Trigger finger is where a finger in a gripping position appears to lock in place. When you pull the finger open, it unlocks with a click (or in my case a loud ‘clunk’ which made anyone around me squirm!), hence the name trigger finger. The condition is caused by a nodule growth on the tendon which gets stuck on the pulley (sheath) system that is there to guide/hold the tendon in place. Doctors have minimal knowledge about why this nodule forms. Nodules on tendons can come and go on their own, but this one has been bad and persistent.

The build up to the operation had certainly been playing on my mind for several months. Unsurprisingly the mental prospect of the surgery was the worst part since the operation itself was only 15min in duration and was carried out under local anaesthetic (although I avoided the temptation to watch it!).

The procedure itself involved cutting open the sheath(pulley) that was causing the tendon restriction to occur, which freed the movement of the tendon (and nodule). The surgical entry point was  on the palm of the hand just below the finger, and the incision itself was only about 1 inch long.

Recovery time has been fast. I am now nearly 3 weeks post op, the stitches are out , and the skin on the scar has fully healed over. I still have joint stiffness, and a bit of swelling which causes my finger to stiffen up in the bent position, but I expect this to gradually subside over time, especially after I keep stretching it like I have been instructed to do by the physiotherapists.

It is too early to do a complete assessment of the experience, but I can say that it’s great not having an annoying triggering finger condition any longer!

I wish there was a simple solution like this to my RSI condition!

UPDATE : 1 month post op

It’s now been about 1 month post operation, and I thought I’d update this post. Although the scar on the plam of the hand is healed over, however I still have a lot of  sensitivity about the entrance wound, as well as a lump under the wound. Not sure at this point if the lump is scar tissue or the nodule. The triggering has gone, but I still have a lot of stiffness in the joint, and the finger still likes to stick in the bent position (I have to physically bend it straight with my other hand). Hopefully this is just a result of the swelling and that this will go away on time. I am using the finger, but it can be sore depending on the task at hand.

Update: 2 1/2 months post op

The finger is getting  better all the time. It doesn’t stiffen up as frequently as before, but it still can stiffen quite badly and there is no cause I can determine for this. I recently had a follow up with the surgeon, and was advised that post op stiffness is common, and recovery can be as much as 18 months for some individuals – they don’t tell you that before the op! He suggested massaging the joint to reduce the swelling. The scar has totally healed up now, and is a whole lot less sensitive than it was a few weeks ago.

Update: 6 months post op

It’s certainly taken it’s time, but the finger is showing very little stiffness now. I can extend it fully contract it fully, grip things tightly, and have no sign of that horrible triggering any more. I can officially say the op was a success. It does go to show that there is a 3-6 month recovery term for this operation. Good luck with the operation if you are someone who is considering having it done and just factor in a few months for the recovery.

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I may not be a medical professional, but I am able to tell when I encounter descriptions of body motion that just make plain sense, and this DVD contains some enlightening information. In a collection of well narrated chapters complete with diagrammatic video illustration, the evidence is laid bare of our common tendencies to keep our bodies out of balance, causing pain through muscle tensions that, in turn, keep our bodies in bad posture. This is due in part to us having mapped the body in a particular way, eg in relation to position, when in reality the position is entirely different.

This DVD is broken into multiple sections covering the many aspects of posture imbalance, and covers areas from the head to the feet and just about everywhere in between. Posture is translated by the authors as ‘Body Maps’ which are essentially memories in your mind of where you think your individual body parts are and how you use them. The DVD highlights how you may have had a flawed map (understanding) of your various body parts in your mind from a very young age. This may have led you to actually move according to those flaws and results in the straining of some parts of your body which can lead to pain. As the narrator tells us, “We move in the way in which we think we are constructed …”, either consciously or unconsciously. Wrong body maps can be responsible for many bad posture related problems, from walking to sitting, to using a computer.

