QD 76 - Trigger Finger Save
QD 76 - Trigger Finger by Dr. Cush
Transcription
Hi. This is QD Clinic. I'm doctor Jack Cush, executive editor of roomnow.com. QD Clinic is brought to you by roomnow.live. You know, there's a quote that I put up recently.
It basically says, people don't care what you do. They do care why you do it. Let me tell you why I've done RheumNow live for the second year conjunction with my partner, doctor Artie Cavanaugh. The reason we've done it is because we wanted to have high impact education. We're a little tired of a lot of the usual meetings that are out there.
You know where they are. They're big, thousands or five, six hundred people. And and basically, you know, they you get lost in the crowd. There's hour after hour after hour of lectures that are then not really backed up by any q and a time. So what we wanted was to have lectures that were different.
Different in that there was a lot more q and a time, that there was going to be this face to face time between you and a small number of participants and the faculty. We wanna have this face to face sort of coupled with a large Internet spread to anybody that wants to watch it from home. We have the flip classroom where you learn before you watch or come. And then, again, more than 25, 30% of the time is devoted to interaction, polling, questions, q and a. It's really quite astounding.
And then, of course, we're doing it in Fort Worth, which is truly novel. And I don't know how to describe why Fort Worth is different, but it's one of those cities that actually is different. It's not cowboy. It's kinda cool Texan. But if you wanna find cowboys, we can show you where they are.
They're down at the stockyards, and there's a big honky tonk that you can listen to country music, or you can just do one of a million things that you'll see in in in Fort Worth, is uniquely Texan, uniquely American. Anyway, today's case for QD video, QD clinic. It's a 49 year old white man who comes to see me because he saw me about a year and a half ago with a trigger finger. Specifically, a trigger finger in his left fourth finger, this one here. And it would get stuck and it would snap open, and it was now at the point of not snapping open and being very painful.
He was back for a repeat injection. Now, we do see trigger fingers. I just wanted to review what trigger finger is and maybe what you should be doing about it. Can happen in almost any age, although it's more common with the elderly. It is said to be part and parcel OA and RA, but it's a fibrotic, nodular change to the flexor tendon usually near the A1 pulley, which is right near the crease of the MCP joint, and that's what gets stuck, that fibrotic tendon.
Which finger is the most common? It turns out actually the fourth one, the the ring finger, followed by the middle finger, followed by the index finger, and then, pinky and thumb being in the middle or being last on the list. Risk factors for getting this would not just be RA and OA, but also those who are doing repetitive movements. That's a key feature in a lot of people. Said to be a little higher in diabetics and those with hyperlipidemia, but is really high more so in women, than men, maybe two to threefold higher in women more so than men.
Treatment is a challenge, you know, it is the best problem. Not many people need surgery. I tell my patients, number one, change whatever it is that you're doing, stop doing it. If you do a lot of this all day long, stop doing this all day long, change your job, and get a different kind of mouse or whatever is driving that problem. I use ice.
I tell patients I can inject it here and now, and it'll probably get better in about two thirds of cases, or half the cases will get better if you just take an ice cube and put it right on that tendon, at the crease, put it in a paper towel, let it melt over fifteen minutes, do that two or three times a day for the next ten days. If it doesn't get better, then come back and see me. A lot of people opt for the ice, and most don't come back for an injection. When you do an injection, obviously, it's a touch here. I mean, a fine touch is needed.
You don't inject the tendon. That will damage the tendon. That will cause a tendon snap. You don't inject the trigger finger more than two or three times because then you'll cause fibrotic tendon changes and the tendon rupture. So once or twice makes sense, but after that, you gotta send to the hand surgeon.
Injection needs to be near the nodular change, in a perinodular fashion. So I use an anesthetic and then I kind of squirt a little bit here, little bit there. I try to put in a diluted amount of ten milligrams of Depo Medrol in and about the nodule. Tell patients to immobilize the joint, not use the joint, the finger, put a, an ice cream stick in there with some tape so they can't flex it for a day or two, and then tell them modify their their activity, and many get better. The ones that don't, the ones that come back for a re early repeat injection or repeated injections, you gotta send them to the surgeon.
