Backache -17

Remedial Exercises  

Backache is a complex problem. It has multifactorial aetiology. There are many exercises that are used as an adjunct to its treatment. Here, some of the exercises useful in the management of backache are described. It is not a complete List. Many more can be added to it. As a matter of fact white charting out the exercise programme for an individual suffering from backache; one should take into account the exact cause of backache, age, the built of the body and even the mental attitude of the patient. The exercises should be done slowly and increased gradually.   During exercise, sudden jerks should be avoided. Most of the cases of backache fortunately settle down with   simple remedial exercises.

 Some of the cases do not respond satisfactorily. It is these -who pose a baffling problem.  Many methods have been tried in the past & new ones are being discovered with the hope that this oldest problem of mankind –the aching back, the most common & yet intractable, is solved.

The actual treatment of backache lies in the therapeutic exercises only

They act by:

   (a)    Improving the muscle tone.

   (b)   Improving the muscle power.

   (c)    Regaining the mobility of the joints and elasticity of the ligaments. (Ligaments are the natural hinges like those of doors which control the direction of the movement of a joint). The usual remedial spinal exercises are:

  

      Exercise no. 1      

Steps :

l. Lie on the belly.                                                                                                                                     2. Lift the chest with support of both elbows & count up to 10 slowly

Fig.

Exercise No. 2

 Steps:

 l. Lie on your belly.                                                                                                                                   2. Lift Right hip with knee straight & count up to 10 slowly.                                                                    3. Bring it back and do same with left hip.

Fig.

Exercise No.3                                                                                                                                              Steps :                                                                                                                                                      

l. Lie on your belly.                                                                                                                                   2. Keep both hands on the back just above the hips.                                                                              

3. Lift up the head and the chest & count up to 10 slowly.                                                                    

4. Come back to step I position.

Fig .

Exercise No. 4                                                                                                                                          Steps :                                                                                                                                                      

l. Lie flat on the back.                                                                                                                            

2. Bend your both knees.                                                                                                                           3. Lift your hips  & count up to 10 slowly.                                                                                              

Fig

Exercise No. 5                                      

Steps:                                                                                                                                                          1. Lie on the belly.                                                                                                                                     2. Stretch both hands beyond head.                                                                                                            3. Lift the head and chest & count up to 10 slowly.

Fig.

Exercise No.6                                                                                                                                            

Steps:                                                                                                                                                          1. Lie on Your belly                                                                                                                                

2. Lift your right hip  with knees straight & left- arm in front  of your head & count up to 10.             3. Come back to step I Position                                                                                                                 4. Do the same with left hip and right arm.

Fig.

Exercise No.7                                                                                                                                            

Steps :                                                                                                         

l. Lie on Your belly.   

2. Lift up both the-thighs keeping the knees straight   & count up to 10 slowly.  

3. Come back to step I Position.

Fig

Exercise No. 8       

Steps:                                                                                                                                                        1. Lie on your belly.                                                                                                                                 2. Stretch both hands beyond head.                                                                                                  

3. Lift up the hands, chest, and both the hips with knees straight & count till 10.

Fig.

Exercise No. 9            

Steps:                                                                                                                                                       1. Lie flat on Your back.                                                                                                                             2. Lift the heels 9 inches above the bed with the knees held straight.                                                       3. Count till 10 and come back to step 1.

Fig.

Exercise No. 10                                                                                                                                       Steps :                                                                                                                                                        l. Lie flat on your back.                                                                                                                              2. Keep the hands under your head.                      

3. Try to sit up.                                                                                                                                          Fig.    

Backache-16

How to Take a Bath

Bathrooms are a common place of accidents in modern life.  The act of bathing in standing position is the ideal condition for an accident to occur. The floor is slippery because of soap & water, eyes closed, breath is held, due to soap /shampoo on the eyes & in nostrils & the hands is groping in the dark here & there to hold the water tap or the shower. A little tilt in the body-balance can cause a sprain in the back in an attempt to prevent the fall. But, if the actual fall occurs, fracture of the hip bone or wrist takes place. It is best to take bath while sitting on a stool- high or low, depending upon once own choice. If for some reason, one has to take bath in standing position, some support must be provided during the proced.

