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Trigger Finger syndrome

Postby Whammo » Mon Nov 05, 2012 5:53 pm

I'm curious if anyone has dealt with this condition. It is a form of tendonitis. Seems to be affecting the middle finger of my valve hand causing it to lock into the down position and snap back up requiring extra effort. Can be painful at times and it is slowing my technique. I have joked that at least it sticks down and not up, but behind the joking is some real concern about how this is going to turn out.

Thanks ahead of time for your comments.
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Re: Trigger Finger syndrome

Postby Tom » Mon Nov 05, 2012 6:21 pm

Just a comment...

Consider your equipment in terms of ergonomics and how well the instrument fits you. I have found that the valve layout, 5th valve trigger placement, and/or thumb ring location on some tubas to be just awful. In some cases the instrument's layout contributed to severe hand cramps, stiff joints, and situations like you've described where a finger gets "locked." It was particularly bad for me on piston CC tubas with "big valves," such as those from the B&S family (Meinl Weston, etc.).

I tried all sorts of things that ranged from using a tuba stand to reposition the instrument to visiting a repairman to see what could be moved and what couldn't. At the end of the day, the ergonomic issues could not be overcome which contributed significantly to the decision to sell that instrument and get a rotary CC.

The rotary instrument is much more friendly to my wrist and fingers and allows (in my opinion) for far greater hand placement and options for playing without making any physical changes to the instrument.

Yes, my F tuba has the same large pistons that I criticized earlier in this posting, but on the F the leadpipe has been moved, the 5th valve setup has been redone, and with the way the instrument sits when I hold it I am able to reach around it and (mostly) keep my forearm and wrist straight. I suspect part of this is due to the F tuba having far less girth than the CC tuba did.

So, take a look at your equipment and consider if it may be contributing to the problem. Playing in pain or on equipment that causes physical problems is not worth it. If it's a major factor, it might be time to think about a change. Otherwise remember that tendonitis, arthritis, and other joint problems can be serious and could well be worth seeing a doctor for.
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Re: Trigger Finger syndrome

Postby peter birch » Mon Nov 05, 2012 6:54 pm

Whammo wrote:I'm curious if anyone has dealt with this condition. It is a form of tendonitis. Seems to be affecting the middle finger of my valve hand causing it to lock into the down position and snap back up requiring extra effort. Can be painful at times and it is slowing my technique. I have joked that at least it sticks down and not up, but behind the joking is some real concern about how this is going to turn out.

Thanks ahead of time for your comments.


this is something to take to your doctor, get a referral to a hand surgeon, it is a 5 minute surgery, with 7-10 days recovery, with minimal risk and very low complication rate (or at least that's what it is in my hospital)
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Re: Trigger Finger syndrome

Postby bearphonium » Mon Nov 05, 2012 9:33 pm

Not me personally, but two different co-workers have had trigger finger...on their trigger fingers. Both had them surgically repaired, and both are back on full duty.
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Re: Trigger Finger syndrome

Postby bilmac » Tue Nov 06, 2012 7:05 am

I had mine injected and it worked fine. Doesn't always need surgery. Sometimes you feel a little node in your hand . I used to press it to get some relief but go see a hand specialist, that's best.
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Re: Trigger Finger syndrome

Postby mark38655 » Tue Nov 06, 2012 10:26 am

I had a problem with pain in my right hand so my situation was likely different. I was playing a rotor valve tuba with a configuration that required a severe bend in my wrist while playing. I did lots of relaxation exercises, changed tubas and avoided surgery.
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Re: Trigger Finger syndrome

Postby Drbuzzz » Tue Nov 06, 2012 11:49 am

I had started down that road. I've got small hands (like that Burger King commercial), and a certain piece (which I'll never play again) played on my Nirschl 6/4 was causing my pinky to hurt. I noticed what I thought was a cyst at the base of my pinky, so I went to a pain specialist in town. He told me it was the onset of trigger finger (the "cyst" was the inflamed sleeve around the ligaments).

He told me to put Aspercreme on it (because it actually contains medicine, not just chemicals that cause topical burning sensations). Of course he also told me to lay off the tuba. Not an option. However, after I performed the piece, I never had the issue again.

In your case, get to a doc (or two) ASAP. Get it fixed. Then do whatever it takes to not get into that situation again (lay off certain pieces, change horns, etc.)...where there's a will, there's a way. Now that you know what it feels like, I'm sure you'd notice the onset and not let it run it's course. Best of luck!
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Re: Trigger Finger syndrome

Postby ralphbsz » Tue Nov 06, 2012 3:06 pm

Go see a real expert. Look around for a hand surgeon. Your average primary care physician or orthopedic surgeon is not sufficiently specialized to deal with tendons in fingers; those are very small, rather complex, and have very "interesting" failure modes.

Quite possibly, the hand surgeon will look at it, and refer you to physical therapy. If that happens, look around for a physical therapist who specializes in hands. Those are quite rare too (here in the S.F. bay area, there is only a handful of them, bad pun).

Most likely, the first thing the doc and the therapist will prescribe is: rest and exercises. Tendonitis (and trigger finger can be caused by that, as well as by traumatic injury) is often caused by the tendon being overworked, then gets inflamed, is harder to move, which means you have to work it even harder, you start doing exercises to help it move, it gets even more inflamed, and that's the death spiral. On the other hand, completely resting the tendon may not be good either, as the tendon can get stuck in its sheath (by forming scar tissue).

Surgery for tendon damage is not a panacea: while it can cure the mechanical problem causing the inflammation, it will also cause swelling, injury, scaring, inability to do physical therapy, which all together may be worse.