They'll go in and do an open surgical, excavation and sort of try to, make that tendon a slimmer and more functional for the future. That's it for trigger finger on QD video. We'll talk to you tomorrow.
It basically says, people don't care what you do. They do care why you do it. Let me tell you why I've done RheumNow live for the second year conjunction with my partner, doctor Artie Cavanaugh. The reason we've done it is because we wanted to have high impact education. We're a little tired of a lot of the usual meetings that are out there.
You know where they are. They're big, thousands or five, six hundred people. And and basically, you know, they you get lost in the crowd. There's hour after hour after hour of lectures that are then not really backed up by any q and a time. So what we wanted was to have lectures that were different.
Different in that there was a lot more q and a time, that there was going to be this face to face time between you and a small number of participants and the faculty. We wanna have this face to face sort of coupled with a large Internet spread to anybody that wants to watch it from home. We have the flip classroom where you learn before you watch or come. And then, again, more than 25, 30% of the time is devoted to interaction, polling, questions, q and a. It's really quite astounding.
And then, of course, we're doing it in Fort Worth, which is truly novel. And I don't know how to describe why Fort Worth is different, but it's one of those cities that actually is different. It's not cowboy. It's kinda cool Texan. But if you wanna find cowboys, we can show you where they are.
They're down at the stockyards, and there's a big honky tonk that you can listen to country music, or you can just do one of a million things that you'll see in in in Fort Worth, is uniquely Texan, uniquely American. Anyway, today's case for QD video, QD clinic. It's a 49 year old white man who comes to see me because he saw me about a year and a half ago with a trigger finger. Specifically, a trigger finger in his left fourth finger, this one here. And it would get stuck and it would snap open, and it was now at the point of not snapping open and being very painful.
He was back for a repeat injection. Now, we do see trigger fingers. I just wanted to review what trigger finger is and maybe what you should be doing about it. Can happen in almost any age, although it's more common with the elderly. It is said to be part and parcel OA and RA, but it's a fibrotic, nodular change to the flexor tendon usually near the A1 pulley, which is right near the crease of the MCP joint, and that's what gets stuck, that fibrotic tendon.
Which finger is the most common? It turns out actually the fourth one, the the ring finger, followed by the middle finger, followed by the index finger, and then, pinky and thumb being in the middle or being last on the list. Risk factors for getting this would not just be RA and OA, but also those who are doing repetitive movements. That's a key feature in a lot of people. Said to be a little higher in diabetics and those with hyperlipidemia, but is really high more so in women, than men, maybe two to threefold higher in women more so than men.
Treatment is a challenge, you know, it is the best problem. Not many people need surgery. I tell my patients, number one, change whatever it is that you're doing, stop doing it. If you do a lot of this all day long, stop doing this all day long, change your job, and get a different kind of mouse or whatever is driving that problem. I use ice.
I tell patients I can inject it here and now, and it'll probably get better in about two thirds of cases, or half the cases will get better if you just take an ice cube and put it right on that tendon, at the crease, put it in a paper towel, let it melt over fifteen minutes, do that two or three times a day for the next ten days. If it doesn't get better, then come back and see me. A lot of people opt for the ice, and most don't come back for an injection. When you do an injection, obviously, it's a touch here. I mean, a fine touch is needed.
You don't inject the tendon. That will damage the tendon. That will cause a tendon snap. You don't inject the trigger finger more than two or three times because then you'll cause fibrotic tendon changes and the tendon rupture. So once or twice makes sense, but after that, you gotta send to the hand surgeon.
Injection needs to be near the nodular change, in a perinodular fashion. So I use an anesthetic and then I kind of squirt a little bit here, little bit there. I try to put in a diluted amount of ten milligrams of Depo Medrol in and about the nodule. Tell patients to immobilize the joint, not use the joint, the finger, put a, an ice cream stick in there with some tape so they can't flex it for a day or two, and then tell them modify their their activity, and many get better. The ones that don't, the ones that come back for a re early repeat injection or repeated injections, you gotta send them to the surgeon.
They'll go in and do an open surgical, excavation and sort of try to, make that tendon a slimmer and more functional for the future. That's it for trigger finger on QD video. We'll talk to you tomorrow.
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