Wednesday, December 30, 2009

Trigger finger-treatment in NYC

Trigger finger treatment NYC
This past holiday weekend I was with family for the holiday's and my father in-law had a terrible case of Trigger Finger.
I started to tell him how I have helped patients with this condition without surgery using a combination of non-surgical techniques like the Graston technique, Cold laser therapy and Kinesio taping in our NYC physical therapy and Chiropractic practice.
Below I have posted some information about Trigger finger.

A trigger finger occurs when the motion of the tendon that opens and closes the finger is limited, causing the finger to lock or catch as the finger is extended.

Causes of Trigger finger

Tendons that control the movements of the fingers and thumb slide through a snug tunnel of tissue created by a series of pulleys that keeps the tendon in place. The tendon can become irritated as it slips through the tunnel. As it becomes more and more irritated, the tendon may thicken, making its passage through the tunnel more difficult. The tissues that hold the tendon in place may thicken, causing the opening of the tunnel to become smaller. As a result, the tendon becomes momentarily stuck at the mouth of the tunnel as the finger is extended. A pop may be felt as the tendon slips past the tight area. This why pain and catching may be felt as the finger is moved.

The cause is not always known. Trigger fingers are more common in women than men. They occur most frequently in people who are between the ages of 40 and 60 years of age. Trigger fingers are more common in people with certain medical problems, such as diabetes and rheumatoid arthritis.I often find that patient complains of previous wrist,elbow and hand pains.

Symptoms of trigger finger

Symptoms of trigger finger usually start without any injury. Symptoms may include the presence of a small lump, pain in the palm, swelling, and a catching or popping sensation in the finger or thumb joints. Stiffness and catching tend to be worse after inactivity, such as when you wake in the morning. Often, finger movement will loosen up with activity. Sometimes, when the tendon breaks free, it may feel like the finger joint is dislocating. In severe cases, the finger cannot be straightened, even with help. Sometimes, one or more fingers are be involved. Patients with diabetes can have several fingers involved, for example.

Traditional treatment methods

If symptoms are mild, resting the finger may be enough to resolve the problem. Over-the-counter pain medications can be used to relieve the pain. Splints are sometimes used to rest the finger.

A physician may choose to inject a corticosteroid. Sometimes, the improvement is temporary and more than one injection may be needed. Injections are less likely to provide permanent relief when the triggering has been present for a long time, or if when there is an associated medical problem like diabetes.
If these treatments do not improve surgery is usually recommended.
I have successfully used the Graston technique,Cold laser therapy and kinesio taping to resolve this condition without surgery. To learn more about the Graston Technique visit the website at

I found a recent abstract online and posted it below

The conservative treatment of Trigger Thumb using Graston Techniques and Active Release Techniques®
Scott Howitt, DC, FCCSS(C), FCCRS(C),* Jerome Wong, DC, and Sonja Zabukovec, DC
* Address correspondence to: Dr. Scott Howitt, Assistant Professor, Clinical Education, Canadian Memorial Chiropractic College, 6100 Leslie St., Toronto, Ontario M2H 3J1. Phone: 416-482-2340 ext. 395, Fax: 416-488-0470; E-mail:
Small right arrow pointing to: This article has been cited by other articles in PMC.

* Other Sections▼
o Abstract
o Résumé
o Introduction
o Case report
o Treatment
o Results of treatment
o Discussion
o Conclusion
o References

To detail the progress of a patient with unresolved symptoms of Trigger thumb who underwent a treatment plan featuring Active Release Technique (ART) and Graston Technique.
Clinical Features
The most important feature is painful snapping or restriction of movement, most notably in actively extending or flexing the digit. The cause of this flexor tendinopathy is believed to be multi-factorial including anatomical variations of the pulley system and biomechanical etiologies such as exposure to shear forces and unaccustomed activity. Conventional treatment aims at decreasing inflammation through corticosteroid injection or surgically removing imposing tissue.
Intervention and Outcome
The conservative treatment approach utilized in this case involved Active Release Technique (ART®) and Graston Technique (GT). An activity specific rehabilitation protocol was employed to re-establish thumb extensor strength and ice was used to control pain and any residual inflammation. Outcome measures included subjective pain ratings with range of motion and motion palpation of the first right phalangeal joint. Objective measures were made by assessing range of motion.
A patient with trigger thumb appeared to be relieved of his pain and disability after a treatment plan of GT and ART.
Keywords: AA1 pulley, Active Release Technique, Graston Technique, flexor tendinopathy, trigger finger, trigger thumb, metacarpophalangeal joints.

I am attended the first series of the ART seminars this upcoming weekend, this will be a additional tool I use to treat this and other conditions.

