A to Z of Medical Conditions

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Trigger finger – signs, symptoms and treatments

Trigger finger

Trigger finger

 

Trigger finger is a condition that affects one or more of the hand’s tendons, making it difficult to bend the affected finger or thumb.

If the tendon becomes swollen and inflamed it can “catch” in the tunnel it runs through (the tendon sheath). This can make it difficult to move the affected finger or thumb and can result in a clicking sensation.

Trigger finger is also known as stenosing tenosynovitis or stenosing tenovaginosis. It usually affects the thumb, ring finger or little finger. One or more fingers can be affected, and the problem may develop in both hands. It’s more common in the right hand, which may be because most people are right-handed.

Symptoms of trigger finger can include pain at the base of the affected finger or thumb when you move it or press on it, and stiffness or clicking when you move the affected finger or thumb, particularly first thing in the morning.

If the condition gets worse, your finger may get stuck in a bent position and then suddenly pop straight. Eventually, it may not fully bend or straighten.

See your GP if you think you may have trigger finger. They’ll examine your hand and advise you about appropriate treatments.

What causes trigger finger?

Tendons are tough cords that join bone to muscle. They move the bone when the muscle contracts. In the hand, tendons run along the front and back of the bones in the fingers and are attached to the muscles in the forearm.

The tendons on the palm side of the hand (flexor tendons) are held in place by strong bands of tissue, known as ligaments, which are shaped in arches over the tendon. The tendons are covered by a protective sheath which produces a small amount of fluid to keep the tendons lubricated. This allows them to move freely and smoothly within the sheath when the fingers are bent and straightened.

Trigger finger occurs if there’s a problem with the tendon or sheath, such as inflammation and swelling. The tendon can no longer slide easily through the sheath and can bunch up to form a small lump (nodule). This makes bending the affected finger or thumb difficult. If the tendon gets caught in the sheath, the finger can click painfully as it’s straightened.

The exact reason why these problems occur isn’t known, but several factors may increase the likelihood of trigger finger developing. For example, it’s more common in women, people over 40 years old, and those with certain medical conditions.

Another hand-related condition called Dupuytren’s contracture can also increase your risk of developing trigger finger. In Dupuytren’s contracture, the connective tissue in the palm of the hand thickens, causing one or more fingers to bend into the palm of the hand.

Long-term conditions, such as diabetes and rheumatoid arthritis, are also sometimes associated with trigger finger.

Read more about the causes of trigger finger.

How trigger finger is treated

In some people, trigger finger may get better without treatment.

However, if it isn’t treated, there’s a chance the affected finger or thumb could become permanently bent, which will make performing everyday tasks difficult.

If treatment is necessary, several options are available, including:

Rest and medication – avoiding certain activities and taking non-steroidal anti-inflammatory drugs (NSAIDs) may help relieve pain.

Splinting – where the affected finger is strapped to a plastic splint to reduce movement.

Corticosteroid injections – steroids are medicines that can reduce swelling.

Surgery on the affected sheath – surgery involves releasing the affected sheath to allow the tendon to move freely again. It’s usually used when other treatments have failed. It can be up to 100% effective, although you may need to take 2 to 4 weeks off work to fully recover.

Read more about treating trigger finger.

Trigger finger in children

Trigger finger is generally less common in children than in adults, but sometimes young children aged between 6 months and 3 years develop it. It can affect the child’s ability to straighten their thumb, but it’s rarely painful and usually gets better without treatment.

Posted on A to Z of Medical Conditions

Body dysmorphic disorder (BDD) – what is it and why we need to know?

Body dysmorphic disorder

Body dysmorphic disorder

Body dysmorphic disorder (BDD), or body dysmorphia, is a mental health condition where a person spends a lot of time worrying about flaws in their appearance. These flaws are often unnoticeable to others.

People of any age can have BDD, but it is most common in teenagers and young adults. It affects both men and women.

Having BDD does not mean you are vain or self-obsessed. It can be very upsetting and have a big impact on your life.

Symptoms of BDD

You might have BDD if you:

worry a lot about a specific area of your body (particularly your face)

spend a lot of time comparing your looks with other people’s

look at yourself in mirrors a lot or avoid mirrors altogether

go to a lot of effort to conceal flaws – for example, by spending a long time combing your hair, applying make-up or choosing clothes

pick at your skin to make it “smooth”

BDD can seriously affect your daily life, including your work, social life and relationships. BDD can also lead to depression, self-harm and even thoughts of suicide.

Getting help for BDD

You should visit your GP if you think you might have BDD.

They will probably ask a number of questions about your symptoms and how they affect your life. They may also ask if you have had any thoughts about harming yourself.

