Trigger Finger/Thumb - has anybody experienced this?

[Smallgoon]

Long story short, I appear to be suffering from this with my left thumb. It's causing me a great deal of pain and seems to be getting progressively worse. Initially the pain and 'locking' of my thumb occurred in the mornings and would then fizzle out with repetitive movement. Now it occurs throughout the day and the locking feels a lot more severe when I wake in the mornings. My left hand now feels strained when I try to grip something or lift a glass of water to my mouth.

My GP has referred me to the Plastic Surgery dept at GSTT and I have an appointment for next Feb. Not sure if this is the standard wait time for treatment, or whether Covid has contributed to this (understandable).

I've read that treatment usually involves an injection in the hand, and if that doesn't work, surgery. My question is, can the injection be administered by somebody who isn't a Plastic Surgeon? Given that the pain is getting progressively worse, I'm wondering if I do have to put up with this for another two months, or whether I can be seen by somebody else quicker? I guess going private is an option, but wanted to exhaust other options before considering this.

Does anybody know? Has anybody received treatment for this condition?

I know it's a form of arthritis but I know little more than this. I'm 35 for clarity.

I had this treated twice, the first time by the GP, then when it recurred a year later, I had a private plastic surgeon do it, and it worked then.

It was only a couple of hundred £, I think; maybe a bit more, and worth every penny.

@Mumblechum0 Thank you, that's really helpful. Can I ask how long you had to wait on both occasions to be treated? Presumably you had the injection twice?

Private may be the way forward for me.

It's not necessarily a form of arthritis, because trigger finger, and more commonly trigger thumb, is one of the main symptoms of Carpal Tunnel Syndrome.

I have it, in my left hand the same as you, and with the exact same symptoms and sensations that you describe. I also have Ulnar Nerve Entrapment, which manifests itself in a total loss of feeling across the lower half of the same left hand. I believe this was originally caused by too much leaning on my elbow, and a conscious effort to stop that has seen the symptoms relent significantly since summer of this year.

Unless you've been examined, diagnosed, and Carpal completely ruled out, I'd suggest going back to a competent doctor and discussing the possibility. Carpal that doesn't respond to change of habits and/or physio often results in injections, and ultimately surgery anyway, but if it is indeed Carpal, if I was you I'd want to know about that rather than fretting about Arthritis at 35 years old.

@XDownwiththissortofthingX That's interesting. I read that it was linked to rheumatoid arthritis, hence my reference.

I've just read up on Carpal Tunnel Syndrome and I honestly can't say I've experienced any of the other symptoms. Interestingly, I purchased a wrist splint online as it was suggested it may help - it actually made it worse, so I've stopped wearing it.

I abandoned the splint also, because it became clear over time that the problem wasn't in my wrist but in the elbow, so the splint is wholly pointless.

The locking of the thumb, pain in the muscle between thumb and forefinger, and occasional locking of the forefinger, are literally the only symptoms of Carpal that I have as well. No atrophy, no backwards contorting of the digits etc, but it's most definitely Carpal Tunnel, and it has responded to me consciously not leaning on, or keeping my elbow bent for extended periods. When it was at it's worst, I could use my left hand to grip and lift anything with any weight (full pans, kettle etc), because the lack of sensation would cause my hand to 'wobble' constantly, and I had no dexterity in the hand either because it was severely impeding my ability to grip with my thumb, and also, the loss of sensation from the Ulnar was a factor in the lack of strength and dexterity. Those are not typical of Carpal alone though, because not everyone experiences Ulnar simultaneously in the same hand. Lack of the ability to grip with the thumb is typical though. Like, if you turn your hand sideways, so your palm is facing directly to your right, then you try to grip a sheet of paper between your thumb and the 'top' of your forefinger. People with Carpal can't grip the paper.

I started wearing the brace just as the symptoms of that and my Ulnar Compression began to relent, so it would have been easy to mistake that for the brace doing it's job, but in reality I know it was the change of behaviours I made weeks before the brace was ever on the scene.

Do you happen to spend a lot of time on your mobile, browsing in bed etc, sitting at a PC, or excessive time with a telephone at your ear? All of these things are known to be fiends for causing Carpal. Anything that involves a constantly bent elbow or wrist, or an elbow that leans on a hard surface.

should add, my Ulnar was far more of an issue than the Carpal for me. The loss of sensation from the Ulnar was total and permanent, whereas the Carpal symptoms were comparatively mild, if still uncomfortable and irritating.

This is why I'm saying my problem was mainly my elbow and not my wrist. By taking steps to address the Ulnar, the Carpal has also relented somewhat over time, but obviously in most cases where the problem is Carpal alone, the problem is very definitely the wrist.

