Carrying heavy purchases in plastic bags and wringing wet clothes out after washing them by hand can be hazardous to your fingers."Tell me the occupation of the person and I can tell you which of his fingers will likely be affected," Dr Vichai said. "Gardeners are prone to have trigger finger in their right-middle finger, golfers on their left-middle, ring and/or little fingers, while teachers, writers, administrators and accountants are affected in their right thumbs."
http://gotoknow.org/file/vijitpornkul/BangkokPost.jpg
Trigger-finger trouble
http://gotoknow.org/file/vijitpornkul/BangkokPost.jpg |
Dr Vichai Vijitpornkul operates on a
patient with a trigger finger. For the past six years he has
operated on thousands of fingers using his specially designed
instruments and a technique which is cheaper, needs no stitches and
leaves no wounds nor scars. |
A Thai doctor has devised a quick and
simple remedy for painfully locked fingers
Story by NORMITA THONGTHAM F Photos by
YINGYONG UN-ANONGRAK
Housewives, BEWARE!
Carrying heavy purchases in plastic bags and wringing wet clothes
out after washing them by hand can be hazardous to your
fingers.
The warning comes from Dr Vichai Vijitpornkul, assistant director
of Lerdsin Hospital and one of Thailand's leading family
physicians, whose name has become synonymous with a condition
called "lock finger" or "trigger finger".
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Trigger finger derives its name from the fact that
the finger "locks" in place, bent as if to pull the trigger of a
gun. The symptoms vary from chronic pain and limited movement, to a
finger that won't bend and straighten automatically, often
requiring the person to pry it open with considerable difficulty
and pain.
Trigger finger may be associated with diabetes, rheumatoid
arthritis or carpal tunnel syndrome, in which tendons or ligaments
in the wrist become enlarged resulting in the pinching of nerves
leading to the fingers and to the muscles at the base of the thumb.
But often it also occurs in strong, healthy individuals who abuse
their fingers by grasping things forcefully and repeatedly.
"Sheath-covered tendons connect the muscles of the forearm with the
bones of the fingers," Dr Vichai explained. "When you bend your
fingers, the tendons glide back and forth, guided by restraining
pulleys. When the tendon sheath becomes inflamed, it swells and may
become thick, fibrous and less elastic, thus obstructing the normal
movement of the tendon. This causes further irritation and results
in a vicious circle of irritation, swelling, catching and more
irritation until, finally, the finger locks in a bent or extended
position."
The tools of the trade: Dr Vichai devised his own tools using
dental instruments he sharpened as small knives. |
Maintaining an overly firm grip on, or the forceful
handling of such tools as a screw-driver, saw, hammer, pliers,
pruning shears, spade, scissors, knife, badminton/tennis racquet,
golf club, etc, while using them repeatedly can eventually lead to
trigger finger, he said.
But the leading cause of trigger finger in Thailand is the carrying
of heavy plastic bags using just one or two fingers, he
added.
Hospitals keep no statistics on the numbers of sufferers but
judging from the number of patients who consult him at Lerdsin
Hospital and at his own clinic, Dr Vichai is confident that in
nearly every other household including women aged 45 and above,
there is at least one sufferer. There are also rare cases of
children born with the ailment.
Patients come from almost all professions and all walks of life,
including dentists, professors, accountants, office secretaries,
writers, golfers, gardeners, butchers, masseuses, motorcyclists and
even actors.
"Tell me the occupation of the person and I can tell you which of
his fingers will likely be affected," Dr Vichai said. "Gardeners
are prone to have trigger finger in their right-middle finger,
golfers on their left-middle, ring and/or little fingers, while
teachers, writers, administrators and accountants are affected in
their right thumbs."
Some of his patients had been suffering from the condition for 35
years, he said. "One, a woman in her nineties, had had three
operations: on her left-middle finger in 2002 when she was 93, on
her right-index in 2003 when she was 94 and on her left-ring finger
last year when she was 95."
The ratio of female to male sufferers is four to
one, Dr Vichai said. This he attributes to the fact that Thai
housewives do most of the marketing for food and groceries, usually
carrying their purchases in plastic bags weighing five to 10kg or
more. "Women carrying shopping bags are a familiar sight near
markets and supermarts and along every street," he pointed
out.
Also, women do more household chores than men, eventually
destroying the fingers' pulleys in such activities as washing
clothes by hand and wringing them out for drying, as well as
chopping meat and peeling vegetables when cooking meals for the
family.
Dr Vichai has written books and articles and gone on radio and
television to raise public awareness on the subject, but the number
of patients needing treatment is still on the increase.
In fact some of the high-risk activities which cause trigger finger
can be avoided, he said.
"When carrying plastic bags, have a cloth or small towel ready to
wrap around the handle, and carry the bag in your palm instead of
having it hang on one or two fingers," he advised. "Whenever
possible use a trolley or mechanised equipment instead of doing the
work manually."
What happens if the affected finger isn't treated? "Eventually it
becomes deformed," Dr Vichai said.
