Typically we want to know how long a patient has had the symptoms because obviously the longer you've had it, the less likely that it's going to go away with simple treatments like anti-inflammatory medication. And we want to know what kind of treatments your general practitioner might initially tell you to try, things like activity modification to avoid aggravating activities. This involves gripping exercises.
You will be given anti-inflammatory medications like mefenamic acid or celecoxib which are known in the market as Ponstan and Celebrex, respectively. With these, you don't want to be taking long term. You use them for a week or so to relieve the inflammation and swelling around the tendons to help to relieve the symptoms like swelling and pain. Taking anti-inflammatories long term can lead to side effects like gastric discomfort. So they're not really a long term solution.
They’re just for short term pain relief; you still need to reduce the aggravating activity. Now sometimes this may be difficult as I said, because a lot of patients just might be just doing their normal daily household chores and, and have gotten a finger so it might be unavoidable.
There’s also an option to give an injection of steroids. I like to think of steroid injections as a stronger anti-inflammatory medication to reduce or force the swelling to go down. This is somewhat unphysiologic: your body is inflamed because there's something going on. With injury, your body needs to rest. By swelling, it’s giving signals in the form of pain, telling you to stop doing what’s causing this discomfort. Steroids relieve this inflammation around the tendons. The clicking and triggering also alleviates this, it can happen quite quickly in about three to four days. Usually most of the symptoms can be abated. But do note that steroids are artificially blocking the signals, these inflammatory signals that are happening naturally in your body.
If we’re using the correct steroids—usually these are depot injection steroids—they stay in the inflamed area for about three to four months and then they disappear. The effects will disappear. A fair number of patients will experience a recurrence once the steroids have worn off. Therefore, I look at steroid injections more as a form of temporary pain relief. It buys time for patients, if they're not able to pursue a permanent solution at that juncture. Repeating steroids is not a good idea.