Your GP may refer you to a mental health specialist for further assessment and treatment, or you may be treated through your GP.

It can be very difficult to seek help for BDD, but it’s important to remember that you have nothing to feel ashamed or embarrassed about. Seeking help is important because your symptoms probably won’t go away without treatment and may get worse.

Treatments for BDD

The symptoms of BDD can get better with treatment.

if you have relatively mild symptoms of BDD you should be referred for a type of talking therapy called cognitive behavioural therapy (CBT), which you have either on your own or in a group

if you have moderate symptoms of BDD you should be offered either CBT or a type of antidepressant medication called a selective serotonin reuptake inhibitor (SSRI)

if you have more severe symptoms of BDD, or other treatments don’t work, you should be offered CBT together with an SSRI

Cognitive behavioural therapy (CBT)

CBT can help you manage your BDD symptoms by changing the way you think and behave. It helps you learn what triggers your symptoms, and teaches you different ways of thinking about and dealing with your habits. You and your therapist will agree on goals for the therapy and work together to try to reach them.

CBT for treating BDD will usually include a technique known as exposure and response prevention (ERP). This involves gradually facing situations that would normally make you think obsessively about your appearance and feel anxious. Your therapist will help you to find other ways of dealing with your feelings in these situations so that, over time, you become able to deal with them without feeling self-conscious or afraid.

You may also be given some self-help information to read at home and your CBT might involve group work, depending on your symptoms.

CBT for children and young people will usually also involve their family members or carers.

Selective serotonin reuptake inhibitors (SSRIs)

SSRIs are a type of antidepressant. There are a number of different SSRIs, but the one most commonly used to treat BDD is called fluoxetine.

It may take up to 12 weeks for SSRIs to have an effect on your BDD symptoms. If they work for you, you will probably be asked to keep taking them for several months to improve your symptoms further and stop them coming back.

There are some common side effects of taking SSRIs, but these will often pass within a few weeks. Your doctor will keep a close eye on you over the first few weeks. It’s important to tell them if you’re feeling particularly anxious or emotional, or are having thoughts of harming yourself.

If you are no longer having any symptoms, you will probably be taken off SSRIs. This will be done by slowly reducing your dose over time to help make sure your symptoms don’t come back (relapse) and to avoid any side effects of coming off the drug (withdrawal symptoms), such as anxiety.

Adults younger than 30 will need to be carefully monitored when taking SSRIs as they may have a higher chance of developing suicidal thoughts or trying to hurt themselves in the early stages of treatment.

Children and young people may be offered an SSRI if they are having severe symptoms of BDD. Medication should only be suggested after they have seen a psychiatrist and been offered therapy.

Further treatment

If treatment with both CBT and an SSRI has not improved your BDD symptoms after 12 weeks, you may be prescribed a different type of SSRI or another antidepressant called clomipramine.

If you don’t see any improvements in your symptoms, you may be referred to a mental health clinic or hospital that specialises in BDD, such as the National OCD/BDD Service in London.

These services will probably do a more in-depth assessment of your BDD. They may offer you more CBT or a different kind of therapy, as well as a different kind of antidepressant.

Causes of BDD

We don’t know exactly what causes BDD, but it might be associated with:

genetics – you may be more likely to develop BDD if you have a relative with BDD, obsessive compulsive disorder (OCD) or depression

a chemical imbalance in the brain

a traumatic experience in the past – you may be more likely to develop BDD if you were teased, bullied or abused when you were a child

Some people with BDD also have another mental health condition, such as OCD, generalised anxiety disorder or an eating disorder.

Things you can try yourself

Support groups for BDD

Some people may find it helpful to contact or join a support group for information, advice and practical tips on coping with BDD.

You can ask your doctor if there are any groups in your area, and the BDD Foundation has a directory of local and online BDD support groups.

You may also find the following organisations to be useful sources of information and advice:

Anxiety UK

International OCD Foundation

Mind

OCD Action

OCD UK

Mental wellbeing

Practising mindfulness exercises may help you if you’re feeling low or anxious.

Some people also find it helpful to get together with friends or family, or to try doing something new to improve their mental wellbeing.

It may also be helpful to try some relaxation and breathing exercisesto relieve stress and anxiety.

Posted on A to Z of Medical Conditions

Trigeminal neuralgia – what are the signs and symptoms of Trigeminal neuralgia?

Trigeminal neuralgia is sudden, severe facial pain. It’s often described as a sharp shooting pain or like having an electric shock in the jaw, teeth or gums.It usually occurs in short, unpredictable attacks that can last from a few seconds to about two minutes. The attacks stop as suddenly as they start.

