" Trigger Finger " problem

[yeeman]

Has anyone developed trigger finger problems & associate it with playing hand drums ?
I had it in my left index finger 3 years ago & had it treated with acupuncture. I just had my 3rd acupuncture treatment today for my left middle finger. I'm hoping I will be OK after today.....until next time.

[thomas newton]

Ok, I'm not an expert but when my hands hurt (which is rare so far), I stop playing. I mean really stop. Playing isn't my living so I have no reason to carry on until I've recovered.

Acupuncture is fine as a symptomatic treatment but it won't remove the underlying condition.
Personally, I'd stop playing, get proper treatment for the condition. In the mean time I'd sing, play clave, kata, learn new songs etc.

There may be technical reasons relating to your playing that has brought this on. Seek some advice on that.

[pavloconga]

I had a problem around 10 years ago with my right index finger, probably due to my technique at the time.
Had to rest it a lot, had a few kinds of treatment including massage and osteopathy.
Did a lot of soaking in hot water with salt and other things. I needed to rest it a lot.

These days it's very rare for me to have any issues with my hands (though just a few weeks ago had an injury not related to drumming, I rested for 10 days before even touching a drum). Better technique these days (especially what I learned in Cuba) enables me to play more with less problems.
pavlo

[willie55]

will be going to get my Trigger Finger problem operated on May 6th, doctor says its a 15 minute operation, with no restrictions. need operation because middle finger is now staying up and can't close it so it looks like i am giving the middle finger salute to everybody, do not need any road rage problems while driving...will post after operation to give more details..

[congamyk]

Best wishes with the surgery from all of us Willie.

[windhorse]

I've had hand and finger issues off and on for as long as I've been playing. Like Thomas says, I simply stopped until it seemed okay again.. But, I also looked at fine-tuning whatever I thought of as a possible culprit, in my hand/finger/arm/shoulder/posture position and form. I've been working on it for 11 years, and it's much better, but there always seems room for improvement. I think that working on our technique is the ultimate path to a conguero's health and happiness.

And best wishes Willie..

[ABAKUA]

While in my 18 years of performing I've never come across this problem with myself or any of the old school players, in fact I've never even heard of any percussionist known to me to suffer from this.
I did find this info below which might be helpful for those interested...

Trigger finger is a common problem that causes pain and snapping of the tendons in the fingers. The problem that occurs in a patient who has trigger finger is due to the tendons of the fingers, and the sheath in which these tendons live.
What are tendons?
The tendons in your fingers are like ropes that attach to the ends of your fingers. When your forearm muscle contracts, the tendons pull the fingers into a fist. The tendons run part of their course through a sheath called the flexor tendon sheath. In patients who have a trigger finger, this mechanism of movement is not smooth.

What causes trigger finger to happen?
The cause of trigger finger is unclear, and can seemingly appear from nowhere. It can occur in one or more fingers, and can occur at different times in different locations. Trigger finger results from a discrepancy between the size of the tendon and the entrance to the tendon sheath. This discrepancy can be the result of localized inflammation or a nodular swelling on the tendon itself.

When the size discrepancy between the tendon and the tendon sheath reaches a critical point, the tendon will experience resistance from the tendon sheath. At first, this is experienced as a snapping of the trigger finger when relaxing a fist. If the condition worsens, the trigger finger may need active force from other fingers to straighten, or may not straighten at all.

Why is it called a trigger finger?
The name trigger finger is from the symptom of triggering or snapping. This occurs when relaxing a fist, the affected trigger finger remains flexed. When enough force has been gathered, the trigger finger will suddenly extend, like pulling a trigger.
The most common treatment of trigger finger is with injection of steroids (cortisone injection) into the flexor tendon sheath. The cortisone injection should decrease the swelling within the tendon, and restore the normal mechanics of the flexor tendon mechanism.
Usually a single cortisone injection will resolve, at least temporarily, the trigger finger. The chance of the cortisone injection providing a lasting solution for a trigger finger is about 50%.

Is surgery necessary to treat trigger finger?
If the problem does not resolve, a surgery to release the tendon may be necessary. This procedure is a same day surgery that can be done under local anesthetic or regional nerve block. A small (less than 2 cm) incision is made in the skin, and the tight portion of the flexor tendon sheath is released.