Do you happen to spend a lot of time on your mobile, browsing in bed etc, sitting at a PC, or excessive time with a telephone at your ear? All of these things are known to be fiends for causing Carpal. Anything that involves a constantly bent elbow or wrist, or an elbow that leans on a hard surface.

I do spend time on my phone, but probably no more than anybody else. I don't really sit at a PC. I have a laptop and will usually use it whilst sat on sofa.

Out of interest, I'm right-handed, so wondering, if constantly scrolling on my phone was the cause, how this would affect the thumb on my left hand rather than right?

should add, my Ulnar was far more of an issue than the Carpal for me. The loss of sensation from the Ulnar was total and permanent, whereas the Carpal symptoms were comparatively mild, if still uncomfortable and irritating.

Gosh, yes I can imagine that wasn't fun for you. I take it this isn't ongoing any longer?

I've had trouble with my thumbs just recently.

Pain etc.

I put it down to phone and laptop. Apparently texters thumb is a thing!

My grip went and lots of pain. I was sure it was due to Holding phone in in same way a lot and the other hand scrolling.

Also using a laptop with a smallish keyboard.

I have stopped holding my phone (it's balanced on leg now). Bought a thumb support brace thing off the net. And switching fingers for writing. Got a decent sized keyboard for laptop.

It's loads better now. Been about 2 weeks of changing behaviour.

I'd say try that before going down the medicalised route but that's just my opinion and I don't know how bad the pain is.

@Smallgoon

I'm also predominantly right-handed, yet all my problems are in the left hand. Merest hint of a spot of Carpal in the right, but only in the sense that I get very infrequent twinges in the aforementioned muscle between thumb and forefinger. No locking of digits as of yet thankfully.

I may be right handed, but I tend to hold my phone in my left and scroll it using my left thumb. This involves a bent elbow, usually resting on a surface at the same time. I also spend a lot of time at a PC, which I'm convinced was the original cause of the trouble because I bought a new chair about 6 months before the symptoms came on. The new chair has armrests, the previous one did not, and I caught myself habitually resting the point of my left elbow on the armrest.

The ulnar compression symptoms have, thankfully, relented to the point whereby now, even on a bad day, I have what could only be described as mild tingling and loss of sensation in the small finger and ring finger. Considering it was complete numbness and total loss of sensation even up to six months ago, I'm relatively pleased with the progress. I'm not consciously and persistently aware of it right now, whereas before it was something that bothered me 24/7, to the point whereby it was constantly on my mind regardless of what else I was doing. I'll admit I was really quite concerned until I found out exactly what was causing it, because there is some familial history of MS, and loss of sensation and dexterity in the extremities is one of the first tell-tale signs.

I only have slight weakness remaining. I'd put my dexterity and strength at probably about 85% of what it was prior to the onset of symptoms. So while I'm not fully recovered as of yet, I'm hopeful that over the course of time it will relent fully and I'll regain full use of my hand. To be honest, even if it never recovers beyond where it is right now, I could probably just about manage. It would mean that things like playing musical instruments would be a thing of the past though, so from that perspective obviously I'd rather it went away entirely.

One other small thing that occurs to me -

Does your pain, sensation loss etc, appear to feel worse to you if you raise your hand above shoulder height? Do you notice any particularly odd sensation of you run it under warm water? Water at the sort of temperature you typically have your shower at for example?

I don't really know why, and I don't know if, again, this is typical with carpal or ulnar, but I always sensed an immediate, further loss of sensation whenever I raised my hand, and also, the sensation of warm water on my hand felt almost like an ice-burn rather than warmth. Almost like what you experience if you spend too long in the cold, outside, on a snowy day, get your hand wet without wearing a glove etc.

Again, I don't know if any of that is typical and common with Carpal, but maybe worth bearing in mind if you recognise any of what I'm describing. I think though that these were symptoms associated with the Ulnar compression though, which by the sounds of things is not relevant in your case.

I had this in both hands (four fingers in total!) when pregnant (along with carpal tunnel), but it went away after birth. Presuming you'd know if you were pregnant! Any hormonal changes you're aware of perhaps?

I'd say try that before going down the medicalised route but that's just my opinion and I don't know how bad the pain is.

@NiceGerbil It's not just random pain in my fingers if you read my post. It's quite specific in that I wake every morning with my thumb locked and stiff. It's painful to move and when I do there is a clicking sensation - this has been ongoing for over a month now. The difficulty is that GPs won't see patients unless it's an emergency so a phone consultation is the best I can get, and now a referral 2 month's away.

Have also already explained that the thumb/wrist splint I purchased seemed to further aggravate the thumb and would cause it to lock more frequently than if i'm not wearing it, so that's gone out the window.

@XDownwiththissortofthingX I'm right-handed and don't tend to use my left hand to hold my phone etc. I simply hold and scroll using my right-hand.

