DR. HOOK- Pointed advice: Trigger finger not a snap to cure

Lily Tomlin was electrifying at the Paramount Theater! I've never really known her one-woman shows or really appreciated the Laugh-In clips I've seen. I'm sure some of you are groaning, "Sigh, it was before his time!" I can relate. I groan at people born after 1980 who don't know or appreciate Rogers and Hammerstein or The Flintstones.

I have appreciated Lily's movies, in particular 9 to 5, because haven't we all imagined accidentally giving a Neanderthal some rat poisoning in his coffee? (Oh, you haven't? Well, ahem... actually, neither have I.)

 "One-ringy-dingy, two-ringy-dingy," she started up her telephone operator skit. I never did quite understand it until I saw her performance. "Ernestine" said she had occupational injuries from working the switchboard, so she couldn't even flip the bird anymore. Poor thing. What happens when you can't straighten out your finger?

 Trigger finger is a medical term that has nothing to do with the NRA. It's inflammation of the finger's flexor tendon sheath that keeps the finger from flexing and extending well (stretching out-– like flipping the bird in Lily's case). The flexor tendons allow the fingers to curl up, to make a fist. The tendons are individually "wrapped up" by a tendon sheath, but in some people– in particular, diabetics– the sheath can scar down onto the tendons. In the worst-case situation, a nodule can form on the tendon itself, making even the most flexible person become inflexible– like plenty of our leaders.

Snapping is common in trigger finger— not like Snap, Crackle, Pop, but a sudden jerk in the finger during flexion. Because it hurts to extend the finger, many people with trigger finger leave their finger curled up all day. (Hmm, you know how really bad singers on American Idol use their hand to conduct themselves while singing? One finger tends to be curled the whole time– that's like trigger finger!)

On examination, it's pretty easy to detect trigger finger. You can feel the jerkiness of the finger while flexing and the locking up during extension. If it's big enough, you can feel a small nodule usually at the base of the finger going into the palm.

Treatment consists of immobilization of the finger for... four to six weeks. Boy, you would starve to death if you could eat only finger foods! Gripping and pinching things tends to aggravate trigger finger. For those who do manual labor, in particular things that vibrate (hmm, sounds fun), Sorbothane gloves reduce the vibrations. If needed, steroid injections can be done, and eventually surgery might be required.

Ganglion cysts can also occur on the finger, palm, or wrist. They don't cause a trigger finger, but they can really hurt. A ganglion cyst comes from swelling over a tendon sheath, but more commonly over a joint. The joint capsule herniates, and contents pour into a cyst formation. Most likely, there's a congenital condition, and repetitive tasks might lead to it. 

Most commonly a cyst is seen as a bump over the backside of the wrist on the thumb side, so wearing a watch feels more like handcuffs. Aspiration with a needle isn't the best thing because the cysts come back at least 50 percent of the time. Injecting steroid or hyaluronidase (say this fast three times) appears to be more effective. Surgery usually gets rid of these cysts for good. Some people use the family Bible (though I think the Torah would be more effective since it's heavier) to "smash the living daylights" out of the ganglion cyst. I have done that myself (with a large medical textbook, though) and it hurt like Holy Cow!

 I would like to see Lily Tomlin again; maybe I'd even straighten out her poor fingers. Because there was so much to absorb in her performance, I think I remember only about 25 percent of the show. 

But overall, she left her fingerprint on me.

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