Unfortunately, due to a nasty injury of my right index finger (I used to be a piano player), I've become a bit of an expert on finger tendons; this year I had two surgeries and over 100 physical therapy appointments. So if you were in the San Francisco bay area, I could recommend excellent people, but you're far away.
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Re: Trigger Finger syndrome

Postby MartyNeilan » Tue Nov 06, 2012 3:37 pm

ralphbsz wrote:Surgery for tendon damage is not a panacea: while it can cure the mechanical problem causing the inflammation, it will also cause swelling, injury, scaring, inability to do physical therapy, which all together may be worse.


That is why I leave my very-limited-range-of-motion left index finger alone. I am concerned that bad hand surgery could only make it worse, and I have learned to live with it (and without it.) The fact that my right hand continues to hurt, and has slight limitations concerns me more, but perhaps it will continue getting better given enough time. At least I can play tuba with it, although longer stroke piston valves definitely aggravate it. Perhaps a short stroke rotor would work best, in my case.
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Re: Trigger Finger syndrome

Postby Whammo » Mon Nov 12, 2012 3:13 pm

Thanks for the replies, everyone. I have an appointment with an orthopedic surgeon who is a specialist in hands and wrists. He has experience with this problem with musicians and comes highly recommended. I have also been told he is a trumpet player but have not been able to confirm it yet.
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Re: Trigger Finger syndrome

Postby scottw » Mon Nov 12, 2012 3:31 pm

Whammo wrote:Thanks for the replies, everyone. I have an appointment with an orthopedic surgeon who is a specialist in hands and wrists. He has experience with this problem with musicians and comes highly recommended. I have also been told he is a trumpet player but have not been able to confirm it yet.

Now you are doing it right! A hand-specific ortho is what you must have, as others do not know enough and have not had the range of experience for such a specialized part of the body. Sadly, I learned that the hard way. The trigger-thumb/finger is easily resolved by an expert. If they are a trumpet player, all the better.
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Re: Trigger Finger syndrome

Postby bbocaner » Mon Nov 12, 2012 5:50 pm

happened to me in my left hand two last fingers from supporting the weight of a heavy trombone. tried cortozone shots, etc, but ultimately needed the surgery. recovery took a long time for me in which I couldn't really use my hand. finaly went to see a hand therapist 3x a week for some rehab, she gave me some great exercises and after a couple of months it was good as new. except sometimes the scar tissue where they did the surgery hurts a bit...
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Re: Trigger Finger syndrome

Postby Whammo » Tue Nov 13, 2012 4:39 pm

Did anyone say that stress was a contributing factor? I know schlepping heavy equipment all summer didn't help. If it ever sticks up (bird finger), I'll call it "faculty meeting". :lol:
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Re: Trigger Finger syndrome

Postby Whammo » Sat Sep 22, 2018 5:09 pm

The Ortho surgeon discovered the ligament to the middle finger was partially torn. He repaired it but the amount of scar tissue needed about a year of PT. Even so, my technique is hindered and my professional career is over. I can and do still play for fun but my CC is up for sale. I'm playing my HB-12 F tuba on the Eb part in the brass band. But as things deteriorate, I will have to sell that one too.

Thanks for all the replies and advice.
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Re: Trigger Finger syndrome

Postby molefsky » Mon Jan 07, 2019 11:01 am

I'm sorry to hear this Bob. Did they say that this would continue to get worse? Where in AR are you located roughly?
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Re: Trigger Finger syndrome

Postby bloke » Mon Jan 07, 2019 12:08 pm

I predict that - eventually (not that far off?) finger joints will be able to be replaced, just as are knees.

Though my ignorance of such matters is epic, I would imagine that some of the roadblocks are miniaturization, and (same issues) the tiny/delicate blood vessels and nerves in the fingers.
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Re: Trigger Finger syndrome

Postby scottw » Mon Jan 07, 2019 1:25 pm

No where have I found the difference between a "good" and a "bad" doctor than in hand surgeons or general orthos who "Also" do hands. The very best are truly miracle workers, the rest are at best hacks. Sadly, I found this out first hand [I know, bad pun.] After 4 hand surgeries and continuing need for maintenance, you appreciate the difference a whole lot. The hack can seriously screw you up. Before you pack it in, maybe go for one of the top ones and see if there is anything to salvage from the hack's work?
Just as an aside: when a post-doc takes the test for surgical placement and training, there is an inflexible cutoff in test scores--score below that number, you will not become a hand specialist. You might dabble in it, but you will never get the training you need to be "good" at your job. I believe the cutoff is top 2% of all who take the test.
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Re: Trigger Finger syndrome

Postby paulver » Mon Jan 07, 2019 2:58 pm

I had the same issue on my left hand.... and now have it with my right hand. Had the corrective surgery done on my left hand years ago, and it works just fine now. That being said, my recovery time was a bit longer than as mentioned above. I wasn't permitted to even take the bandage off for two full weeks. I was doing quite a bit of mechanical work on farm tractors at the time, and the pain lasted for six to eight weeks after after the surgery. So, I would think that some very specific questions should be asked of your doctor for clarification, as everyone's situation is most likely different.

The way my doctor explained it to me was that the tendon sometimes will get irritated due to constant repetitive motion. The irritation develops into a "bump" or "lump", that swells up inside the lubricating sheath that the tendon travels through.The bump causes the tendon to get stuck inside the sheath. The surgery is nothing more than getting to the sheath and slitting it open so the bump doesn't get stuck anymore.

That was his simplified explanation to me, but like I said..... every situation may be different.
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