Fig:

Backache-15

Backache and Sex

Sex has nothing to do with backache directly.  Over indulgence in the sex or even masturbation does not lead to backache.    The feeling of exhaustion, tiredness, lassitude, listlessness and other similar expressions used to describe the 'post sex'   or 'after night' effects are psychological in nature. It has been observed that these sort of symptoms are encountered more often in adolescents who have a very 'strict and holy' atmosphere at home and elders with 'puritan approach' to life. This induces a guilt complex in their minds and arouses greater curiosity to know and participate in sexual activities. Similarly the adults who have extramarital sex relation develop an idea of guilt and have a 'pricking conscience' all the times because it is an act which neither their spouse nor the society approves. Backache is sometimes picked up, at the subconscious level, as a symptom by these people as self-inflicted punishment for their misdeeds and immoral acts that they had indulged in.

Besides this there are certain causes of backache which are related to reproductive system in females. They are not directly linked with sex though reproduction is the natural sequel of sexual activity.

Backache-14

Psychological Aspects of Backache

Back is a very special organ. It has certain unique aspects in relation to its structure, function and location. Back is used to support other parts of body and the Loads which are placed upon it for transportation. We think of psychological and social, as well as physical burdens being carried on our backs. In short back symbolises physical strength. Hence the terms unyielding, stiff, unbending attitude are common terms which are used in society by an individual by certain degree of pride and aroma of being a very straight forward, honest, non compromising and a person of firm decision. These terms have originated with particular reference to back  as an organ of execution.   Back is also considered as an organ for protection & defence, perhaps because of natural instinct of putting forward the back if an unexpected attack is to be faced.  Back is also considered as an organ for expression of love & affection. An arm around the waist is universally accepted as an act of romance, love & affection.

Fig:

Patting on back by a senior or parents will boost the morale of any individual, if he or she has done a reward winning deed. Thin waist symbolises beauty. All these thoughts do prove that there is a special orientation of back in human psyche. It is natural that certain knots develop during the growth of an individual, which manifest as backache, at one time or the other during life time.

Such people can be labelled as, backache personalities.  They are likely to repress their anger and avoid conflicts, traits they share with many victims of peptic ulcer& migraine. In such cases back pain is just tension headache that has slipped down to back.

It has become customary on part of general practioners to label a case of backache as psychological if the patient does not   respond to usual dosage of pain killers and-some vitamin B-complex injection.   But no patient should be labelled as ‘psychological’ unless a very detailed history has been taken & physical examination done. The patient should be thoroughly investigated- even with advanced investigation like MRI, CT scan etc. If, a single examination does not reveal the exact cause of backache, then repeated examinations & investigations should be done. It is found that quite a few cases which are initially labelled as ‘backache of psychological origin’ on careful examination & investigations turn out to be suffering from Tuberculosis & even cancer. The right treatment, if given early, could have changed the entire course of life of these individuals.

Even if the backache is proved to be of 'psychological origin, there is nothing to get disheartened. It is still curable. A psychiatrist should be consulted. Backache  has been observed due to boredom also. A large number of middle aged ladies attend the physiotherapy clinic regularly because they find it an- outlet for their monotonous routine at home. In India most of the middle and higher income group families do not permit their women folk to undertake any gainful vocation. It is taken as a social stigma & a family insult. Sometimes, some people have a heavy emotional investment in continuing their pain.  An elderly lady had been married for decades and had grown up children, settled in Canada. Her husband was always busy in factory. One day while cleaning the ceiling fan she fell down and sustained some injury to the back. Suddenly her husband became attentive to her. She realised that she was rewarded by painful illness. The original injury was healed but she continued to complain of low backache.

(She had emotional need for love, care and affection which she got through injury).

Backache can also be a by product of difficulties on job, problems of personal relation or grief over the death of some near and dear one. Such cases of 'masked depression' can go on for years undetected.  Some people tend to be hard driving or exhibit to be pushing forward type but actually lack self confidence, also develop backache as a protective phenomenon to their failure and ascribe their inability to achieve the goal to their backache subconsciously.

Backache-13

How to read in bed?

It is not advisable to read in bed even in sitting position. But, sometimes the temptation   is great & difficult to resist. In such a situation it is recommended to keep a pillow to support the lower back.

Fig:

Backache-12

What should be your car seat like?

One of the common causes of backache in high executive is an improper motor-seat and the faulty office-chair. The car seat should not be too far away from the foot controls (foot break, clutch and accelerator) rather it should be at minimum comfortable distance so that the knees are at a higher level than the hips. In this situation there will be a total contact between the back and the seat. The head should be held straight so that the things in front are clearly visible. Sometimes, a small cushion pad may have to be used in the low back area to give support to the back. This is particularly useful when one has to drive for hours together at a stretch.

