Managing Recurring Trigger Finger and Carpal Tunnel Syndrome: Non-Surgical Solutions

Old ailments unresolved with new issues arising?

Hello Doctor: I have been dealing with carpal tunnel syndrome in both wrists and trigger finger in my right ring finger since last year.
I have been undergoing rehabilitation intermittently, but due to work commitments, I haven't had time for therapy lately.
The symptoms of my right ring finger improved slightly during rehabilitation, but they still fluctuate.
This year, I purchased a TENS (Transcutaneous Electrical Nerve Stimulation) machine, and when I started using it along with rehabilitation, my carpal tunnel syndrome improved significantly.
However, the issue with my right trigger finger did not improve, so I consulted a rehabilitation physician who administered a corticosteroid injection, which resolved the problem.
Unfortunately, after I moved my pillow away while sleeping, I sometimes end up pressing on my hand, causing my carpal tunnel syndrome to flare up again.

Additionally, quite unfortunately, my left index and ring fingers have also started to develop trigger finger.
Sometimes, when I have to push a lawn mower for work, improper use of my fingers and hands may have caused my previously resolved right ring finger trigger finger to relapse.
I work in cleaning, which requires frequent use of my hands.
I understand that excessive use and improper handling can lead to these issues.
I know I need to rest more, but in my environment, even when I'm not working, I still have to do household chores and other basic tasks.
I am not the boss; I have to accept my circumstances.
I was previously doing rehabilitation, but now I hardly do it, and I find wearing a splint cumbersome.

Why does my trigger finger keep recurring? I do not want to resort to surgery as a solution.
Surgery is not the only option.
I have heard that Veterans General Hospital has conducted extensive research on trigger finger, including treatments like regenerative therapy.
Therefore, I would like to ask you if you have any effective treatments for carpal tunnel syndrome and trigger finger that could prevent these conditions from recurring without the need for surgery.
Thank you.

A Yi, 30~39 year old female. Ask Date: 2019/10/13

Dr. Yin Xinbei reply Rehabilitation

If you don't have time for rehabilitation and don't want to undergo surgery, prolotherapy is a good option besides traditional steroid injections.
Compared to steroids, it has fewer side effects, but it cannot guarantee that there won't be a recurrence.
Injured tissues may become inflamed again if overused, and prolotherapy simply helps the tissues heal better.

Reply Date: 2019/10/13

More Info

Managing recurring trigger finger and carpal tunnel syndrome can indeed be challenging, especially for individuals whose daily activities require frequent use of their hands. Your situation highlights a common dilemma faced by many, particularly those in physically demanding jobs. While surgery is often considered a definitive solution, there are several non-surgical approaches that can be effective in managing symptoms and preventing recurrence.

Understanding Trigger Finger and Carpal Tunnel Syndrome
Trigger Finger (stenosing tenosynovitis) occurs when the tendons in the fingers become inflamed, causing them to catch or lock when you try to straighten your finger. This condition can be exacerbated by repetitive hand movements, gripping, or prolonged use of tools, which seems to be the case in your work environment.

Carpal Tunnel Syndrome (CTS) arises from compression of the median nerve as it travels through the wrist. Symptoms often include numbness, tingling, and weakness in the hand, particularly affecting the thumb, index, and middle fingers. Factors contributing to CTS include repetitive wrist movements, poor ergonomics, and even certain health conditions like diabetes or thyroid disorders.

Non-Surgical Treatment Options
1. Activity Modification: Since your job requires frequent hand use, it’s crucial to identify and modify activities that exacerbate your symptoms. Taking regular breaks, using ergonomic tools, and adjusting your work environment can significantly reduce strain on your hands and wrists.

2. Physical Therapy: Engaging in a structured physical therapy program can help strengthen the muscles around your wrist and fingers, improve flexibility, and reduce inflammation. A physical therapist can provide tailored exercises and techniques to alleviate symptoms.

3. Splinting: Although you mentioned finding splints cumbersome, they can be very effective in managing both trigger finger and carpal tunnel syndrome. Wearing a splint at night can keep your wrist in a neutral position, reducing pressure on the median nerve and allowing the tendons in your fingers to rest.

4. Corticosteroid Injections: As you have experienced, corticosteroid injections can provide temporary relief from inflammation and pain. These injections can be particularly useful for trigger finger and carpal tunnel syndrome, but they should be used judiciously and not as a long-term solution.

5. Therapeutic Modalities: You mentioned using a TENS (Transcutaneous Electrical Nerve Stimulation) unit, which can help manage pain. Other modalities like ultrasound therapy, heat therapy, and ice packs can also be beneficial in reducing inflammation and promoting healing.

6. Regenerative Medicine: Techniques such as platelet-rich plasma (PRP) therapy and prolotherapy (a form of injection therapy that stimulates healing) have shown promise in treating chronic tendon issues. These methods aim to promote healing in the affected areas without the need for surgery.

7. Ergonomic Adjustments: Consider evaluating your workspace and daily activities for ergonomic improvements. Simple changes, such as adjusting the height of your workstation or using tools designed to minimize strain, can make a significant difference.

8. Self-Care Practices: Incorporating regular stretching and strengthening exercises into your routine can help maintain flexibility and strength in your hands and wrists. Additionally, practicing good posture and body mechanics during daily activities can prevent further strain.

Conclusion
While surgery is an option for persistent cases, many individuals find relief through non-surgical methods. It’s essential to remain proactive in managing your symptoms and to consult with healthcare professionals who can guide you through the best treatment options tailored to your specific needs. Regular follow-ups and adjustments to your treatment plan may be necessary as you navigate your recovery. Remember, the goal is to find a balance that allows you to continue your daily activities without pain while minimizing the risk of recurrence.

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