In most cases trigeminal neuralgia affects part or all of one side of the face, with the pain usually felt in the lower part of the face. Very occasionally it can affect both sides of the face, although not usually at the same time.

Diagram of trigeminal nerve

People with the condition may experience attacks of pain regularly for days, weeks or months at a time. In severe cases attacks may occur hundreds of times a day.

It’s possible for the pain to improve or even disappear altogether for several months or years at a time (remission), although these periods tend to get shorter with time.

Some people may then go on to develop a more continuous aching, throbbing and burning sensation, sometimes accompanied by the sharp attacks.

Living with trigeminal neuralgia can be very difficult. It can have a significant impact on a person’s quality of life, resulting in problems such as weight loss, isolation and depression.

Read more about the symptoms of trigeminal neuralgia.

When to seek medical advice

See your GP if you experience frequent or persistent facial pain, particularly if standard painkillers, such as paracetamol and ibuprofen, don’t help and a dentist has ruled out any dental causes.

Your GP will try to identify the problem by asking about your symptoms and ruling out conditions that could be responsible for your pain.

However, diagnosing trigeminal neuralgia can be difficult and it can take a few years for a diagnosis to be confirmed.

Read more about diagnosing trigeminal neuralgia.

What causes trigeminal neuralgia?

Trigeminal neuralgia is usually caused by compression of the trigeminal nerve. This is the nerve inside the skull that transmits sensations of pain and touch from your face, teeth and mouth to your brain.

The compression of the trigeminal nerve is usually caused by a nearby blood vessel pressing on part of the nerve inside the skull.

In rare cases trigeminal neuralgia can be caused by damage to the trigeminal nerve as a result of an underlying condition, such as multiple sclerosis (MS) or a tumour.

Typically the attacks of pain are brought on by activities that involve lightly touching the face, such as washing, eating and brushing the teeth, but they can also be triggered by wind – even a slight breeze or air conditioning – or movement of the face or head. Sometimes the pain can occur without any trigger at all.

Read more about the causes of trigeminal neuralgia.

Who’s affected

It’s not clear how many people are affected by trigeminal neuralgia, but it’s thought to be rare, with around 10 people in 100,000 in the UK developing it each year.

Women tend to be affected by trigeminal neuralgia more than men, and it usually starts between the ages of 50 and 60. It’s rare in adults younger than 40.

Treating trigeminal neuralgia

Trigeminal neuralgia is usually a long-term condition, and the periods of remission often get shorter over time. However, most cases can be controlled with treatment to at least some degree.

An anticonvulsant medication called carbamazepine, which is often used to treat epilepsy, is the first treatment usually recommended to treat trigeminal neuralgia.

Carbamazepine needs to be taken several times a day to be effective, with the dose gradually increased over the course of a few days or weeks so high enough levels of the medication can build up in your bloodstream.

Unless your pain starts to diminish or disappears altogether, the medication is usually continued for as long as necessary, sometimes for many years.

If you’re entering a period of remission and your pain goes away, stopping the medication should always be done slowly over days or weeks, unless you’re advised otherwise by a doctor.

Carbamazepine wasn’t originally designed to treat pain, but it can help relieve nerve pain by slowing down electrical impulses in the nerves and reducing their ability to transmit pain messages.

If this medication is ineffective, unsuitable or causes too many side effects, you may be referred to a specialist to discuss alternative medications or surgical procedures that may help.

There are a number of minor surgical procedures that can be used to treat trigeminal neuralgia – usually by damaging the nerve to stop it sending pain signals – but these are generally only effective for a few years.

Alternatively, your specialist may recommend having surgery to open up your skull and move away any blood vessels compressing the trigeminal nerve.

Research suggests this operation offers the best results in terms of long-term pain relief, but it’s a major operation and carries a risk of potentially serious complications, such as hearing loss, facial numbness or, very rarely, a stroke.

Read more about treating trigeminal neuralgia.

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The Infections That Cause Guillain-Barré Syndrome

person washing hands over sink

 

Guillain-Barré Syndrome (GBS) is a rare, but serious condition where the person’s immune system mistakenly attacks the peripheral nervous system. Up to half of people experience severe nerve pain and triggers have been linked mainly to infections. GBS is characterised by a rapid-onset change in sensation or pain and muscle weakness, usually starting in the hands and feet, which can lead to paralysis. The reason why the immune system attacks the peripheral nervous system is unclear, but links between certain viruses triggering GBS have been found.

Campylobacter Infection

Campylobacter is the most common cause of food poisoning in the UK and many other developed countries. Since laboratories were able to isolate campylobacter in stool specimens 20 years ago a link between it and GBS became apparent as people reported its onset after infection. More recently, stronger evidence has been able to support the association. Based on a study by McCarthy and Giesecke it’s estimated that 14% of people will develop GBS following a campylobacter infection.