Fig:       

 

Backache-11

How to get out of the bed?

Getting out of the bed is a common activity which all of us knows & need not be written about. Children like to get up after turning on their-side, bend the knees & hips. Adults usually get up by first lifting the head then the trunk followed by standing on-the legs & feet. But in those individuals who are prone  to backache and who are actually having backache, it is  advisable it is that they should  first turn on one side, then  lower the  feet on the ground, then sit up with  support of the  elbows & hands. Sudden movements & jerks during the process of getting up should be avoided.

Fig:

Backache-10

How to lie in bed?

The beds have been basically designed for relaxation.  An individual should lie in bed in a position of maximum comfort. No rigid rules can be framed about the posture or mode of lying in bed.  Some people like to lie flat in bed on their back, while others like to sleep on their belly. All the poses are correct as long as the individual can get a sound sleep & relax.

After the days hard work, back begins to ache.  It has been observed that, if in lying down position, a small pillow is kept under the knees; it relaxes the muscles and gives comfort to the back. Similarly lying on one side with the upper hip and the knee bent (flexed) and a soft pillow kept under the thigh, a soothing effect is produced. Constantly, a position of extreme flexion (crouching) is not recommended during sleep. It is suggestive of perhaps a fear complex in the individual.

Fig:

Backache-9

How to take Rest?

In most of the day to day activities, the back is bent forward. This can lead to backache, if it continues for a long period of time. If the situation is such that the necessary modifications cannot be accomplished in the work place, then rest on a hard bed in the after noon will help a great deal. The bed should be soft enough to accommodate the body contours comfortably but at the same time it should be on a firm base like a wooden plank or even floor of the room.

Fig:

Backache-8

How to sit on a Chair?

Those who have to sit on a chair for long hours e g. business executive, judges and magistrates, students, clerks etc. should make sure that they are using the proper chair. The height of the chair should be such that while sitting on it, the feet are placed flat on the ground. The knees are at the same or a slightly higher level than the hips and the back is touching the back support of the chair. If for some reasons a high chair has to be used then a foot board should be placed under the feet to achieve the same effect.

Fig:

Backache-7

How to push or Climb?

To push, pull or climb the stairs are few of the commonest activities that is done in day to day life by all the individuals. The Degree of ignorance is surprisingly enormous-and quite often a cause of backache. While pushing an object (say grass cutter) one should not bend the back at the hip joint and apply force with the arms held straight. The right way of doing such an activity will be by keeping the back and the hips straight and bend the arms at the elbow as shown in the illustrations below.

Fig:

Backache-6

How to tie laces of shoes?

While tying laces of shoes, one should not bend forward while knee are completely straight. This puts a lot of strain on the back & can cause backache. Best way is to keep the foot bearing the shoe on a stool or a foot board by bending the knee. Now tie the laces. It will be a pleasure.

Fig:

Backache-5

HOW TO PICK & LIFT?

One of the common day to day activities in every one's life is to pick up an object from the ground, be it a house wife lifting a utensil from the floor, a mother picking up a child or a worker in a factory lifting a packet. In all such situations, the back should not be bent with the knee kept straight.

While picking up an object from the ground, one should not bend forward, pickup the object & then straighten the back. This puts lot of stress on the lower back & cause backache. The correct way is to come close to the object, bend the knees, pick the object & stand up. When you carry the object from one place to another, keep it close to your body.

Fig:

Backache-4

How to stand for a long time?

In certain duties one has to stand for long time at a stretch e.g., house wives (in kitchen or bath room) workman operating a lathe machine, Architects, nurses, surgeons etc. In such situations one should not keep standing, with feet firmly planted on the ground at one place. They are likely to develop pain in back, thigh, calf &/feet. These people should keep moving their feet; bend the knee, some time stand on toes & sometimes on heel. It is advisable that a foot board be kept & the person should keep one or the other foot on it alternately.

Fig:

Backache-3

Backache, no doubt is the commonest ailment that the mankind suffers from, but its causes are also the common acts of commission & omission, that we, the humans do in our activities of daily living. Here are some of the tips, if observed, can help us in prevention of backache.

How to work in the house?

House wives are the commonest victims of low backache. This is because of their working conditions. A standing kitchen is always better than the one where one has to squat on the floor to cook or clean the utensils. The washing machine for clothes should be adjusted to such a height that there is no strain on the back of the operator. Similarly ironing of clothes should be done in standing position to avoid strain on back.

