Francesca O. Johnson, MD
Medical Student
California University of Science and Medicine
TEMECULA, California, United States
A 58-year-old female professional cellist was diagnosed with trigger finger, a condition causing pain and finger locking due to tenosynovitis of the flexor digitorum superficialis at the A1 pulley.
Case Description: The patient experienced pain in her left palm near the ring finger, due to repetitive and prolonged cello playing, and partially relieved with rest, ice, and ibuprofen. Over four months, symptoms progressed despite hand therapy. Corticosteroid injection provided no relief. She reported her left ring finger getting stuck after playing for over 10 minutes. Ultrasound showed thickening of the A1 pulley and effusion in the flexor tendon sheath. The patient refused immobilization and profound rest as this would significantly harm her career and income during her peak performance season. She gave informed consent for off-label Extracorporeal Shock Wave Therapy (ESWT) and refused to rest from cello work. After one ESWT session, her VAS score improved from 7 to 4; after four weekly sessions, her VAS score was 2, even with extended practice sessions. She reported sustained relief 3 months after ESWT.
Discussions: Trigger finger develops from repetitive microtrauma and flexion-extension movements, and can be debilitating for musicians. The thickening of the A1 pulley impedes smooth tendon movement, causing pain and locking. ESWT, typically used for tendinopathies, has shown potential benefits in reducing pain and signs tendonitis. This case highlights ESWT treatment for people who will not stop the aggravating activity and need relief. We are interested in further ESWT research in the population of people who cannot rest from the injurious activity.
Conclusions: ESWT effectively reduced pain and improved function in this cellist with trigger finger, allowing her to continue performing during her peak season. This case highlights that rest is not always accepted. ESWT showed that significant benefit is possible even while injurious activity continues.
