Issue link: https://www.massageandbodyworkdigital.com/i/72121
@WORK A key factor In trigger finger, a fibrous nodule on the tendon gets stuck against the edge of the retinaculum. when addressing any nerve compression pathology with massage treatment is to make sure that treatments do not aggravate the client's neurological symptoms. If neurological symptoms are aggravated, you are likely putting additional pressure on the nerve, which is already compressed. There is no physiological benefit to the additional compression, and it is likely to make the condition worse. Consequently, your massage treatments must be measured to match the severity of the injury with the particular treatment strategies you employ. Of most importance in addressing any nerve compression pathology is getting pressure off the nerve. That means the client must continually focus on home care and self-treatment strategies that can decrease the amount of time the elbow is held in flexion and try to reduce any cumulative overload on the finger and wrist flexor muscles. You cannot directly manipulate the nerve to speed healing, so the best we can do from a treatment strategy is to remove any of the factors that are leading to increased nerve compression and irritation. TRIGGER FINGER Another condition that occurs with greater frequency in musicians is trigger finger. The tendons of the hand and fingers travel underneath numerous retinacula between the wrist and fingertips. Each of these retinacula is designed to bind and hold the tendon close to the bone during finger movements. Trigger finger occurs when a fibrous nodule develops on the tendon adjacent to where the tendon must slip underneath a binding retinaculum (Image 4). The nodule gets caught on the edge of the retinaculum and the finger is unable to move until the nodule pops underneath the retinaculum and moves to the other side. It is this sudden popping movement, like pulling a trigger, which gives the condition its name. The exact cause of trigger finger is unknown, but there are situations when it is associated with frequent repetitive motion. It also seems to have a correlation with other systemic disorders such as diabetes or rheumatoid arthritis, as well as metabolic issues. Trigger finger can be a debilitating impairment for musicians because so many musical instruments rely on repetitive and rapid finger flexor movements. There are a variety of treatment strategies for trigger finger, including over-the-counter pain medications, steroid injections, or, in more severe cases, surgery. There is very little, if any, research on the use of massage in treating trigger finger. However, practitioners do report improved function and decreased aggravation of the fibrous nodule as a result of massage. Massage treatment includes friction of the nodule and at the site of tendon restriction at the retinaculum. Therapists should ensure the friction applied to the nodule is not too aggressive, as it may exceed the client's pain tolerance. Work easily on the nodule first and see how the client responds to the initial treatment to determine future strategies. The treatment will also be most helpful if it is applied frequently, so teaching the client to perform the friction techniques on themselves can often speed recovery time. A GREAT DEAL TO OFFER Musculoskeletal injury in musicians can be career ending, but it does not always have to be. Massage therapy has a great deal to offer this group of professionals as it addresses the primary complaints of repetitive stress. In addition to soft-tissue treatment, massage therapists can advise their musician clients to seek other beneficial treatments such as ergonomic training, postural improvements, and even counsel from specialists trained in improving instrument skills and injury prevention. Increasing awareness of the ways in which musicians are injured should lead to better care of those who bring music to our ears. Whitney Lowe is the author of Orthopedic Assessment in Therapy and Orthopedic Massage: Theory and Technique (Churchill Livingstone, 2009). He teaches advanced clinical massage in seminars, online courses, books, and DVDs. Contact him at www.omeri.com. Celebrate ABMP's 25th anniversary and you may win a refund on your membership. ABMP.com. 105