Fig:

Backache-2 Know your back: It’s Structure & Functions

Human back is an amazing example of biological engineering. It provides the basic framework on which the skull, Ribs, Pelvis, & shoulder bones are attached. Can we imagine the human shape without backbone? We would have looked like a gunny bag filled with some putty like material & would have had no shape of our own. It would have been impossible to lift or carry any object from one place to another.

When we speak   of back, we usually mean spinal column which is extending from the back of skull to pelvis in a graceful yet extremely strong double S shaped curve. This natural architectural masterpiece of human skeleton consists of 33 blocks of bones called vertebra. They are given different names according to the region of spine they belong to.

In the neck they are called cervical vertebra.

In the upper back (Chest) they are called Dorsal vertebra.

In the lower back they are called Lumbar vertebra.

In the tail bone they are called Coccyx

The vertebrae are hollow structures. The hollow of all vertebrae put together make a long tunnel through which the tail of the brain (spinal cord) runs. The width of spinal canal is almost equal to the thickness of a finger.

Vertebra resembles a house in shape & functions.

As a house protects its residents, so does the vertebra protects the spinal cord.

BACKACHE-1

BACKACHE is the oldest agony that the mankind suffers from. In the prehistoric era, even the angels must have suffered from it. Though in the ancient Indian literature, no direct mention of this disease is made, it can be safely assumed that in the epic period of Mahabharata, Bhishma Pitamaha must have had some backache when he was lying on the bed of thorns.

NOT ALL PATIENTS OF BACKACHE NEED SURGERY. MOST OF THEM CAN BE TREATED WITHOUT OPERATION.

Fig: 1

Whatever be the exact etiology of backache, it is for the medical scientist & the Pundits in the field to determine. Human back is a big Pandora box. Causes for backache are many. They range from a thorn prick in the foot to prolapsed inter-vertebral disc in the spine. Even, a trauma to human pride can cause backache. It will be no exaggeration to compare the backache with an elephant that the six blind men wanted to know about. One of them called it a pillar, other called it a wall, third called it a rope, fourth it a flap of lather, & so on. Similarly many scientists have approached the problem of backache from different angles & have ascribed as many reasons as its causes & suggested remedies for the same; depending on their own concept of human back –its structure & functions.

In last few decades, much scientific work has been done; data compiled & analysed to determine the exact cause of backache. It is estimated that at one point or other in their lives, eight out of every ten people on earth suffer from this universal affliction. It can strike almost every one, the young & the old, male & female, people of all classes 7 & profession. Biggest leaders of the world have suffered from backache. President John F Kennedy spent hours in the soothing comforts of White House rocking chair, only to nurse his backache,

This was his war time injury.

The largest group of people who suffer from this are the young housewives who have small children & are fully occupied at home. They have no outside job. When they have backache, a double burden is imposed on the family. If the person affected is the chief bread earner, then the situation becomes all the more worse.

Backache is not a killing disease, but it certainly cripples the individual for the time being. No one except the victim can truly understand the complete sense of helplessness & despair that overcomes, once an energetic adult who is suddenly struck down by the devastating, usually temporary ailment. The victim’s world quickly shrinks, often limited at the onset to bed or couch. Work & house-hold rituals are totally ignored due to pain. Dressing becomes torturous, a visit to toilet is a major expedition, sitting in chair for reading or eating can be an agony. Sex becomes virtually impossible. Even after the pain subsides, the sufferer wonders, almost at every turn, whether it will strike again.

Beyond the personal grief, back pain exerts a staggering socio economic cost. Million & millions of work days are lost each year because of backache. It is the single largest cause of worker absenteeism in all the countries of the world.

The remedies are simple & effective in most of cases. The most important being ‘not to get tense & nervous’. An objective personal assessment of the disability with a relaxed mind & a wilful relaxation of the whole body coupled with a few pills & postures ( remedial exercises) is perhaps the secret of success in getting rid of this man’s  oldest agony. But in some cases even surgery or psychotherapy may be needed.

In the present series, I have attempted, step by step, how to modify the style of daily living so that this ‘devastating though temporary ailment’ can be prevented.

Writer’s Cramp

Writer's cramp is a focal dystonia of the fingers, hand, and/or forearm. Symptoms usually appear when a person is trying to do a task that requires fine motor movements, such as writing or playing a musical instrument. Clumsiness and painful tightness in the hand

and forearm occur during writing or playing, and abnormal tension

and strange posturing of hand develops.  