The surgeon grades trigger finger according to severity. "In Grade
1 you feel painful tenderness at the base of the finger; this can
be cured by rest and physical therapy. In Grade 2 the finger
doesn't bend with the others but when it does it unlocks by
itself; this can be cured by rest and physical therapy plus
anti-inflammatory drugs and/or steroid injections in the tendon
sheath. Grade 3 is when the finger cannot unlock by itself and has
to be prised open, and Grade 4 is when the finger is deformed and
cannot be unlocked.
"For Grade 3, surgery is necessary when all other remedies prove
useless, while Grade 4 can be cured only by surgery."
The traditional method is open surgery at the base of the affected
finger. This takes about half an hour. The incision is at least
about two centimetres long, is more prone to infection and takes
months to heal fully. Over years the scar may contract in some
cases, causing tenderness in the area which has been operated
on.
In his early years at Lerdsin, where he has worked for the past 20
years, Dr Vichai used to operate using the traditional method. Six
years ago, he devised a new technique which is cheaper, needs no
stitches and leaves no wounds nor scars, and takes only five to 10
minutes from the time the hand is scrubbed up to the time it is
bandaged. It can be carried out while the patient is in either a
sitting or a prone position.
This writer had one such operation on her forefinger recently. A
nurse instructed me to wash my hand, then she applied a tourniquet
around my wrist and sterilised my palm before Dr Vichai took over.
He probed the base of my affected finger to feel for uneven
movement, then he injected it with a local anaesthetic before
puncturing the skin with the tip of his instrument to release the
pulley and the fibrous sheath. Before I knew it he had cleared the
tendon of impediments and I could move my finger freely. The whole
operation took only about five minutes.
When I removed the dressing three days later I was surprised to
find no puncture mark on my palm. By the third week my finger had
healed fully. By contrast, an open surgery I had on my left-middle
finger in another hospital left not only the scars of three
stitches but a lingering pain in my palm _ nearly eight years after
I had had the operation.
"Actually this probing or percutaneous technique is not new," Dr
Vichai said. "Since an orthopaedic surgeon named Lorthioir came up
with the idea in 1958, several methods using a hook or a needle had
been reported with satisfactory results. I devised my own tools
using dental instruments I sharpened as small knives, which are
easier to handle and strong enough even for the toughest
cases."
Over the past six years Dr Vichai has operated on thousands of
fingers using his specially designed instruments. After trying his
method, a satisfied Dr Pongsak Vathana, chairman of the Arthritis
Foundation and a member of the advisory board to the Royal College
of Orthopaedic Surgeons of Thailand, predicted that in the near
future the technique will be used as a world standard for the
treatment of trigger finger.
Already, surgeons from Canada and the US have adopted the Thai
doctor's technique. "I taught a Canadian hand surgeon, Dr Phil
Narini, three years ago and he has informed me of his continued
success with my technique," Dr Vichai said with pride. "He no
longer practises open surgery like he did before."
More recently Dr David Rowe from the Medical College of Wisconsin,
an academic institution in the US, spent two weeks in Bangkok
observing Dr Vichai's work and learning from him.
Dr Rowe was observing when this writer went to consult Dr Vichai at
Lerdsin Hospital. I was the 25th patient he checked that day, but
the first to be operated on, with the surgeon explaining every step
to the US observer.
Dr Rowe was surprised at the number of patients coming to see Dr
Vichai. "In America cases like this are very rare," he said, adding
that he believed the number of percutaneous trigger-finger releases
that Dr Vichai had performed during the two weeks he himself was in
Bangkok was far more than the number of cases ever reported in the
US.
Over the years Dr Vichai and his colleagues have brought their
know-how to Chanthaburi, Nakhon Ratchasima, Surin, Ubon
Ratchathani, Udon Thani and several other provinces, doing mass
operations free of charge to mark royal birthdays. On His Majesty
the King's birthday on December 5 last year, they performed 94
surgical operations on 84 patients at the State Tower next to
Lerdsin Hospital as a tribute to His Majesty.
"In the past we received support from the Rotary clubs of Charoen
Nakhon and Phrakhanong, as well as District Governor 3350 Rotary
International," Dr Vichai said. "The operations were both cheap and
effective, and if we get further support we might go to
neighbouring countries [to alleviate the suffering of patients
there]."
For Dr Vichai, the satisfaction comes from being able to help
people with deformed fingers regain full use of their hands. "Since
I started the new technique, the number of fingers I've operated
on has reached nearly 5,000, and I expect to operate on another
5,000 in the next two years.
"Treatment for trigger finger is available in any hospital in
Thailand. But prevention is better than cure, and I'd be happiest
if people were to heed my warnings and avoid doing things that
could trigger trigger finger in the first place."
Dr Vichai Vijitpornkul can be found at Lerdsin Hospital
(02-353-9799) from 8:30am to noon on Mondays, Tuesdays and
Thursdays, and from 1:30 to 4pm on Fridays. At other times, and on
weekend mornings, he treats patients at Rungjaroen Polyclinic. Web
site: http://lockfinger.com/