Doc: Trigger finger no cowboy ill
Dear Dr. Roach: Three or four months ago, the ring finger on my right hand started making popping noises when I bent it. Now it's still doing that, and it catches in a bent position from time to time. I work as a carpenter, and I can't afford to take time off. What do you think this is?
Dear R.B.: My guess is trigger finger. The tendons that bend the fingers travel from the forearm into the palm and then onto each finger and the thumb. On their way to the fingers, a sheath of tough tissue encircles them.
Repetitive movements of the fingers irritate the protective tendon sheaths, and they swell. The swelling squeezes the tendon, and the popping noise you hear is the tendon freeing itself from its swollen sheath. That snapping noise sounds like the noise heard when cocking a gun's trigger.
As time goes by, the finger might become locked for some time in the bent position.
You don't want to hear this, but rest is essential to permit the tendon to move smoothly. If you must work, padded gloves afford some protection for the finger. Gripping a tool like a hammer is particularly hard on the tendon and its sheath. Tools with a larger-than-normal handle are less of a problem. The best protection is wearing a metal splint so that the finger can't move.
Your doctor can give you a cortisone injection into the problem area, and that often reduces the swelling quickly. You must rest your finger after the injection for at least three days.
If two injections fail to free the finger, then you need to consult an orthopedic surgeon for an opinion on surgical release of the tendon.
Dear Dr. Roach: About a month and a half ago, I received a cortisone shot for trochanteric bursitis. I felt relief for a month and gradually began using an elliptical machine. The pain returned shortly after I resumed walking. Then I had another shot. When and what kind of cardio exercise should I do?
Dear M.M.: The greater trochanter is the bony projection at the top and side of the thigh bone. It's an area with three bursas — small, flat disks inserted between tendons and bones to prevent friction when the tendon moves across the bone.
Excessive exercise, hip arthritis, a discrepancy in the length of the legs and a turning of the foot to the big-toe side when it hits the ground are some of the causes of trochanteric bursitis.
Have you tried using a stationary bike? If it brings on pain, stop. How about swimming? It's an excellent cardio (heart) exercise and doesn't put stress on the legs.
You shouldn't try any exercise until you have been free of pain for two weeks. When that happy day arrives, walk a block or two. If you're tolerating walking fine, increase your distance and speed by 10 percent every week. That's a safe way to get back into exercising without inflaming bursas.
Email questions to ToYourGoodHealth@med.cornell.edu.