as a
retaining band and fulcrum that keeps the tendon in
close proximity to the bones of the hand. The tendons
become surrounded by fluid-filled protective sheaths as
they pass under a retinaculum. This sheath prevents
friction from occurring between the tendon and the
With overuse of the tendon
from such activities as computer use, musical instrument
playing, and hobbies such as crocheting and firing
pistols or rifles, the sheath may become inflamed and
the contents will thicken. This compresses the tendon as
it passes through the sheath.
Because of this constriction
of the tendon, it begins to swell also. The tendon
swelling tends to occur just before it passes through
the sheath and retinaculum. In most cases, this involves
the flexor tendons of the hand. This inflamed and
enlarged flexor tendon will have difficulty passing
through the swollen sheath and will have difficulty
passing under the retinaculum.
The person suffering from this condition will notice
that one or more fingers will get caught up as he/she
tries to straighten them out. The finger will get stuck
midway in a flexed position.
The afflicted person will
have to physically straighten the finger with the
opposite hand. This procedure could painful enough to
bring the person to tears. When straightened, the person
may hear an audible snapping sound. This snapping is
caused by the thickened tendon squeezing through the
tunnel of swollen material.
Treatment of this condition
should begin as soon as the person begins to notice
difficulty moving the fingers. If treated early on,
conservative measures will be effective to bring the
inflammation down, and normalize tendon movement.
Conservative measures should include primarily
chiropractic spinal and extremity adjustments to
normalize nerve flow to the hand tissues. You should
also consider acupuncture, and myofascial therapy to
release bound-up strain in the fascia, muscle, and
If the condition is allowed
to progress whereby the finger cannot straighten,
conservative measures should still be considered over a
period of six weeks. If no relief if noticed in that
time frame, then more invasive measures may be needed,
such as corticosteroid injection, and possibly surgery
to cut open the sheath to give the tendon more space to
Several studies have reported an higher incidence of the
development of trigger finger, carpal tunnel syndrome
and tenosynovitis in diabetics. The use of
corticosteroids in this population has not been very
successful in remedying this disease, with only a 50%
success rate. It is also noted that diabetics tend to
have multiple digits involved. In these cases it is
important to use conservative care initially, since most
medically cared for individuals will usually require
With any condition of an
inflammatory nature, the key to prevention is education,
proper biomechanics, and common sense. The biggest
mistake people make is trying to work through the pain.
Those computer users making thousands of keystrokes and
under the pressure of deadlines are susceptible to these
injuries. Also in danger is the musician who is under
the gun to perfect a piece for an upcoming recital or
gig. Many musicians will practice 6 hours per day to
learn musical pieces. This puts a tremendous amount of
strain not just on the tendons, but also on the
musculature of the entire body.
An important aspect in prevention is to take frequent
brakes while computing, playing an instrument, or
enjoying your hobbies. I recommend at least a 10 minute
break every 45 minutes for the health person. Taking a
break does not mean heading to the coffee machine.
Breaks should be a time for stretching of the hands,
arms, and neck. If youve been sitting for the entire
time, get up and move around, loosening up your legs and
back. Give your body the attention it needs to keep you
going throughout the day
Copyright © 1998-2004 Timothy
Jameson. All Rights Reserved.
About The Author: Dr.
Timothy Jameson has been in private chiropractic practice for 15
years. Dr. Jameson has spent the last six years focusing on the
care of the musician population. His practice is family-oriented
and he also specializes in the care of infants and children.
(Our musicians to be!) He is the author of “The Musicians Guide
to Health and Wellness, which is available for download at
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