The Link Between Zika Virus And GBS

The link between the Zika virus and GBS was first reported in 2014, and in 2016 the World Health Organisation concluded that it is a trigger. A 2016 study by Cao-Lormeau et al. found that 88% of patients with GBS had a history of viral infection 6 days before the onset. The results were compared against control patients and other infections and the Zika virus showed a stronger correlation as a trigger for GBS. Many countries with the Aedes mosquitoes, which carry the Zika virus, have also reported an unusual increase in GBS, adding to the strength of the theory that the two are linked.

Long-Term Treatment For GBS

Unfortunately, up to 20% of people left severely disabled after having GBS and others have persistent symptoms, such as poor balance, coordination and muscle weakness. Long-term treatment often involves physical therapy to strengthen muscles or re-learn movements, such as walking. An occupational therapist can help find ways to do daily tasks that you’ve always done but now find difficult. The Speech And Language Therapy (SALT) team may also be involved if you have problems with speech or swallowing and can help to strengthen these muscles or find alternatives that suit you, such as puréed foods. Counselling is helpful when GBS is life-changing, which can be overwhelming and difficult to deal with, so having a professional to talk to is beneficial.

To reduce your chance of developing GBS you should take precautions to avoid the infections that can trigger it. When it comes to food poisoning, make sure meat, especially poultry, is stored and cooked correctly to kill off campylobacter. If you’re in a country where Aedes mosquitoes are prominent, be sure to use insect repellent and wear clothes that fully cover your skin. Treatment can be a long battle, but it is possible. Using the affected muscles is the best way to get them working correctly again.

 

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Aspergillosis – what is Aspergillosis?

Aspergillosis is a condition caused by aspergillus

Aspergillosis is a condition caused by aspergillus

 

Aspergillosis is a condition caused by aspergillus mould. There are several different types of aspergillosis – most affect the lungs and cause breathing difficulties.

How you get aspergillosis

Aspergillosis is usually caused by inhaling tiny bits of mould. The mould is found in lots of places, including:

soil, compost and rotting leaves

plants, trees and crops

dust

damp buildings

air conditioning systems

You can’t catch aspergillosis from someone else or from animals.

Most people who breathe in the mould don’t get ill.

Aspergillosis is rare in healthy people

You’re usually only at risk of aspergillosis if you have:

a lung condition – such as asthma, cystic fibrosis or chronic obstructive pulmonary disease (COPD)

a weakened immune system – for example, if you’ve had an organ transplant or are having chemotherapy

had tuberculosis (TB) in the past


Symptoms of aspergillosis

Symptoms of aspergillosis include:

shortness of breath

a cough – you may cough up blood or lumps of mucus

wheezing (a whistling sound when breathing)

a high temperature of 38C or above

weight loss

If you already have a lung condition, your existing symptoms may get worse.

See a GP if you have:

a cough for more than 3 weeks

a lung condition that’s getting worse or harder to control with your usual treatment

a weakened immune system and symptoms of aspergillosis

Get an urgent GP appointment if you cough up blood. Call 111 if you can’t see your GP.

What happens at your appointment

Your GP will check for an obvious cause of your symptoms, like a chest infection or asthma.

If they’re not sure what the problem is, they may refer you to a specialist for tests such as:

X-rays and scans

blood tests or tests on a sample of mucus

allergy tests

a bronchoscopy – where a thin, flexible tube with a camera at the end is used to look in your lungs

Treatment for aspergillosis depends on the type

Treatment usually helps control the symptoms. If it isn’t treated or well controlled, there’s a risk it could damage your lungs.

Common types Treatment
Allergic bronchopulmonary aspergillosis (ABPA) – an allergy to aspergillus mould steroid tablets and antifungal tablets for a few months (possibly longer)
Chronic pulmonary aspergillosis (CPA) – a long-term lung infection long-term (possibly lifelong) treatment with antifungal tablets
Aspergilloma – a ball of mould in the lungs, often linked to CPA surgery to remove the ball if it’s causing symptoms
Invasive pulmonary aspergillus (IPA) – a life-threatening infection in people with a weakened immune system antifungal medicine given directly into a vein in hospital

You can’t always prevent aspergillosis

It’s almost impossible to completely avoid aspergillus mould.

But there are things you can do to reduce your risk of aspergillosis if you have a lung condition or weakened immune system.

Do

try to avoid places where aspergillus mould is often found, such as compost heaps and piles of dead leaves

close your windows if there’s construction work or digging outside

wear a face mask in dusty places

consider using an air purifier at home – devices with HEPA filters are best