It has a strong psycological over lay. A patient hearing of the complaints of the patient  & reassuring him of recovery helps him a great deal. Tranqulizers  & anti oxydents give relief.

Local Botulinum toxin injection produces temporary relief.

Retraining and learning new techniques help some patients. But the outlook is poor  in some cases and may lead to the end of musical careers.

Transient Synovitis Or “Irritable Hip”

Transient synovitis of hip usually affects children below the age of 5 years, caused by a fall, un noticd trauma or unaccustomed physical exercise.The child limps, may have slight rise of temperature & be irritable. Affected children are not acutely ill and can

move the hip, but with some degree of stiffness. An effusion may

be seen on ultrasound images and the condition is usually self -

limiting. They respond to non  steroidal anti  inflammatory drugs well.

These children should not be allowed to bear weight on the affected limb for 2-3 wks. as they run the risk of avascular necrosis (AVN)of femoral head later in life.

Septic Arthritis Hip

Septic Arthritis of Hip is relatively uncommon condition in children, but it should be suspected in a child who is ill, toxic and unable to walk. Movement of the affected joint is not possible because of pain. Diagnosis is confirmed by raised white cell count and erythrocyte sedimentation rate(ESR) and perhaps by effusion on ultrasound images. No test is perfectly sensitive or specific, so expert clinical judgement is required.

Urgent surgical drainage should be done to save the hip joint from destruction or to reduce the risk of late osteoarthritis.

Diagnosis may be particularly difficult in neonates.

Staphylococcus aureus  is the usual infective organism.

Patient will need long term antibiotic  therapy.            

Weight bearing should be avided until complete recovery.

Rheumatoid Arthritis

Rheumatoid Arthritis is a self limiting condition. But, by the time it leaves, the patient is crippled due to deformities & contractures & is demoralised.  Medicines help in controlling the pain & inflammation. Physiotherapy maintains join mobility, prevents contractures & deformities & helps in locomotion.

Anyway it may be tried:

Acetaminophen 250 mg TDS X 5 days

Bio D3 Max  1 tab OD X 10 days

Keep your moral up.

God bless you.

Commonly used drugs in rheumatoid Arthritis are

1.    HCQS (IPCA lab)200/300/400mg tabs OD/ BD

2.    FOLITRAX tabs (IPCA lab) methotraxate  2.5,/5.0,/ 7.5,/ 10.0,/ 15.0, mg tabs. Weekly dose

3.    SAAZ tabs (IPCA lab) 500/1000mg tabs.OD

4.     LEFNO lefunomide (IPCA lab)20.0,10.0mg tabs.ODdose.

These are all effective but toxic drugs. They should be taken under close medical supervision. Their doses need to be monitored from time to time. They can cause bone marrow depression & affect other organs adversely. LFT , KFT  & other investigative procedures may have to be under taken repeatedly.

Many of the anti Rheumatoid drugs (DMRD) have teratogenic effect i.e. they affect the unborn baby adversely. You must discuss it with your treating doctor in detail.

Raynaud’s Phenomenon

It results from severe vasospasm in response to

a temperature change, causes marked and typically sharply demarcated pallor of one or more digits. As circulation recovers, the digit becomes blue (cyanotic) and then bright red because of rebound

hyperaemia — the triphasic response. Raynaud ’s is commoner in

females than males. In young women the condition is often a harm less nuisance, requiring warm gloves and sometimes vasodilators.

Its onset for the first time in older people warrants investigation.

Raynaud ’s may also be part of a systemic autoimmune disorder

(rheumatoid arthritis, systemic lupus erythematosus, or systemic

sclerosis), and it occasionally leads to necrosis. When associated with rheumatoid disease, Raynaud’s can be extremely severe and requires specialist referral. It can also occur in people who use vibrating tools. Roughly two out of  three patients with primary Raynaud ’s phenomenon have spontaneous resolution of their symptoms (Spencer - Green, 1998).

Mallet Finger

This is a flexion deformity affecting the distal interphalangeal joint

of the finger and is due to either distal extensor tendon rupture or

avulsion with a bony fragment after traumatic forced flexion of the

extended finger tip. The resultant weakness is often painless and

presents with an inability to actively extend the fingertip.

Non traumatic mallet finger occurs more often in diabetics.

Treatment is usually by splinting the distal interphalangeal joint in extension

Surgery is rarely required.