Subjects covered in the DVD include -

• Body maps – identifying flaws in the human body map and how to recognise those errors
• Balance – identifying correct balance with core posture, and identifying posture related pain
• Kinesthesia – learning free and fluid movement to correct body imbalances
• Arms – covering shoulders, elbows,  wrists and hands
• Legs – covering hips, pelvis, knees and feet
• Breathing – covering lungs, skeletal/muscular system, diaphragm
• Mapping the whole body
• Correcting the map
• Inclusive attention

The areas I can relate to most pertain to the shoulders, arms, wrists and hands. These are covered in detail and are very applicable to the RSI sufferer. The main posture/skeletal issues with RSI type injuries are listed, adding to the viewer’s knowledge and understanding through plain and straightforward explanations along with clear diagrams and video.

From previous experience, I knew that over-supination of the wrists was a bad thing, but now I know about the natural axis of rotation of the forearm and how it ties in with a neutral position wrist, as well as why supination causes so many injuries.

The company website rather generously shows sample videos of some chapters which are well worth checking out, and will give you a sneak peak of the DVD content and style as well as some key body map information!

• ‘Elbows’ chapter
• ‘Arms’ chapter
• ‘Forearms’ chapter
• ‘Hands’ chapter
• ‘Lower Back’ chapter
• ‘Balance’ chapter
• ‘Lungs’ chapter

I also found the section on breathing very interesting. It’s probably the first time I’ve been able to picture the role of the diaphragm in breathing, and I certainly had my lungs mapped as being a bit lower than they actually are. The related section on the ribcage was also revealing to me having just recently strained my sternum connective tissue whilst gardening. It  also reinforces the benefits of some breathing practices including Yogic breathing (Pranayama).

The DVD run time is a substantial 2hrs,  and certainly lends itself to being watched in stages. There is the temptation to skip straight to the section you are most interested in, however it should be watched as a whole to get the complete picture and overall message firmly ingrained in your mind. I expect that multiple viewings would be best to fully absorb the detail.

All in all this DVD is an excellent resource for just about everyone. It is not solely aimed at one specific group of people eg RSI sufferers, but covers the whole body, and should be a useful education tool for everyone, including ergonomists, physiotherapists, fitness instructors, yoga teachers etc, as well as many others including in the medical profession.

If you have posture related pain it’s likely that it’s down to your bad body map and it’s certainly time to re-educate yourself!

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There are a lot of braces out there, and what works for one person may not work for everyone. Braces are usually made out of neoprene or elasticated material coupled with a metal or hard plastic support to immobilise the wrist.

The primary use of the wrist brace should not be forgotten ie to rest wrist joints and forearm muscles that drive the wrist motion (forearm extensors, flexors), and reduce the pain associated from overuse injuries. While this may sound like a good thing, quite often if you wear a brace while using a computer, you will end up using other muscles in a strenuous way to do the same work, and can cause other injuries because of this.

There is no such thing as an ideal wrist brace, it really depends on what they are trying to do.

In the course of your RSI journey you way well encounter many different styles of wrist braces.

My general rules concerning wrist braces are -

1. You shouldn’t jump in and buy a wrist brace without first seeking advice from a physiotherapist or doctor.
2. Ideally, it should be used to rest (heal) the wrist and the overused (painful) muscles that drive the wrist extension and flexion, and not worn when using a keyboard or mouse.
3. Exceptions to the rule are perhaps specific braces intended to stop excessive flexion of the wrist if you are prone to this. It’s a far better idea to be able to spot this flexion yourself and change it, but if you have difficulty doing this then a brace may be required. Alternatively have someone stand and watch over you with a big stick, you will learn faster then!
4. Braces used to rest the wrist should not be too tight, just a snug fit. Over tightening can lead to restricted blood flow to the hand and wrists.
5. Consider wearing a wrist brace at night in bed to avoid sleeping with your arms/wrists/hands in bent positions. It is critical that you don’t have a tight brace when doing this so as not to restrict blood flow.
6. Don’t use them unless you have to. Its better to know your pain, when it happens and try to make adjustments to your  work practice etc to reduce the causes than it is to just ‘bandage up’ your injured wrists into a brace.
7. Neoprene braces can be hot, sweaty, smelly and itchy to wear even for short periods of time. Better to look for ventilated elastic material ones.
8. Wrist braces are not a good  universal fit for everyone, so you may have to make some adjustments to it to make it comfortable, including cutting bits out of it or adding some customised padding.
9. Wear them at work and they do flag to your employer and colleagues that you have a RSI problem!

