Aromatase Inhibitors and Trigger Finger/Thumh

I am another who has been having both trigger fingers and triggers toes on Armidex!

I have started to do exercises everyday--raise my arms up and "pump" my fingers and fists, open and close, and then repeat, and until I am tired.

I also do exercises on my feet--flex, extend, flex, extend, circle right, circle left, then do it again.

I find if I keep this up and do it every day, my trigger fingers and thumbs take a walk south!!

Hopefully this will help.

I got trigger finger in 3 fingers after taking only 3 Aromasin pills.  I had previously had bad arthritis symptoms ( but no actual arthritis) from trying first Arimidex, then Femara.  I have just had surgery on the fingers - not a real bad thing to have!

Trigger fingers that are not treated do not get better and may end up as chronic curved fingers.  I tries all sorts of NSAIDs, hot water soaks, sleeping with a splint and PT with zero relief.  The cortisone shots hurt like the dickens for a week and gave not even a day of relief.

I get the stitches out in a couple of days, but already I feel so much less pain!  I'm sure it would be even better if the stitches weren't pulling.  I'll do my own therapy - swimming, which has been better than any other type for anything where I've needed to recover.

Of course I had to give up on the AIs. I probably would have kept on with a reduced dose (1/5 pill, which the company website is still theraputic), but my oncologist can't prescribe it because it's not approved.  Since I would like to be able to use my hands (and toes!!) I have no choice but to take my chances with recurrence.

BTW, I had the surgery with only local anesthetic and didn't need anything more.  The local completely blocked any feeling in my hand, lasted for 13 hours.  There is no reason for "something to relax you," aka amnesic bensodiazepine that makes you dizzy, if there is a nice nurse just standing there talking to you.  I had no IV, was able to leave a few minutes after surgery - which took only 15 minutes.  Only disappointment was I wasn't allowed to watch.

I also have to (gently) disagree with Alcie.  Some orthopods say surgery will eventually be needed, but my reasoning about that is, hey, who will gain $$$ from the surgery?  (Not that I'm suspicious or anything...)  I have an alternative strategy (non-surgical, non-steroidal) that worked for me, for the carpal tunnel syndrome (CTS) in my right wrist and the de Quervain's syndrome in my left wrist.

I've been on Arimidex since the last week in June '08, so that makes it almost exactly 2 years.  I developed CTS in November '08, 5 months after starting the AI.  My PCP said it was very early-stage, and prescribed a wrist splint, which I got from a medical supply place he recommended.  It did not fit properly.  My mom also has CTS, so I tried her wrist brace and it fit and felt much better; so I bought one of those on-line through Amazon.com. 

I wore that wrist brace every night for 6 to 8 weeks, until the tingling in my thumb and forefinger were completely gone.  I still wear it sporadically when I think the tingling might be coming back.  The key to relieving CTS is to treat it before it gets too bad and causes nerve damage; and the wrist brace prevents your wrist from flexing too much.  This happens to me a lot while I'm asleep, so what I do now is rest my hand on a small, soft pillow (my "arm-pillow") in a position that keeps the wrist straight or very slightly extended.  (It's "extended" when it's bent backwards.)

BTW, my med onco agreed that there is an association between aromatase inhibitors and CTS, although the published studies say the risk is pretty low -- around 5 or 6 %.  Leave it to me to keep winning those low-odds lotteries.

I don't know if I have "trigger thumb", but I did develop what very likely was "de Quervain's syndrome" in my thumb on the non-CTS side last summer (a year after finishing chemo & starting Arimidex).  With de Quervain's, it hurts like crazy to grasp things with your thumb against your hand, or even make a fist or move your wrist sideways.  Opening a screw-top lid can be excruciatingly painful.  Sometimes you can see and feel a swollen area at the wrist near the base of the thumb.  Sometimes movement of the thumb even "catches" a bit, because there's inflammation in the tendon sheath of the thumb and it doesn't slide smoothly.  Here's a description:  http://www.mayoclinic.com/health/de-quervains-tenosynovitis/ds00692

After googling like crazy, I went to the drugstore and bought a "spica splint".  That's a wrist brace that holds your wrist fairly steady and holds the thumb away from the hand ("abducts" the thumb).  I wore the spica splint at night for about a week, but I found that it rubbed my thumb in the wrong place and the constant immobilization made my wrist and thumb ache by morning.  So, I stopped wearing the splint and began sleeping with the corner of that little arm-pillow clasped between my thumb and forefinger of that hand.  Holding the corner of the pillow like that, with my thumb wrapped around it, kept the thumb abducted but still allowed me to move my hand and wrist a little (as needed).

Voila!   Within a couple of weeks of the pillow-clasping strategy, all the pain in that hand/wrist/thumb was gone. I still use that arm-pillow most nights, and I no longer have the least bit of pain on the de Quervain's side and rarely, if ever, have any tingling on the CTS side.

Simple, cheap, painless, trauma-free strategies you can try at home, before resorting to cortisone injections and/or surgery.

otter

otter, I toss and turn too much at night to be able to keep a pillow in the same position.  Maybe if I strapped it in place LOL.

