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Thursday, April 23, 2009

Some aspects of “Trigger finger” with homoepathic mode of treatment

Also known as ‘Flexor Tenosynovitis’, it is a stenosing tenovaginitis, in which the sheath of a flexor tendon thickens, apparently spontaneously, so as to entrap the tendon. It is more common in dominant hand & most often affects the thumb or middle or ring finger.
Sex- More common in women than men.
Age- Occur most frequently between the ages of 40 to 60 years.

Aetiology-Exact cause is not known. It is usually found in those with repetitive gripping actions. Diabetics are also more prone to this disease. Diabetics can have several fingers involved.
Aggravating factors- Prolonged, strenuous grasping may aggravate the condition.

Associated medical condition- Rheumatoid arthritis, gout, hypothyroidism, amyloidosis, diabetes mellitus.

Pathophysiology-The protective sheath surrounding the tendon in the affected finger if becomes inflammed due to any cause, the space within the tendon sheath may become narrow & constricting। As a result, the tendon cannot glide through the sheath easily & at times there is catching of the finger in a bent position। With each catch, the tendon itself becomes irritated & inflammed, worsening the condition। With passage of time inflammation becomes prolonged & there is scarring & thickening & occasional formation of nodules. As a result the gliding of the tendon becomes more difficult & the tendon may momentarily be stuck at the mouth of the sheath as the finger is extended. A pop may be felt as the tendon slips past the tight area. This causes pain & catching as the finger is moved.

Presentation- Pain & limitation of the movements of the involved tendons are the presenting features.

Clinical features- Patients frequently note catching or triggering of the affected finger or thumb after forceful flexion। In some instances, the opposite hand must be used to passively bring the finger or thumb into extension. In more severe cases, the finger may become locked in a flexed position. Triggering is often more pronounced in the morning than later in the day. Stiffness & catching tend to be worse after inactivity. A nodule or tenderness is noticed at the base of the affected finger. The nodule generally moves with finger flexion & extension.

Investigations- No X-rays or laboratory investigations are usually needed for its diagnosis। But blood sugar examination to rule out diabetes mellitus & other investigations to see the presence of associated medical conditions like rheumatoid arthritis, gout are to be done. Blood sugar estimation is particularly essential if multiple fingers are involved.

Differential Diagnosis- Trigger finger may be confused with Dupuytrens contracture, Carpal tunnel syndrome, Rheumatoid arthritis etc.


[A] General measures to be taken are- Besides treatment of the associated medical conditions, if any the following should be done-
(1) Rest.
(2) Limitation of activities that aggravate the condition.
(3) Occasionally a splint on the affected hand to restrict the joint movement.
(4) Exercise.
(5) Physiotherapy.

[B] Homeopathic medicines to be used – Ruta Graveolens (Ruta) is the specific remedy which is very effective as its remedy. The potency & frequency of dosage as well as duration of treatment varies with the severity of the condition & the individual

(1) Avoidance of repetitive grasping & releasing of objects.
(2) Modification of activity if it can not be avoided.
(3) Proper selection of tools for the job.
(4) Minimization of repetition. Periodical rest of the hands briefly during repetitive or stressful activity.
(5) Frequent stretching during repetitive activity.

Prognosis- Trigger finger can be effectively managed with homeopathy if treatment is started at the beginning। But patients with diabetes mellitus have a lower response rate.

In short, Trigger finger is a stenosing tenovaginitis which is manifested as a painful condition where a finger or thumb locks when it is bent or straightened & is treated by Ruta.

But in every case, a doctor should be consulted.

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