Remember though, wrist braces are not a solution to RSI, they are really only there to rest an injury and ease pain. To address your injury it is far better to try to make adjustments to your work to stop the motion that is causing you to have the pain. In other words, you should monitor your wrist, hand motions at a keyboard etc, and make adjustments to your bad working practices, including posture changes. You should also introduce more regular breaks away from your computer along with a good stretching routine and some physical activity.

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It’s happening (quite badly) on the middle finger of my right hand – so much so that I have to use my other hand to prise the stuck finger open again! I also have minor trigger symptoms on some of my other fingers. It’s not just an inconvenient condition, it can be quite painful too! Usually trigger finger cases can clear up with some rest, ice and anti-inflammatory medication but this one has been with me for quite some time.

The trigger condition has been diagnosed as such by doctors, and has been treated twice with steroidal injections (to no avail). Surgery looks like the next option for me to relieve this condition, and is only a day patient procedure done under a local anaesthetic. I am however waiting for summer to pass before going ahead with the surgery, although going through with it will mean me taking 1-2 weeks off work to allow it to heal. This would be fine if I was employed with entitlement to sick pay, but being self employed means two weeks without pay! Not fair is it?

Interestingly enough this is a condition that I can remember happening mildly when I was younger (maybe as young as 12), where the middle finger of both hands would lock and click when I forced them open. These symptoms were not much of a problem to me back then, and they ceased completely when I reached my late teens.

However, the condition has over the last 10 years returned, and in the last 5 years has got much worse. The consultant that I have seen asked me what it is that I grip tightly, but I’m not aware of any one task I do with excessive gripping. It’s apparently a common symptom of over-gripping power tools or bicycle handlebars etc.

I personally feel like it has flared up due to the other RSI symptoms I have. The tendons in my arms, wrists, hands and fingers have taken some amount of abuse from computers over the years.

According to one summation from RSI Relief -

“Most clinicians believe that the disorder is caused by the tendon sheath because it becomes thickened or swollen and pinches the tendon and prevents it from gliding smoothly. But common sense reveals that the history of patients suffering with Trigger Finger have one common denominator, overuse, excessive use and/or abuse of the hands from work and recreational activities.”

The only ‘abuse’ I can think of over my history is keyboard and mouse related. Other than a bit of cycling, kayaking etc I have rarely abused my hands in any other way, and certainly am not aware of any excessive gripping.

To me it is one more aspect to my life dealing with a long term RSI condition(s).

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There are so many ways today to fritter away huge amounts of our time in our new virtual worlds. Have you ever played a video game and noticed how 3 hours of your life just disappeared?

Technology has brought us immense benefits as a society, but it has also made us slaves to a great extent, and we spend ever increasing amounts of time interacting with devices whether they be computers, mobile phones, PDAs, games consoles, MP3 players, GPS or TV remotes.

A substantial portion of employment now involves working on computers, whether it be the inputting/analysing of data, or the creation of the latest software that controls our lives. The trouble is that, the more high technology we introduce to our lives, the more time we spend interacting with it, often to the disadvantage of our health. It’s not too hard to imagine that, if current trends continue, there will be a technological gadget to interact with from the moment we wake up until the moment we fall asleep (or more scarily from the moment we are born until the moment we die!).

