Inflammation makes finger snap like a trigger
DEAR DR. DONOHUE: I would like some information about a condition called trigger finger. About nine years after my retirement, at age 73, I had three trigger finger operations — left middle, left ring and right middle fingers. Generally, my health is good. I take no medicines.
What causes trigger finger, and is it possible to prevent it? — S.K.
DEAR DR. DONOHUE: I have been plagued by trigger finger for several years. I have it in the index finger of my left hand — not painful, but annoying. I also have it in the middle finger of my right hand, which was very painful. I got relief after injections. Now the ring finger of my right hand is triggering. What causes this? — M.D.
ANSWER: We’re able to bend fingers because tendons run from the forearm muscles through the palm to the fingers. A protective sheath surrounds those long tendons. When the sheath or the tendon to a finger becomes inflamed, a nodule forms. The inflammation and nodule trap the tendon when the finger is in the bent position. Motion hurts, and the finger stays bent. Pushing the finger straightens it. A snapping noise occurs when that happens, and it sounds like the noise made by a gun’s trigger.
Any finger can become a trigger finger, but the middle finger, the ring finger and the thumb are the ones most often involved.
Trigger finger can come with overuse. Diabetes and rheumatoid arthritis lead to it. In many, a cause cannot be found.
Early in the condition, a splint worn on the finger during sleep rests the tendon, calms inflammation and halts the progress of trigger finger. A cortisone injection around the tendon and sheath greatly reduces inflammation. If the pain is intolerable or if the finger remains bent, surgery frees the finger and cures the condition.
DEAR DR. DONOHUE: In the early 1930s, the doctor recommended that my father, my two younger brothers and I have our tonsils removed. He said they were of no value and would cause problems. I think the adenoids were removed too. I don’t believe any body part has no function. What is the function of tonsils and adenoids? What happens when they’re removed? Could their absence cause difficulty in swallowing, which I now have? I am 86. — L.J.
ANSWER: Tonsils and adenoids have the same tissue and cells that lymph nodes have. They serve a similar purpose. They filter out germs, and they make antibodies that are ammunition against invading germs. At one time, it was fashionable to remove them. The belief was that removal prevented infections like scarlet fever and strep throat. This was at a time before there were antibiotics. People do OK without them, but now they’re removed only if they are repeatedly infected or are so large that they obstruct air flow into the lungs.
Absence of tonsils and adenoids does not interfere with swallowing. Trouble swallowing can come from weakness of the swallowing muscles, nerve dysfunction, pouches in the throat, tumors or esophageal problems. It’s a serious sign, and you should tell your doctor that you have it.
DEAR DR. DONOHUE: I am a 56-year-old woman. I read about a device called a vaginal ring that alleviates a dry vagina. Is it safe? — F.R.
ANSWER: You’re referring to silicone rings with an estrogen core that are inserted into the vagina and stay there for three months. The rings release a small amount of estrogen daily. They ease the drying and shrinkage of vaginal tissues that occur after menopause and lead to itching and painful intercourse. Two brand names are Femring and Estring. They work. They carry the same warnings that all estrogen products carry after menopause — a slight increase in the risk of breast and uterine cancer, as well as a slight increase in strokes, heart attacks and blood clots. The amount of estrogen released is small, and the chances of such side effects are equally small. You have to decide if your symptoms warrant the small risk of those side effects.
Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.