Following the procedure, a sterile bandage is applied to the site of surgery. This bandage is removed after a few days, and full use of the finger may then begin. Activity of the finger is encouraged as this will help prevent new adhesions (scar) from forming where the surgery was performed. Full recovery is expected for surgery.

What are the possible complications of a trigger finger release?
Trigger finger surgery is very safe, but there are possible complications. The most common problem is that the trigger finger can come back if the tendon sheath is not adequately released. Other possible problems include infection, stiffness of the finger, and damage to the nerves of the finger. The likelihood of these problems is very small, and trigger finger surgery has a very high success rate.

[Mike]

Finger problems can be caused by nerve problems,
the radial nerve in particular, when it is partially obstructed by
hypertension in the muscles.
At least this is what I have painfully experienced in the last weeks,
a doctor had the diagnosis of arthritis in the thumbs, but a very
competent PT found out that the long radial nerve is somewhere
blocked in my arm, and that makes fingers and thumb hurt.
BTW it can cause pain in the elbow as well.
The reason might be too much sitting, or also stress and hence
hardened muscles.
And today´s long office hours are pretty harmful for your mind and body.

So all in all I guess the pain in the OP´s index finger could spring from
what I also experience at the moment.
And it might be less a matter of false technique, at least not exclusively.

Abakua, perhaps the old-school drummers simply have or have had a lifestyle
completely different to what many of us have today?


FYI

Hutchinson encyclopedia on radial nerve:

In biology, the nerve in the upper arm. Nervous impulses to regulate the function of the muscles which extend the arm, the wrist, and some fingers pass along these nerves. They also relay sensation to parts of the arm and hand. The radial nerve arises from the brachial plexus (network of nerves supplying the arm) in the armpit and descends the upper arm before dividing into the superficial radial and interosseous nerves.

see also:
http://en.wikipedia.org/wiki/Radial_nerve

[willie55]

i have been playing since 1977 mainly congas, but this last year i switch to playing timbales at the festivals, and then in febuary i woke up one day and Trigger Finger just happen. like the description says, and my thought process also took me to thinking about all the percussionist that have been playing and i never heard of this until i got it. can this be a Kit Drummers problem more than a hand drummer. The point being is the hand gripping the sticks in a locked position? i will keep you guys in the loop with my surgery and the progress that should come with it.

[jorge]

Hi Willie and Yeeman,
Sorry to hear about your trigger finger problem. Various types of repetitive overuse can cause trigger finger, not only stick playing or hand drumming. Like most of us, you have a long history of highly repetitive hand overuse. The reference Abakua posted is a pretty good summary. Here is some additional medical information. I am a practicing physician, specializing in occupational and environmental medicine and internal medicine, and this information is from peer reviewed reliable medical sources. I cannot provide direct medical advice over the internet, so the main recommendation here is to be evaluated and treated by your local physician. I have provided this information in the hope that it will be helpful to you in discussing your situation with your own doctor.

The exact physical and genetic factors that combine to cause trigger finger, ie, why one person gets it and a hundred others don't, are not completely understood. Diabetes can increase the risk of getting it and decrease the success of treatment. The "triggering" is a locking and then sudden release of the tendon that flexes a finger, so smooth bending and straightening of the finger is no longer possible. The tendons are like strings attached to a part of the finger on one end and the muscle in the forearm at the other end. Like a fishing line when the hook is at the end of the rod, pulling on the tendon causes the finger joint to bend. Each tendon that bends the finger runs inside a flexible tube, a tendon sheath, that lubricates and nourishes the tendon. The usual cause of the triggering is a nodule that forms on the tendon and gets hung up inside the sheath when you try to bend the finger. Almost always the trigger finger is preceded by inflammation of the tendon sheath, called tenosinovitis. This can be caused by repeated trauma and other things as well. The chronic inflammation of the tendon sheath can cause a nodule to form on the tendon. The diagnosis is usually fairly obvious once you get triggering, but should be confirmed by a competent physician with experience in musculoskeletal problems, like an orthopedic surgeon, rheumatologist, reheabilitation medicine physician, or an experienced internist or family practitioner. It is a clinical diagnosis that does not generally require xrays, MRIs, or other imaging. Other tenosinovitis, injuries, or posttraumatic arthritis can cause pain similar to that caused by trigger finger, but they don't cause triggering. Carpal tunnel syndrome and radial and ulnar nerve compression are very easy for a physician to distinguish from trigger finger. Although they do occur in conga players and other drummers, they are very unlikely to have been misdiagnosed as trigger finger in this case.

