Q: I am a 52-year-old woman.
About three months ago, my left thumb felt painful and I was not able to bend it forward.
I consulted an orthopaedic surgeon who said it was due to a condition called trigger thumb. I was given a shincort (anti-inflammatory) injection to reduce the inflammation.
The pain went away after the injection and I was able to bend my left thumb forward again.
However, a month ago, the pain returned and is now felt on the side of the thumb and all the way to the side of the wrist, which is now slightly swollen.
It is painful when I turn my left wrist or when I bend my left thumb or palm backwards. It also hurts when I press my palm on the table and bend the wrist at a right angle.
What is this medical condition and how can I get it treated?
Will acupuncture and traditional Chinese medicine (TCM) help?
A: What you have sounds very much like an inflammation of the tendon sheath. If the inflammation involves the flexor tendons, we call it trigger finger.
Trigger finger or trigger thumb is a condition where a patient feels pain or discomfort when trying to bend or straighten their finger or thumb.
Sometimes, the finger may become locked or stuck when there is swelling of the tendon lining.
The tendon lining is like a tunnel in which the tendon muscles glide to bring about motion.
The swelling of the tendon lining impairs the smooth gliding motion of the tendons, which results in pain or a catching feeling when the patient tries to flex his finger.
The causes of this condition are not always clear, although it may be due to rheumatoid arthritis, gout, diabetes and playing golf.
When you suffer from trigger finger, you may start to feel aching sensations at the base of your finger or thumb, and a thickening of the affected area.
However, when your finger begins to trigger or lock, it is likely that you will feel pain in the middle of your finger or thumb.
If the inflammation involves the extensor tendons of the thumb, it is called De Quervain's tenosynovitis.
It is a condition in which a patient feels pain over the wrist joint near the base of the thumb.
The tendons that extend and abduct the thumb become constricted in a tight tunnel that becomes progressively inflamed from friction and repetitive tendon gliding.
Frequent and increased use, or sometimes, overuse of the wrist, is the cause of this condition.
Often, nursing mothers or grandparents are affected by this problem when they are caring for their infants or grandchildren.
Most would experience pain at the side of the wrist, near the base of the thumb. It usually occurs after a recent increase of activity involving the wrist and the hand.
It begins as an aching sensation and worsens to a point when any movement of the wrist or thumb produces a sharp pain in the affected area. At times, that area of the wrist may become swollen.
Doctors will first try non-surgical methods of treatment, such as hand therapy, getting you to wear a splint, prescribing oral anti-inflammatory medication, or, as in your case, administer local steroid injections.
About two-thirds of patients will be permanently relieved of their symptoms. The remaining may have recurring symptoms.
In the latter group, a second steroid injection can ease the discomfort.
When symptoms persist without any improvement, surgery may be recommended.
The procedure is minor and is performed as day surgery, without the need to be hospitalised.
Surgery is almost always successful and you will regain normal use of your hand upon recovery.
Occasionally, you may require hand therapy after your surgery to regain normal function of your hand.
As for acupuncture and TCM, these treatments may help if they adhere to the principles of rest and pain relief.
DR ANDRE CHEAH, consultant at the department of hand and reconstructive microsurgery at National University Hospital
This article was published on April 24 in Mind Your Body, The Straits Times.Get a copy of Mind Your Body, The Straits Times or go to straitstimes.com for more stories.