The Web has expanded the information available at our fingertips by a staggering amount. It has also changed the way we spend large amounts of our leisure time (news surfing, watching videos, e-shopping, chatting, talking, sharing photography, socialising, network gaming, browsing) but this has come about at the expense of our health since we are now sitting in a sedentary posture for hours on end making small repetitive movements with our arms, hands and eyes, often in a slouched, bad posture. Before the Internet was available, we obtained our information from books, magazines, newspapers, talks etc which at least involved a walk to the newsagent, library, pub, town hall etc. Socialising was solely done by interacting with people you physically met, and gaming involved running around the public park kicking a football. Nowadays the exercise involved is often no more than climbing out of bed and turning the computer on, and we wonder why obesity rates are spiralling out of control! Not only do we have all this technology available, but we also feel compelled to use it for longer (often hours at a time) in a way that we never did with other more conventional pastimes.

The one thing that all of this technology has in common is that it has forced us to replace lots of big movements with lots of small, repetitive movements, and spend many hours interacting with virtual worlds on a small screen instead of interacting with the real world. It has disassociated us from reality, and made us feel like this virtual world is hugely important, so much so that we can’t imagine life without it. It has led us to be at a heightened risk of developing many types of problems including the very real threat of Repetitive Strain Injuries (RSIs). It has also just as worryingly made serious addicts out of all of us.

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In a nutshell, it combines a fairly physical activity encompassing muscle and tendon stretches from your head to your toes, with core conditioning and balance practices. This is coupled with controlled breathing techniques to allow the participant to focus their mind on the present moment. As well as the physical practice, yoga teaches techniques to promote deep relaxation and the ability to clear everyday thoughts from the mind with meditation. This powerful combination really can address a lot of the factors that lead to conditions like RSI (primarily driven by the overused micro-movements of muscles and tendons coupled with bad ergonomics and stressful working conditions).

Yoga practice can

• stretch out abused and injured arm muscles and tendons that have been used in a very poor/restrictive motion for numerous hours
• stretch out your neck, spine, and shoulders which most likely will have also been in a bad posture for hours at work, and can be the sources of a lot of RSI conditions
• enhance the blood flow to fatigued muscles
• enhance overall strength and flexibility
• stretch out tight tendons
• promote relaxation
• promote calmness through meditation
• make the participant feel good about their health
• make the participant decidedly fitter

I have only relatively recently delved into yoga. For those of you who think it’s an activity for girls and hippies, I can assure you it isn’t! It’s really a great practice for everyone and there truly are no age or gender barriers. It can be quite physically involved, which I didn’t realise before I tried it out! I really wish I had started practising at an earlier stage in life while my RSI was not as bad as it is now, when it could perhaps have helped me to address my RSI condition during its early stages.

There are many different types of yoga class out there. The class I currently attend is based on Ashtanga Yoga, and is fairly physical. It involves many stretches (some quite challenging) interspersed with vinyasas* which are physical sequences or “flows” between each Yoga pose. A typical class goes for 1 to 1.5 hrs, and follows a sequence of

• Controlled breathing practice (relaxation, focus of breath and readying self for practice
• Sun salutations (sequences of vinyasas to warm body up with)
• Standing stretch/posture sequences interspersed with vinyasas
• Seated stretch/posture sequences with vinyasas
• Reclined stretch/posture sequences with vinyasas
• Relaxation/meditation.

I can honestly say the time goes by in a flash, and I always leave way more relaxed than before I arrived. It’s a great way to switch off from the working day. The Ashtanga class is fairly physical, and it may be a good idea for you to try to experience yoga at an easier pace first of all, and there are many classes to suit. You can also get many great yoga DVDs these days so you can try it out at home if you prefer (all you need is a yoga mat and motivation!), before jumping straight into a class. I do however recommend trying to aim for a physical version of yoga, since this is what will help you achieve core strength and conditioning, giving your muscles a helpful intensive stretch based workout, coupled with relaxation and the ability to refocus your mind.