I can't say that I notice a difference if I raise my hand above shoulders, or when it's under warm water. One thing I have noticed is that it seems to kick in when my body is winding down/relaxed etc. In the evenings when I'm wrapped up on the sofa, during the day when I'm cosy, just before bedtime etc, and then obviously the locking in the mornings. I did wonder if it had something to do with my body temperature, but it doesn't seem to occur during or after a warm shower (I take my showers hot), which makes me think it's linked to relaxation rather than warmth if that makes sense. I tend to notice it kicking in in the evenings when I find myself drifting/just before a nap.

@bluebearss I'm not pregnant, no. If anything, I recently went back on the pill (2 months ago) and this was after a break of perhaps 3-4 months. When I go on the pill, I don't take a break so am on it for the entire month - my GP says it's fine that I stay on and don't have periods. Not sure if this is in any way linked.

The only real lifestyle change I can think of is that I've recently taken up yoga - well I've been doing Adrienne's 30 day yoga challenge, albeit spreading this out every 2-3 days, so I've been doing this for little over a month. I can't see how this would be the cause seeing as I've done yoga on and off for years.

I'm really at a loss. Today's locking was extremely painful, I needed to use my other hand to move my thumb. I'm going to explore getting the cortisone injection next week, if after speaking to my GP I'm no way clearer. I do feel that I need to expedite this now as it's making me feel quite anxious.

Ok I was only trying to help. Sorry.

If you have classic trigger thumb, then it’s just caused by a swelling of the tendon getting caught on the tendon sheath so that you have to force the lumpy knot of tendon through the sheath to straighten your thumb. I should imagine having a relaxed thumb all night so that it settles in the bent position would make the first straightening out in the morning feel more painful than the others! Other causes/exacerbating features would need to be ruled out before treatment is decided on, but if in the end they decide to operate, eg if injections don’t work and it’s very painful, it’s an incredibly quick procedure where they just cut the tendon sheath so that the knotted tendon can move freely without catching. The scar is hidden in skin folds.

Thanks. I think it's clear to me, almost 6 weeks into this that I have a case of "classic trigger thumb".

I've resisted taking anti-inflammatories, since all I'd have access to are Ibuprofen, and I know continually taking these are not good. Yesterday was the first time in 6 weeks that I decided I needed to pop two as the locking was consistent throughout the day. I took two at 6pm and they certainly had an effect, but this wore off by 10pm and I was back to square one. That said, this morning I woke up without the clicking. My thumb was locked into a bent position, felt stiff and was sore but I was able to move it around without the clicking. I'm going to see how it goes. Perhaps my GP can prescribe a stronger anti-inflammatory that I can take for particularly bad flare ups.

Otherwise, I'm already exploring cortisone injections to be administered privately. Am hoping surgery won't come into it.

Just wanted to post an update. Managed to see a Consultant today at GSTT rather than having to wait for my appointment next year. I'd been pestering them to see if they had any last minute cancellations, before I committed to paying £350 to go private - luckily they had one today and gave me 2 hours notice to travel to the hospital which I was happy to do.

Was seen by hand surgeon who upon investigating, confirmed it was a classic case of Trigger Thumb rather than anything else. He administered the steroid injection which was fine and nowhere near as painful as some of claimed in other posts I've seen on MN, so am currently sat here with a slightly inflamed hand, but fingers crossed it sorts itself out.

I've had 2 trigger fingers in the past, and both were treated with steroid injections which worked like magic after a few days.The relief was amazing.I was a barista and making 50-60 cups of coffee a day and gripping the handle of the coffee machine caused mine.
Good luck hope it sorts itself out.

Just to update a week later that the Trigger Thumb has all but gone. It continued to lock for a few days but with no pain at all, which made it a lot more bearable. I've now had 3-4 days with no issues at all so the steroid injection worked a charm. So pleased that this is finally sorted, I didn't enjoy the idea of having to wait 3 months to be seen. Also, thrilled with the service I received at St Thomas' Hospital, despite there being a global pandemic. Really makes me love and appreciate the NHS that much more!

Glad it's better! I have had it... it did come back after the first injection but not for a few years. I had a second injection and the hand specialist said he won't do any more, next time it will be surgery. I read that bromelain supplements can help and was taking them for a while when I thought it was coming back again - they seemed to help. Worth a try to keep it at bay? I am on long-term slow-release anti inflammatories now for another condition, which may be helping too.

@MountainDweller Thank you, this is really useful to know. I suspect that mine will return though I imagine it won't do so in the near future. My consultant said the same - something about the steroid injecting thinning the skin, so not appropriate to have more than two. I wonder what causes it in the first place, and why it appears to be common in women?