Trigger Finger – Something I Have Had in Common with Steve Vai

What comes to mind when you think “trigger finger?”  Someone holding a large revolver at you with his finger on the trigger?  Dirty Harry brandishing a silver ‘45 revolver in your general direction?  Now that the catchy title caught your attention and you’re getting ready to type the key combo CTRL-T to open a new browser tab to search “what is trigger finger?”  Please read o as I really do (did) share this condition with Steve Vai.  Except I had suffered from a trigger thumb and I didn’t get it from meditating on a difficult chord for 20 minutes.

In early November of 2020, I woke up every morning with a painless stiffness in my right thumb.  It seemed like my thumb was still asleep.  I’d have difficulty bending it but after five or ten minutes of morning stretches, it would eventually comply.

At that time, I was working 12 to 14 hours a day on a company project that kept my hands on various computer keyboards for most of that time.  Admittedly, fear invaded my thoughts about ever playing again, especially at a time where I had much more time to play with my sons, who were just excelling like the prodigies they are.

What is Trigger Finger?

Trigger finger is usually a condition where you cannot voluntarily bend or unbend one of your digits.  Your finger or thumb remains latched or locked open or bent.  To unbend, you may have to use the other hand to force the finger.

A very rudimentary description I like to use is imagining a rope or strap coming off a pulley whether it be a garage door or clothesline.  In any case, when this rope or strap comes off the pulley, the garage door will stay stuck open or closed.

Can You Play Guitar with a Trigger Finger?

Sure.  But not always.  While it’s not dangerous to play guitar with this condition, for a finger, it can be very difficult, if not painful to try to play.  Your finger remains locked open or closed and the level of discomfort will vary depending on which finger is affected as well as the tendon.

In my case, I was able to play probably 95% of what I had been able to play with my trigger thumb.  Fortunately, I was able to keep my left thumb stable on the guitar neck.

How is Trigger Finger Treated?

There are three conventional ways to remedy this.  Some may include a splint.

1. Rest, anti-inflammatory meds, and physiotherapy
2. Cortisone injection
3. Surgery

At first, I put up with it, but as my thumb grew stiffer each morning after waking, I became more concerned.  So I self-diagnosed on Google and I determined that this sounded like trigger thumb.  I was convinced of this after eliminating arthritis and carpal tunnel syndrome.

I emailed my doctor as that was the only way to reach him during the COVID-19 lockdown here.  He called me a few hours later and agreed over the telephone with my self-assessment and without even examining my hand that this did sound like trigger thumb.

“From what you’re telling me, it sounds like trigger thumb, but this is generally rare.  Trigger finger is not uncommon, but trigger thumb is quite rare.”

“OK, why do I have this and more importantly, how do I get rid of it.?”

“You’ll need a cortisone shot or surgery.”

“Yikes.”

“Pardon me, what did you just say.”

“Nothing, I was talking to myself.  Where do I get a cortisone shot?”

“You’ll have to call one of the radiology clinics, but the wait is long, unless you go privately and pay out of pocket.”

“OK thank you doctor.”

A few hours later my prescription for a cortisone injection was ready.  It simply read, “trigger thumb (left), cortisone injection.”

I waited 20 minutes on the phone to book an appointment and gave up.  I attempted to book an appointment online via their website.  I immediately received an acknowledgement and that someone would get back to me as soon as possible.

One month elapsed before I followed up by complaining when someone responded that the wait would be indefinite, likely more than a year.

I couldn’t accept that.  I need my thumb for more things than just guitar.  I’m also aware that there are many people who have waited much longer for more important life-saving treatments such as chemotherapy or dialisis, so I couldn’t really be so pushy and entitled.

I booked physiotherapy sessions, and after the fourth one, Stephanie told me I would need cortisone or surgery.

I found a private radiology and booked my appointment online at 1:00pm and my appointment was booked for the following morning at 9:00am.  The session would cost $330 out of pocket, of which only $100 would be refunded to me to cover the cost of the cortisone and marcaine.  The remaining $220 covering the doctor’s procedure and other accoutrements would be left to me.

The Radiologist Asks me the “Question”

Nurse Nadine was as diligent as a girl scout to get me prepped and explain the procedure as she referred to the radiologist in the third person like he was the saviour.

Dr. Robitalle entered with an air of confidence and when he spoke, he was very reassuring.  He explained to me he had done about 5,000 similar injections and jokingly reassured me that no one had died and only one got an infection.

All was good until he asked me the question.

“So, which tendon do you need the injection for?”

“You’re the doctor, you tell me.  At least by now I know I have two tendons around the thumb, after having gone to physio.”

“Actually, you have three tendons around the thumb.  I need to know which one.”

“Really?”

“Yup.  Show me where it hurts and we’ll figure it out.”

“I love trying new things but not at $330 a pop.”

“What if you don’t get the right tendon?” I quip.

“There will be no effect and you’ll need to get another shot.  Also, even if I do inject you in the right one, it may have no effect or only very temporary relief. You may need surgery”

Uggh.

So he lubes the ultrasound probe with the lube jelly and he begins rubbing it around the base on the thumb and I can clearly see a lot of inflammation on the monitor.  He says, “If I only have one try at this, I would guess it’s this tendon…” as he presses the probe harder, I shriek.

We agree to the shooting point and it was one of the most painful needles I’ve taken besides the two required for my forgotten vasectomy.

The pain is sharp, acute and I’m forced to wince and mumble @$!@*#$*%^$#J!!!! The pain lasts less than 20 seconds.

“All done.”

“Why can’t I still not bend my thumb?”

“The effect will take 3 to 4 days. You can keep icing several times a day.”

There was no improvements for the following 24 hours, when my wife asked me the next morning, “How’s your thumb?”

“Very disappointed.  I thought the cortisone would provide instant relief.”  I say, as I’m unconsciously flexing my affected thumb.

“Didn’t you say it was the left thumb?”

“Yeah.”

“Well you’re bending it as you talk to me.”

“OMG I am….”  I ran around the house to tell the boys about my thumb, bending and unbending like a little boy in a PEZ dispenser shootout.”

A few hours later, the thumb seized up again.

A few hours after that, my thumb came back.

I iced for about a week and my thumb is about 90% cured.  I get the occasional stiffness throughout the day, but it’s much better.

I’ve gone back to my regular practice routine, which includes playing difficult barred chord shapes that require a little more endurance from my thumb to hold the chords strongly from the back of the neck, but I won’t attempt to meditate on a chord for 20 minutes.

Mr. Vai, if I am so graced that you are reading this, please save yourself the trouble and get a good sustain (Hold/Freeze) pedal if you want to hold a chord.