It is perhaps the idea of channelling the hyperactivity of the mind into more useful positive energy and thoughts that is one of the key aspects of yoga. If we can control the over activity of our minds, we can achieve a positive state of mind and can face day to day stresses on a more even keel, ie. it can be adapted to many areas of your life. For example, are you perhaps over stressing a lot in the office? Then maybe a 20 min break away from your desk and a bit of controlled breathing and meditation can bring your mind back to a less stressful place, and begin to bring things into perspective, which can’t be a bad thing in these crazy busy lives we now lead now can it?

*”Vinyasa has since been thought of as a physically demanding practice, which can be successful at channelling the hyperactivity of … minds. This system can also be used as a vessel for helping calm ongoing chatter of the mind, reducing stress and teaching extroverted personalities to redirect their attention to their internal experience.” wikipedia

An article from the San Francisco Chronicle highlights the benefits of Yoga practice in the high tech industry.

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My typical RSI day

7.00am wake up. RSI pain feels best right now having had a good sleep. May feel even better if I have remembered to wear my wrist brace over night. If I haven’t, then I may have tingling/pain and numbness in the hands and wrists before the day starts – not good! (stress level 0/10, pain level 1/10)

8.30am put wrist brace on to drive in traffic to job. Between busy driving conditions and thoughts of workload ahead, I’m starting to feel less relaxed.  Arrive at work, on time, but a bit stressed after all that traffic! (stress level 2/10, pain level 2/10)

10.00am spent 1hr catching up on overnight emails, creating actions from them and replying to others (stress level 4/10, pain level 5/10)

11.00am spent most of mid morning working on latest priority work (maybe if I get this out of the way now, I’ll get to my real work this afternoon). Pretty absorbed in work, trying to ignore burning sensations in arms, wrists and hands (stress level 5/10, pain level 6/10)

12.00pm time for short lunch break. Leave desk to get away from work and help arms recover. Difficult to ignore workload that is mounting up for the afternoon. One meeting to break the afternoon up, but actions from meeting likely. Hour goes by really fast! (stress level 3/10, pain level 4/10)

1.00pm meeting to go to before I start to get to my original workload, which is now backing up. I worry about whether I’ll get through it because of this meeting. (stress level 5/10, pain level 4/10)

2.00pm meeting is over, have been allocated more work. Go back to desk, and find several phone messages which I need to return. They generate more workload. I get interrupted several times by co-workers with friendly banter. I break free and start my original today’s workload (stress level 6/10, pain level 6/10)

3.00pm Have managed to get a lot of work done in 1 hr, feel like I made some progress, but haven’t rested arms or hands during this time. (stress level 5/10, pain level 7/10)

4.00pm I am paying the price for working solidly for 1 hr. My arms and hands hurt, I am typing weirdly (to try to minimise the pain) and have tried out every combination of input device I own to see if I can ease the pain.  I am still working, but it’s not comfortable now. It’s like running a marathon with a badly cramping leg that won’t go away. I’m now stressing about my workload and the pain. I’m spending a lot of time rubbing my sore arm muscles. No-one around understands what pain I am in. I often wonder what they would do if they were me? (stress level 7/10, pain level 8/10)

5.00pm In pain, but have to work on past 5 pm to try to make some inroads. If I don’t, the work will just build up. If I don’t get through these key projects, it could be perceived badly and I’ll look like a failure. I have my arms strapped up in braces now even though I know this is bad practice.  (stress level 8/10, pain level 9/10)

6.00pm I leave work, drive the busy commute back home, and get home very stressed, 10% about the commute, 50% about workload and 40% about the pain I’m in.  (stress level 8/10, pain level 9/10)

7.00pm I comfort eat, sit down and watch TV. It distracts me from the pain. I try to read, but I can’t get comfortable. Holding the book up is sore. I try using some physical therapy techniques like hot/cold contrast baths to ease the pain (painkillers don’t work with RSI, if they did I’d be first in line!) (stress level 6/10, pain level 5/10)

8.00pm My arms ease off slightly, enough to get me to calm down. I have a sore but less stressful evening. I wonder how they’ll be after a good night’s rest. (stress level 4/10, pain level 4/10)

9.00pm I go to bed early to get a long rest, but am concerned about what my arms will be like tomorrow. Hope that I’m not doing them more permanent damage. (stress level 3/10, pain level 3/10)

(Repeat this cycle 5 times each week, 4 weeks each month, 12 months each year and for 7 years and you get a picture of my life at that time. It all added up to a lot of stress, pain and worry!)

