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L i s te n to T h e A B M P Po d c a s t a t a b m m /p o d c a s t s o r w h e reve r yo u a cce s s yo u r favo r i te p o d c a s t s 89 with mild conditions (Stages 1 and 2), but there is limited research to support this treatment and several side effects. Generally, the doctor gives the patient an initial injection and then evaluates if improvement follows. If the patient has no improvement, further injections are not recommended. If there is some improvement, a second shot may be suggested, spaced about six months later. Some studies show improvement to be too limited to warrant a third shot, so only two injections are recommended. 5 There is generally no improvement with corticosteroid injections if the trigger finger results from diabetes, rheumatoid arthritis, de Quervain's tenosynovitis, osteoarthritis, or hypothyroidism. Initial side effects of corticosteroid injections can include additional swelling, discoloration, and fat atrophy and infection at the injection site. Blood sugar may be elevated for up to 10 days, so anyone with insulin-related diabetes should consult their doctor. Longer-term effects can sometimes include tendon weakening. Extracorporeal Shockwave Therapy A relatively new treatment for trigger finger/thumb has emerged in the last few years. Extracorporeal shockwave therapy (ESWT) is effective with various conditions, including kidney stones, plantar fasciitis, and other soft-tissue disorders. In this treatment, a high-intensity shockwave is generated by a small device and applied to the affected area. The shockwave is thought to break up adhesive tissue and accelerate the healing response. 6 The ESWT treatment is still relatively new but shows promise for those who do not want injections and may not be ready for surgery. Surgery If other conservative treatments have not been effective, surgery is usually the next step. There are two primary surgical procedures performed to address trigger finger. The first is called percutaneous release and generally involves inserting a needle into the affected area to probe and break up the fibrous adhesions preventing effective movement. Because it only involves the needle incision, percutaneous release is considered less invasive, and the recovery time is shorter. However, because the physician cannot see the tissues being worked on, this treatment can be challenging. Ultrasound can be used to help guide the location of the needle, making the treatment more exact. The other surgical procedure is called an open release and involves creating a small incision in the finger over the affected pulley. The pulley or tendon sheath is usually cut to allow the tendon to move underneath the pulley freely. Allowing increased movement can decrease the inflammatory response and allow the person to get back to normal activities. Both of these surgeries are minimally invasive and usually have a moderately short recovery time. CONCLUSION Trigger finger can be a debilitating and painful condition. It is also something massage therapists should be aware of because it could be a career-limiting injury. There is no gold standard for effective treatment, and many people prefer to investigate conservative options first. As a result, there is a serious need for more exploration into the potential of massage to address this condition. There is an excellent physiological argument for why massage, mobility, and safe, protected movement can all work together, especially in the early stages, to prevent the condition from developing further. Soft-tissue mobilization strategies have the potential to reduce health-care costs, long-term impairment, and the need for invasive procedures. Notes 1. Brian Zafonte, Dora Rendulic, and Robert M. Szabo, "Flexor Pulley System: Anatomy, Injury, and Management," Journal of Hand Surgery 39, no. 12 (December 2014): 2,525–32, 2. Angelo V. Vasiliadis and Iraklis Itsiopoulos, "Trigger Finger: An Atraumatic Medical Phenomenon," Journal of Hand Surgery 22, no. 2 (February 2017): 188–93, https:// 3. Amber Matthews et al., "Trigger Finger: An Overview of the Treatment Options," Journal of the American Academy of Physician Assistants 32, no. 1 (January 2019): 17–21, https:// 4. Amber Matthews et al., "Trigger Finger: An Overview of the Treatment Options." 5. Benan M. Dala-Ali et al., "The Efficacy of Steroid Injection in the Treatment of Trigger Finger," Clinics in Orthopedic Surgery 4, no. 4 (December 2012): 263–68, https:// 6. P. Yildirim et al., "Extracorporeal Shock Wave Therapy Versus Corticosteroid Injection in the Treatment of Trigger Finger: A Randomized Controlled Study," Journal of Hand Surgery 41, no. 9 (January 2016): 977–83, https:// Whitney Lowe is the developer and instructor of one of the profession's most popular orthopedic massage training programs. His text and programs have been used by professionals and schools for almost 30 years. Learn more at CLINICAL EXPLOR ATIONS

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