Thursday, December 10, 2009

Physical Therapy and Carpal Tunnel Syndrome

For many of us, our jobs revolve around a desk, a keyboard, a computer and a mouse. It’s simply a modern reality that much of our work and communication has become both sedentary and repetitive. So much so that we now RSI’s (Repetitive Strain Injuries) that reflect these issues like “Blackberry Thumb” and Carpal Tunnel Syndrome from improper keyboard posture. Carpal Tunnel Syndrome in particular affects thousands of people each year, and due to the nature of repeat strains, it causes people to miss work so they can immobilize and rest the ailing wrist. At Living Well Medical in NYC, we routinely help patients suffering with repeat strain injuries like Carpal Tunnel using a program of physical therapy supported by other treatment methods.

So just what exactly is Carpal Tunnel Syndrome and how does it develop? The carpal tunnel is the canal in the wrist through which the median nerve passes which innervates (supplies sensation and motor function to) the thumb, index and middle fingers as well as part of the ring finger. It is surrounded on three sides by bone and on the fourth side by the transverse carpal ligament. Several tendons also pass through this canal. You could call it a high traffic area of the wrist. With repeated strain or overuse, theses tendons swell and can compress the nerve causing pain, numbness, muscle weakness, and in severe or chronic cases, wasting of the muscles of the palm. Tingling, burning, and ‘pins and needles’ sensations are also commonly described symptoms with median nerve compression.

Carpal Tunnel Syndrome, also called median neuropathy at the wrist, can have significant effects on the ability to function normally, making general movement painful, and we depend on our hands for so much. It is one of our primary means of interacting with the world around us, so an injury of this sort can be more than a little frightening.

Physical therapy has been shown to help reduce pain in the carpal tunnel in moderate to mild cases. In particular, stretches and hand exercises are often combined with other therapies to achieve the best results. In most cases, splinting is also an important component of treatment as immobilizing the joint can help prevent further irritation and promote proper healing. Deep tissue ultrasound and other conservative treatment methods might also be employed by your physical therapist to stop the pain and numbness. At our practice, we integrate the Graston Technique, chiropractic care, and cold laser therapy as part of our physical therapy protocol to relieve pain and stimulate faster healing. Each of these individual treatments can be added on to physical rehabilitation to improve outcomes. This unique approach to treatment, coupled with our commitment to wellness, is what separates us from other practices.

If Carpal Tunnel Syndrome is causing you pain, Living Well Medical in NYC can help. Call us today at 212-645-8151 to schedule your appointment for treatment at our SoHo office.

Thursday, December 03, 2009

Diagnosing Muscle and Nerve Pain: Nerve Conduction Velocity and Electromyography in NYC

Severe pain can have any number of causes, many of them related to the muscles and the nerves, and part of the job of any effective pain treatment center is making an accurate diagnosis on the cause of pain. Doctors, medical centers and hospitals make use of a number of different diagnostic tools when a patient is in pain like x-rays and other imaging methods. However, making sense of nerve and muscle related pain can be a much more complicated endeavor that requires a specialized touch. Diagnostic images don’t always tell the whole story. That’s why we make use of tests like the Nerve conduction velocity study (NCV) and Electromyography (EMG) at Living Well Medical in NYC. By combining these state-of-the-art tests with a wide range of pain treatment protocols, we can help patients reduce pain and enjoy a better quality of life.

A nerve conduction study is a method of measuring and evaluating the function of the motor and sensory nerves in the human body. By applying an electrical stimulation and measuring the response, a specially-trained doctor can gather information about whether there is any interruption to correct nerve function. Typically, NCV’s are only performed for patients who are experiencing numbness, burning, tingling or muscle weakness. Measurements that are taken include latency which shows the time delay between the stimulus and the recording site and the amplitude which shows the size of the reaction. Nerve conduction velocity is often used to diagnose common conditions such as Carpal tunnel syndrome, spinal disc herniation, and other types of neuropathy (damage to the peripheral nerves). NCV studies help our NYC office make the right diagnosis the first time so that treatment can proceed smoothly.

Electromyography (EMG) is a method of recording and evaluating the activation signal created by muscles in the human body. By measuring the electrical potential that is generated by muscle cells when both active and at rest, abnormalities in the muscles and nerves can be detected and diagnosed. By placing an electrode on the muscle that is believed to be the cause of pain, a doctor can observe whether muscle contractions are activating in the acceptable normal ranges. Any deviation can help diagnose nerve and muscle dysfunctions like Carpal tunnel syndrome, sciatic nerve dysfunction, spinal stenosis, and various types of myopathy (a muscular disease that results in muscle weakness).

Living Well Medical in NYC has a medical doctor who is Board Certified in Pain Management on staff performing nerve conduction velocity studies (NCV) and electromyography (EMG) so that we can make the right choices in creating an effective treatment plan. Combining several non-surgical treatment options, we can help you stop the pain. This is just one aspect of Living Well that makes us special and different from your average pain treatment center. Call us at (212) 645-8151 for more information on evaluation and treatment.