A CASE OF TRIGGER FINGER, Dr G R Mohan

INTERDUCTION: Trigger Finger or snapping finger or Digital Tenovaginities Stenosans are SYNONYMS. In this condition when patient attempts to open the closed fist the affected finger remains in flexed position (locked) and it has to be passively stretched with other hand. It goes into extension with click. More commonly seen in females with a frequency 2-6 times that observed in men. (1). The most commonly affected digit is the thumb, followed by the ring, long, little, and index fingers Increased incidence in the dominant hand is observed. Involvement of several fingers is not unusual. It is a result of nodule formation on flexor tendon. It occurs as complications of either simple Tendon Synovities or Rheumatic Arthritis. Nodule is usually small. The Nodule commonly is trapped under the Meta carpo Phalyngeal ligament as the tendon flexes. The finger is them locked in flexon and active extension is impossible. To unlock the finger passively pressure is used. Sudden snapping (Trigger) of the digit occurs, finger is extended. Locking or catching during active flexion-extension activity may need passive manipulation to extend the digit in later stages .Stiff digit, especially in long-standing or neglected cases ,Pain over the distal palm ,Pain radiating along the digit are symptoms. Systemic causes of Trigger Finger are collagen-vascular diseases, including Rheumatic Arthritis, Diabetes, psoriatic arthritis, amyloidosis, hypothyroidism, sarcoidosis, and pigmented villonodular synovitis.
Treatment is not satisfactory in other systems of medicine. Only cartico steroid injection or operation in which incising the mouth of the fibrous flexor sheath longitudinally (1).

CASE:

Patient by name Ms. J. aged 45 years, married with two children without any history of Diabetes or Hypertension. She was diagnosed as Trigger finger by local orthopedic surgeon. She came to me with following symptoms to avoid Surgery. Pain in Rt. Little finger since one year – pain drawing type, aggravated by initial movement, aggravated early morning, inability to extended the finger, only passively she has to extend the finger with other hand and in general aggravated in damp weather. Sleep: N, appetite: N, Bowels: Regular, Urine: free, perspiration: Normal and menses: attained Menopause.

F/H Arthritis

O/E Slight swelling the finger with tenderness.

There are no much symptoms, only probable cause is over use of her fingers in daily dowe mixing. On 22/6/05 Rhus Tox 200 C, 3 doses. 4th hourly one dose was prescribed followed placebo for 5 days. Very slight improvement was noticed. 30/06/05 Rhus Tox 1M, 1 dose followed by placebo 7 days was prescribed. After this course pain reduced slightly only, inability to extend finger is as usual. Nodular condition, involvement of flexor tendons (3) Ruta Graveolen 200 C, 3 doses, 6th hourly one dose followed by placebo for 7 days prescribed. After Ruta.G patient was able to extend the finger little bit and pain reduced. Ruta G 1M, 1 dose was given along with placebo for 15 days. Patient reported back and she was able to extend her finger without any help, pain totally reduced. A complimentary drug Cal Phos 200 C, 3 doses was given lastly. The symptoms did not return even after one year.

DISCUSSION:

This is a case of few symptoms. Rhus Tox only helped her to some extent. Ruta G is having tendency to the formation of deposits in the periosteum, tendons, and about joints, especially wrist it acts upon the periosteum, cartilages and Flexor tendons, was tried up to 1m potency with good response even after one year there were no recurrence of symptoms. Case was diagnosed on clinically only. Most of the Pathological and radiological investigations will be normal.

REFERENCE:

1. John Crawford Adams and David L. Hamblen (1991) Outline of Orthopedics, 272 Churchill Livingstone.
2. C. Vyaghreswarudu, Principles and Practice of Orthopedics, Andhra University Press – Waltair.
3. J.T. Kent (2EDI) Lecturer on Homeopathic Materia Medica, 834)
4. Robin Murphy ND, Lotus Materia Medica.
article published in The Homoeopathic HERITAGE, Vol 30,no 12,Dec 2006