trigger finger

I had this affliction, for about three months. It involved myalgia — that’s the name of the symptom, muscle pain — that limited my movements, produced frequent nasty cramps in several parts of my body, made me miserable and depressed. Among the affected muscles were those in my fingers, which cramped up painfully without warning. Especially my ring finger (third finger, left hand).

Eventually, it was seen to be a side effect of the very powerful statin drug I was taking (for blood pressure and cholesterol control), generic atorvastatin, trade name Lipitor, a very powerful statin prescribed at maximum dose. Which was breaking down muscle fibers. Essentially, I was being poisoned by one of my medicines.

That’s now over — I went off the Lipitor three months ago and recently started small doses of the steroid prednisone for symptomatic relief —  and I feel very much better, but an odd effect remains. My ring finger occasionally gets stuck in a bent position. No pain, no swelling or anything, just stuck, as here:

(#1) Stuck bent finger (workdesk spathiphyllum plant as background)

I can push it back with my other hand, and it makes a little pop! as it resumes its normal working position.

It’s called trigger finger, fancy name tenosynovitis. And it has nothing to do with the Lipitor poisoning.

Lots of lexical stuff here, much of it in medicalese.

ring finger. From NOAD:

noun ring finger: the finger next to the little finger, especially of the left hand, on which the wedding band is worn. [“third finger, left hand”, as they say]

For some time, I wore what I referred to as my “wedding-equivalent ring” on the third finger of my right hand — a symbol of my commitment to my “husband-equivalent” (marriage not being available to us in those days) — and Jacques did the same. Right hand with a bit of in-your-face, because everyone knows that queers like us do everything perversely, the wrong way round. (The rings were made of hematite, a black semi-precious stone, rather than the metals that straight people favor, so another bit of in-your-face, jointly decided on.)

Then he died, and I got to fret over how long a widower should wear the ring after his man is gone. I fashioned a compromise: put the ring on an elegant silver chain and wear it around my neck, as a remembrance.

Then I nearly died, from necrotizing fasciitis (the famous flesh-eating bacteria), and the ulnar nerve in my right arm was damaged by the many surgeries that saved my life, so I ended up with a severely disabled right hand, no longer able to manage fastening and unfastening the catch on the chain. Now the chain and ring live in a treasure box.

Here ends the story of my wedding ring. Except to say that it never had anything to do with the affliction of my third finger, left hand. (My little finger, right hand, doesn’t work at all, but is permanently curled up in a digital equivalent of the fetal positon; my third finger, right hand, barely works; and the muscles at the base of my first finger, right hand, have wasted away, leaving an unsightly pit. Oh, and the hand hurts all the time, mostly just an ache, but occasionally dramatic stabbing pain.)

trigger finger. A N + N compound, with the first, modifying, N referring to the trigger of a gun. From NOAD:

noun trigger finger: 1 the forefinger [aka first finger] of the hand, as that with which the trigger of a gun is typically pulled. 2 Medicine a defect in a tendon causing a finger to jerk or snap straight when the hand is extended.

The definition for sense 2 (which is a metaphorical extension of sense 1) is balled up in some way. What it should say is that in the condition trigger finger, a digit is bent as if pulling the trigger of a gun — see #1 above.

NOAD‘s definition for tensosynovitis provides fresh and useful information, but errs in failing to mention what a digit afflicted by the condition looks like:

noun tenosynovitisMedicine inflammation and swelling of a tendon, typically in the wrist, often caused by repetitive movements such as typing. ORIGIN late 19th century: from Greek tenōn ‘tendon’ + synovitis.

Organic symptoms of  the condition, possible causative factors, but no visual symptoms. (Also, I have neither noticeable inflammation nor swelling, just the bent finger (and the pop!).)

Tracking things back to synovitis, and then synovial (all from NOAD):

noun synovitis:  Medicine inflammation of a synovial membrane. [with the ‘inflammation’ suffix –itis]

adj. synovialAnatomy relating to or denoting a type of joint [the finger and toe joints, for example] which is surrounded by a thick flexible membrane forming a sac into which is secreted a viscous fluid that lubricates the joint. ORIGIN mid 18th century: from modern Latin synovia, probably formed arbitrarily by Paracelsus.

You’d probably never thought in such detail about the inner workings of your finger joints. And then the reference to Paracelsus, the 16th-century physician, alchemist, and astrologer, is an unexpected bonus — and he was Swiss! (from Schwyz, one of the original three cantons). A Swiss doctor and prognosticator.

Yesterday morning to my rheumatologist, about the myalgia and also my persistent dyspnea (another symptom name: shortness of breath), and added in the stuck bent finger, understanding that it was surely independent of the other stuff (and of my osteoarthritis as well). But it’s a joint condition, and she’s a rheumatologist.

So she had a pamphlet on trigger finger at the ready — from the Krames StayWell company, which specializes in patient education and offers booklets and brochures on many conditions and procedures. From that pamphlet:

(#2) Note curled finger in the illustration

She offered to inject some cortisone at the base of the affected finger, but since I have no swelling or noticeable inflammation, I thought I’d stay away from more drugs. I could always get it if I wanted.

Carnival of the specialists. Besides my primary care physician (in the Family Practice department), in the past year I have consulted with physicians in nine specialities at the Palo Alto Medical Foundation, most of them several times: a nephrologist, cardiologist, pulmonologist, neurologist, rheumatologist, orthopedist, ophthalmologist, radiologist, and gastroenterologist. I no longer see the podiatrist regularly, getting my feet tended to (once a month) by a pedicurist at a nail salon. (I never really recovered normal function after hip replacement surgery, so I can’t take care of my feet on my own.)

Mostly I’m a giant patchwork of medical conditions. Many many many of them. (Atrial fibrillation is the latest. Apparently, the standard way to discover you have it is to have a heart attack precipitated by it, so I suppose I’m lucky that it appeared during a routine EKG, seriously unnerving the technician. Soon to see a specialist described, by my cardiologist, as a cardiologist’s cardiologist. Meanwhile, I’m on a heavy-duty blood thinner.)


3 Responses to “trigger finger”

  1. Robert Coren Says:

    As a pianist, I’ve always thought of the ring finger as the fourth, not the third. (Fingering notation in piano music starts with the thumb as 1.) String players will disagree.

    • arnold zwicky Says:

      That’s a difference between technical language and ordinary language. Ordinary English has “thumb” and then four “fingers” in order from 1st (pointing finger, trigger finger) through 4th (little finger, pinky). In pianist-talk, the five manual digits are all “fingers”, numbered 1st through 5th. Correct usage then depends on context. If the piano fingering says 4, you use — shift to ordinary language — your third finger (your ring finger).

  2. arnold zwicky Says:

    A large number of Facebook friends report travails with trigger fingers — most noting that the cortisone injections are usually incredbly painful.

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