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If you are anything like I was, you are a good conscientious performer in your job. You may have been working extra hours to make sure you did a good job, you may also have worked evenings, weekends and even holidays. This is more often than not done to meet or exceed your goals, improve your chances of promotion and attain the related pay increases. It’s quite often the people who work hardest who are the most stressed in life, because they care about the quality of their work. They may often be the ones carrying the biggest workload, mainly because they are performing the best. This high pressure work may all be being conducted on a computer and therefore exposing the worker to some of the greatest risk factors for an onset of an RSI.

It would be interesting to do a poll of RSI sufferers in the industry and see how many correlated to previously ‘good’ performing employees, although reliable data may be very hard to obtain.

It’s an old cliche, but in your job you have to try to strike a good balance between work and your life outside work. Let’s face it, which would your employer prefer: an employee who does 2 years’ worth of work in 1 year and then hits a health problem with an RSI, or a worker who does 1 years (or less) worth of work in a year and works for them for 10-20 years with no health issues? The question is – is it worth striving to be a top performer when you work extensively on a computer? Are the rewards really worth putting your health at risk for?

I partially blame the environment where employers reward individuals who “exceed expectations”, as this usually translates to those who work the longest hours, who have the greatest output and who are under the most stress. In other words, it encourages people to take health risks to achieve the best rewards.

I’ve seen plenty of former co-workers who are still happily employed, but have managed balanced their workload sensibly. They are attaining a decent salary, and as far as I know have never acquired a computer related injury. Who do you think has the best philosophy when it comes to choosing how to work?

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The UK has a high rate of mobile phone use for texting (we are a nation of texting addicts!), and it is highly prevalent in the under 20 age group. Texting of course is the act of creating a text message on a small mobile device, with either a standard numeric phone pad with alphabetical letters encoded in the pad or a full mini sized keypad with a key for each letter/character. Irrespective of the key count that these small devices have, they all have something in common and that is very small repetitive motion of the fingers and mainly thumbs, in a very confined location.

I first encountered such a device in 2001 when I had my first text messaging pager with tiny full keypad. As an RSI sufferer back then, I was interested to see how it felt to use. Of course being a thumb typing device, it was easier for me to use (since my pain was mainly located in my fingers and arms). However, after a few weeks of repeated messaging, I began to notice pains in the thumbs developing. I also found my wrists aching too. I began to realise that these devices are just as dangerous to use as a computer mouse and keyboard. It hit me then that any small micro-motion using any device for long periods of time has the potential for causing RSI. You are especially vulnerable if you use a computer frequently or indeed have RSI symptoms from another source already.

A lot of people are surprised to find out that RSI is not solely a computer use problem. It can occur in anything that involves small repetitive motions of the hand, fingers and arms. What we are doing these days, however, is maximising our exposure to RSI through the wide array of technology gadgets and their related interactions in our lives. With text messaging (along with the equally addictive computer/console gaming) , there is a whole generation of youth (like this 8 year old girl) who are being exposed to RSI from an early age (and it is the young who are going to be more susceptible to RSI because their bones and muscles are not as fully developed as adults), which could break into epidemic proportions by the time they are older and looking for employment in a highly computerised world.

Phone service providers are also recognising the potential danger. One of them, Virgin Mobile has even got a web site called ‘Practice Safe Text‘ dedicated to avoiding text message RSI injuries.

Finally a statistic to ponder (from the linked article, keep in mind by 2008 the figure will be larger):”Each day, almost 100 million texts are sent in the UK”, a large portion of which are non-essential. This staggering statistic highlights the huge potential for problems resulting from repetitive strain injuries.

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