The usual inital treatment is conservative, meaning rest (no gripping or grasping with you involved hand, and no playing!) and immobilization of the finger for several weeks until the acute symptoms have resolved, and then stretching exercises. Sounds like you are beyond that. Next step is usually local injections of corticosteroids into the tendon sheath. This is usually very effective in the first year, and combined with reduction of the repetitive trauma, often resolves the problem long term. Close examination of your playing technique, both congas and stick drumming, might reveal some bad habits that could be corrected. I like to hang out with old Cuban drummers who have been playing for their whole lives, and especially observe the ones who don't have hand pain, arthritis or other major hand problems. Characteristics I have noticed among them are that they get much more sound out of the drum than the apparent effort in hitting the skin would suggest. For example the late Puntilla didn't hit real hard, like Mongo or Poncho Sanchez, but got super clean, distinct, and loud sound from the drum. Skip Burney, who played Iya for Puntilla's group, is another one who can get great sound with minimal force. I think this is a factor in reducing risk for severe hand problems, but this is my own opinion, based on observation and formed without any medical evidence to support it.

Back to trigger finger, surgery is not usually done until after conservative treatment and 1 or 2 local injections have failed to resolve the problem. Willie, if you have not yet had local injections, ask your doctor what he or she thinks about getting an injection first and seeing if that works, before you get surgery. If you can, get a second opinion from a doctor who is not going to perform surgery on you. Most medical insurance will gladly pay for a second opinion before surgery. When you get back to playing, practice hitting the drum more softly but getting clear and loud sounds from it. Also check out your stick technique to see if you are doing anything that could be overusing and injuring the involved tendon(s). Get better fast.

George Friedman-Jimenez, MD
212 562-4572

[willie55]

well, i did my trigger finger opeation on my right hand on may 6th, yesterday may 19 i went back to the doctor, everything is good, still have swelling on my middle finger and tightness were they cut on the palm of my hand. the trigger finger problem is not happening anymore. have to do rehab exercises, opening and closing hand to make fist and strech out hand straight.
coco butter cream on scar to smooth out skin and try to relieve the swelling, no hand drumming for six weeks, but still have contracted festivals to do, so i will just let the kids lead the playing and make sure no one get hurt or to rowdy when playing the drums. got a set of marching tri toms to add so there will be 25 drums playing at a time. thank you all for your concern and may i never see this Trigger Finger problem again..

[jorge]

Hi Willie,
How is your hand doing now, about 3 months after your surgery? I hope your recovery has gone well and you are back playing congas again. Have you changed your technique for hitting the drum? Your stick technique? Someone today is starting a new thread on trigger finger.

[willie55]

i had the operation, and the middle finger on my right hand does not lock up anymore. BUT!!!!! the middle finger is slightly swollen and stiff, still and does not give me a closed fist easily, have to do therapy with a medium sponge to open and close hand, stick drumming on timbales or tri toms is no problem. to play congas i have to tape up middle finger good and play at about 75 percent hitting, will get pain if not using tape, Hand will warm up and i can play, at end with cool down finger will stiffen up. using EMU balm on hand to soften up and rub down, looks like the healing process will be 6 months to a year to get back to normal. so the OPERATION for TRIGGER FINGER WORKS, its the stiffness and swelling that stays on. the alternative to operation was steroid shots, which will help until you need to get the operation. i decided to get the operation first. i think as a percussionist the temptation to play after the operation got the best of me, and that is why my hand is not healing as fast as it should,,i have no gigs or festivals this month so i will post how the healing is speeding up..

[jorge]

Recovery from hand surgery does take some time but a good occupational therapist can help speed up the rehabilitation process. Often surgeons forget to refer you or for other reasons don't go out of their way to make sure you get appropriate occupational therapy. If you are not already getting regular occupational therapy, ask your surgeon to refer you. If you were just sent to OT once or twice, ask your occupational therapist if he or she will work with you more intensively. OT should be covered under most health insurance, but you need a referral from the surgeon.

[willie55]

i got a ocupational therapest at work that i went to in the begging, so i will start back up with him and make an appoitment to continue with the hand, thanks Jorge for your insight. just another hard head boricua who dosent' want to listen to do the right thing...