What is the cause for sore and stiff fingers, and which specialist should I see in Singapore?

The most common cause of the symptoms described is trigger finger. Trigger finger is a condition where the tendons controlling flexion of the digit become inflamed and swollen. As these tendons glide in and out within a fitting tunnel called a tendon sheath, any increase in girth of these tendons can disrupt the smooth gliding action. Trigger finger is categorized into 4 grades.

Grade 1 trigger finger:

Initially, the additional friction from the swelling of the tendons cause pain when moving the finger. This swelling is usually worse upon waking up in the morning as the swelling accumulates overnight. There is no demonstrable triggering or locking of the finger at this stage.

Grade 2 trigger finger:

As the condition progresses, the finger may start locking or getting stuck in flexion. This may be even more painful as the swollen tendon "clicks" in and out of the opening of the tight sheath.

Grade 3 trigger finger:

3A -

At this stage, the finger becomes locked when in a flexed position and can only be released with some force, usually by pulling it open with the other hand.

3B -

As the tendon swelling worsens, the finger can no longer be flexed fully as the tendon refuses to glide within its sheath. At this stage, the finger actually no longer locks, but the range of motion is significantly reduced and painful.

Grade 4 trigger finger:

This is the end stage of trigger finger where the finger is contractured, or stuck, in a flexed position. The finger looks bent and has minimal range of motion. The bent finger can no longer be straightened and this is called a fixed flexion deformity. At this stage, treatment is usually unsatisfactory as the proximal interphalageal joint (PIPJ) becomes stiff and non-pliable.

In your specific case, it is clear that you perform frequent forceful gripping and grasping of heavy dumbells, barbells and overhead bars at the gym. These exercises actually increase the risk of trigger finger in the ring and little fingers. The ring and little fingers are the most employed digits in power gripping, hence the higher propensity of developing trigger fingers in these digits in a power lifter! As you don't have symptoms of locking of the affected digits, you most likely have grade 1 triggers of the ring and little fingers.

Treatment for trigger finger ranges from:

• simple splinting to rest,
• immobilize the inflamed tendon,
• taking non-steroidal anti-inflammatory drugs (NSAIDS),
• more invasive treatment such as corticosteroid injections and
• surgery.

A hand & wrist specialist will be able to advise on the appropriate form of treatment based on the grade of trigger finger one has.

thank you for your question. Although arthritis might be a cause of your symptoms, there are other conditions that can account for your symptoms such as a simple sprain of the joints of the fingers (from your exercise, from using computers etc). Furthermore, there are many subclasses of arthritis (rheumatoid, osteoarthritis, gouty arthritis etc) and many conditions that can cause arthritis as part of the disease process including SLE.

It will be difficult to diagnose based on your submitted history, as a more elaborate history and physical examination may be required. If necessary your doctor may even order more specific investigations including further blood tests to look for autoimmune disorders, uric acid levels etc. as well as further imaging investigations such as X-rays of the hand, Ultrasound or even an MRI scan.

From a western medicine perspective, arthritis is due to degeneration of the joint, either from repeated wear and tear (normal process of aging) or due to inflammation from autoimmune conditions, gout, infections etc. There is no evidence to support contact with water or drinking cold drinks as a cause for arthritis 🙂

Arthritis is certainly uncommon in a 33 year old, but may be one of the earlier symptoms of an underlying condition. As such you should definitely consult a doctor for further workup.

I would advise you to consult a Hand Specialist (doctor specialising in conditions of the hand) or a Rheumatologist (doctor specialising in conditions of the joints of the body). Treatment options range from simply giving your fingers sufficient rest to recover, using finger/wrist braces, oral painkillers and anti-inflammatory medicines, to injections of steroids into the joint or even surgery depending on the diagnosis and severity of the condition.

Good luck!