Ganglion

A ganglion is a cystic swelling in continuity with a joint capsule or tendon sheath. It is a degenerative disorder  arising from the joint capsule. It is filled with clear, viscous fluid. Ganglia are common on the dorsum of  wrist.

They are often painless and resolve spontaneously

Often, only reassurance of the patient is required.

Wrist splints relieve the pain.

Aspiration and injection are rarely effective.

surgical excision is best avoided as recurrance rate after surgery is quite high.

De Quervain’s Disease

It is a painful condition of wrist.Pain is at the lower end of the wrist at the root of the thumb.Wrist movements become painful  particularly when rotation with fore is required eg. Opening & closing of a water tap or squeezing or wringing of clothes.

There may be swelling at the lower end of radius which is painful to touch.

Some times it appears during third trimester of pregnancy , but settles down of its own after delivery.

De Quervain’s stenosing tenosynovitis affects the tendon sheath of

abductor pollicis longus and extensor pollicis brevis at the radial

styloid process.  

 Tenderness & swelling  at the wrist are suggestive, but Finkelstein’s test   diagnostic. ( Ask the patient to close wrist with thumb in palm,give a sudden ulner jerk to the wrist,patient stands up with pain)

  Crepitus or a tendon nodulemay cause triggering.

Management   — Rest is essential, with avoidance

of thumb extension and pinching. Immobilization splints help, but are

are inconvenient.

Anti inflamatory drugs along with antioxidents gives relief.

Physiotherapy including wax bath, US. IFT & remideal exercises help.

Injection of steroid with local anesthetic give immidiate relief.It is better avoided,as the long term effects of steroids are not desirable.

Rarely surgical release of the tendons may have to under taken.

Carpal Tunnel Syndrome

Carpal tunnel syndrome is characterised by pain, burning / tingling sensation, numbness at the wrist, palm, thumb, index, middle & adjoining half of ring finger. It is caused by entrapment of the median nerve in a tunnel, called Carpal tunnel. Entrapment is caused by the inflammation of the synovial sheath covering flexor tendons at the wrist.

Pain, tingling and numbness in fingers are typically present on waking up or can wake the patient.

The fingers feel swollen and intense aching is felt in the forearm.

The symptoms may appear when the patient holds a newspaper

Or the steering wheel of a car or holding objects in kitchen. Permanent numbness and wasting of the thinnear eminence cause clumsiness of movements. It may lead to depression.

Sometimes it is seen in the third trimester of pregnancy which settles down of its own after delivery.

Tests and investigations — tapping the median nerve in

The carpal tunnel or holding the wrist in forced

Flexion may provoke symptoms.

 Weakness of grip of hand is also suggestive of the condition.

 The carpal tunnel syndrome can be confirmed by US, MRI & CT scan. But they are usually not needed.

Management and injection technique — A splint worn on the wrist

at night relieves or reduces the symptoms of carpal tunnel syndrome.

This is diagnostic and may be curative.

Anti inflammatory & neurotropic drugs help in recovery.

 A corticosteroid injection into the carpal tunnel may also be considered,

This often helps rapidly, although recurrence is common.

Surgical decompression of the median nerve is usually a permanent solution.

TRIGGER THUMB

(Syn. Stenozing Tenosynovitis of Flelexor Pollicis Longus Tendon)

Trigger Thumb is a painful clinical condition in which the terminal phalanx if the thumb gets locked in a state of flexion. Sometimes it is bilateral i.e. involving both hands. Big toes of the feet are usually not involved. The condition at some stage may become painless. It is more common in diabetics.

Trigger thumb is caused as a result of inflammation of the tunnel of the thumb in which the (Flelexor Pollicis Longus) tendon moves. As a result the tunnel gets narrowed, usually at the metacarpo phalangeal joint and arrests the gliding movement of the tendon. Sometimes there is a nodule formation in the tendon at the same place producing obstruction to the tendon movement.

Treatment

Non steroid anti inflammatory drugs help in reducing pain and swelling. Physiotherapy helps in regaining movements of the joint. Sometimes in local infiltration with steroids gives relief. However long term effects of steroids are not desirable.

Surgical Treatment if the medical treatment does not succeed, then surgical release of the tendon should be undertaken. It a one stitch surgery which can be done under local anesthesia with constantly good results.

Congenital Trigger Thumb some children are born with it. The congenital variety is usually bilateral. In these cases the treatment is surgical only. It should be done early otherwise the terminal phalanx of the child will not grow and remain small in size.