I did develop CTS in my right hand after starting Arimidex and used wrist support during the day and a wrist/hand splint at night (more support).  After a few months of that I am CTS free in that hand.  Now the left thumb, I've called it trigger finger but your de Quervain's syndrome description actually almost fits - it doesn't hurt to move the wrist sideways but all the other symptoms fit.  That is why I am immobilizing it 24/7 because it really hurts when I bend it (and pops), I can't make a fist or grab anything circular.  Screw top - I'll throw it against the wall before I subject myself to that pain.  The websites I visited, including Mayo, suggested immobilizing up to 6-weeks for relief so I'll go with that.   The little nodule does appear to have gotten smaller although it's still painful so I'm claiming it will work over time but not if I take off the brace during the day - I use my hands a lot.  We'll see. 

About 6 months after I started Arimidex I had trigger thumb in my right thumb (when I had Taxol I had numbness in my left hand!). My onc said carpal tunnel, get it checked by primary MD. Well I came for help at these boards and got advice for stretches. It helped me and within 2 months all was normal again. I do wake up with tight feeling hands and feet but after I'm up it gets better. I just couldn't handle the thought of another surgery so was glad things resolved. Good Luck!

KTN -

Thank you!  My trigger finger is my ring finger on my left hand, so I don't really know how I will "walk" it over my other fingers, but at least I have a starting point in knowing that stretching and massage will help.  Guess it's time to see the doc as to how to stretch that finger.  Appreciate it!  Good luck with yours.

Linda

One week wearing thumb brace 23.5 hours/day.  Nodule at base of thumb is a little less swollen but still very sore.  If I bend first joint it still hurts but it's only a week so will just keep wearing it and hoping over time it gets better.  I've been massaging and stretching also several times a day.

Tomorrow will be 2 weeks since wearing the thumb brace 24/7.  Nodule has not gotten any smaller and still hurts.  Without the brace it hurts really bad when I forget and bend my thumb.  Might have to give in and have the Xray done although I don't see the point.

Another trigger thumb chiming in, this one from Brazil, where my Arimidex package insert in Portuguese tells me that "dedo de gatilho", i.e. trigger finger, is a known side effect of the drug, though it describes it as "rare" (as opposed to "dores articulares"--joint pain--described as very common.

Mine started about three months ago, nine months into Arimidex and has been getting progressively worse. The popping sensation comes and goes, coming more frequently as time goes by, and taking longer to go away after I start flexing my fingers. It is definitely worse at night. This morning when I  woke up I could not straighten the thumb and it stayed bent for several hours. It is my right thumb and I am right handed so it affects my writing in a major way. Unscrewing jar tops--forget it! even manipulating keys, door knobs and faucets is a problem. 

I also have a host of other joint issues that started around the same time. Knees, elbows, feet, hips, shoulders, lower back. I started doing Pilates to see if it would help; so far no noticeable difference. What I want to know is, is this going to continue for as long as I´m on the drug? I have 2 oncs. One says switching to another AI could help, the other says that it often makes no difference. Since I get the Arimidex through Brazilian national health care but would have to pay for other AI´s, I am in a quandary. I could get tamoxifen for free, but I wonder if it is as effective in controlling the cancer as AI´s. I am stage 4 and the Arimidex has been holding my lone bone met at bay pretty well.

Lisa

PS--FernDiva, I LOVE the head tattoo. Or is it henna painting? 

Patoo, I have been taking glucosamine+chondritin for over a year because of arthritic stuff. I honestly don´t think it has helped much if at all. I will see my onc tomorrow and find out what he has to say about thumb splints. But it being my right hand, wearing a thumb splint would be kind of disabling in itself, during waking hours. which hand is yours?

from what I read on the mayo clinic site, trigger finger tends to be the result of repetitive motion issues. in those cases the splint would force the patient to stop the activities that cause the problem. In our case, if the AI is what brings it on, how would the thumb splint address the problem?

Pitanga -- Great to see you here again!

Just wanted you and others to know that trigger finger does not have to be permanent.  I developed it in third finger of both hands about 6 months into Femara, and both fingers are back to normal.  What I've noticed (and I'm sure others have a well) is that the sore joint issue seems to move around.  I had real problems with my hands and wrists for awhile, but now it's my feet (heels especially).

I tried the glucosamine/chondroitin and it made me nauseous.  I take an Omega 3 Fish Oil capsule once a day and it think it has helped alot.  The only time I actually need to take an advil is for a headache.

DH has arthritis in his lower back and has found a new supplement which is really helping.  It's called Relev-X and contains chondroitin, cat's claw, devil's claw, curcumin, boswellia and fish oil.  Made in Canada by Platinum Naturals but no doubt it's manufactured in other countries as well.

There's another local analgesic that might work for your hands or other specific joints.  It's called Voltaren Emulgel and is available online.  You just rub the gel onto the specific joint and it does provide temporary relief.

Hope this helps!

Linda

Hello,

My pains where helped a lot with adding omega 3 and magnesium citrate supplements. I would notice the difference whenever I stopped.