Trigger Finger

Trigger finger or also called the stenosing tenosynovitis is a medical condition in which a finger is stuck in a bent position. The finger can suddenly snap straight or bend drastically, imitating the pulling and releasing of a trigger.

A trigger finger occurs because of inflammation in the finger, which reduces within the sheath, surrounding the tendon of the concerned finger. The condition can be easily treated; however, if the problem is intense, it can lead the finger to become locked in a bent position for a lifetime.

People who are engaged in professions or have hobbies that require them to perform repetitive gripping actions are more prone to developing this condition. A trigger finger is very common in women and people with diabetes. The type of treatment varies per the severity of the condition.

Symptoms of trigger finger

Depending on the case, the symptoms of a trigger finger can range from mild to severe. Some common signs of a trigger finger include:

  • Stiffness in the fingers, especially in the morning after waking up
  • A pop or a click sound or sensation upon the movement of the finger
  • Tenderness at the base of the affected finger
  • A bump in the palm – at the base of the impacted finger
  • Unable to straighten a finger, which is locked in a bent position

Trigger finger can impact any of the five fingers of the hand, including the thumb. Also, it can affect more than one finger at a time and could also include both hands. The condition is usually very severe in the morning hours, typically while attempting to grasp an object or straightening the affected finger.

A person should seek immediate medical attention if the finger feels too hot or is inflamed. This could also indicate a possible infection.

Causes of trigger finger

Tendons of the fingers are cords that link the muscle of the fingers to the bones. Each tendon is covered by a protective layer, known as a sheath. A trigger finger occurs when this protective layer of the tendon is inflamed or irritated due to any reason. The problem disturbs the usual gliding of the tendon through the sheath and tends to cause pain, bending of the finger, stiffness, etc.

If the problem persists for a long period, it can lead to scarring, thickening, and development of bumps in the tendon, which will further aggravate the issue.

Risk factors of trigger finger

Some people are at a higher risk of developing trigger finger condition. However, the problem can occur in people of all ages and gender. Some risk factors include:

  • Occupations and hobbies that require regular gripping, repeated use of hands, and extensive pressure on the fingers can increase the chances of the person developing a trigger finger.
  • Trigger finger is a common issue in women. Men are less prone to this medical condition.
  • Trigger finger can also occur as a complication of the carpal tunnel syndrome surgery, especially in the first six months post the surgery.
  • People suffering from rheumatoid arthritis are at a higher risk of developing the issue.

Diagnosis of trigger finger

The doctor does not need extensive testing or diagnostic exams to detect a trigger finger. The healthcare provider can conduct an assessment based on the medical history and the physical exam. In the physical exam, the patient would be required to move the finger, bend and straighten the affected joint to identify areas of pain, the stiffness, smoothness in movements and the existence of locking.

The doctor will also apply pressure on the palm to check for a lump. If there is a lump present in the palm, it will move along with the finger since it develops in the swollen area of the tendon.

Treatment of trigger finger

Trigger finger can be easily treated provided it receives the care in due time. The type of treatment depends on the severity and duration of the problem. Some methods used to treat trigger finger include:

Therapy: Non-invasive method such as therapy can be used to treat the trigger finger condition. These include:

  • Resting the affected area and avoiding activities that involve repeated gripping, grasping or extended use of machinery that sends out vibrations.
  • The doctor can also advise wearing a splint to support the affected finger to stay in an extended position for six weeks.
  • Exercising as suggested by the doctor to restore mobility of the finger.

Steroid injection: This involves treating the affected finger or the tendon directly withsteroid medication to minimize swelling, allowing the tendon to glide smoothly like before. However, this treatment lasts for one year or slightly more in some cases. After which, a repeat procedure may be required if symptoms appear again. In the case of people with diabetes, steroid injections are not that useful.

Percutaneous release: In this method of treatment, the doctor numbs the affected palm and then inserts a strong needle into the tissue surrounding the tendon of the affected finger. The doctor then moves the finger and the needle to remove the blockage that constricts the smooth gliding of the tendon. This procedure is performed under the ultrasound guidance to help reach the right tendon, without harming the surrounding tendon sheaths.

Surgery: In most severe cases of tendon finger, the doctor can also recommend surgery to treat the condition. In this, the healthcare provider makes a small incision at the base of the affected finger to open the affected area of the tendon sheath. The constricted part is then relieved, allowing the tendon to glide smoothly.

Overall, a trigger finger is an uncommon condition but can be treated easily, if it occurs. Only in very severe and rare cases, does a patient need an invasive method such as surgery.

Carpal Tunnel Syndrome

Carpal tunnel syndrome is a medical condition caused because of compression of the median nerve in the hand. This median nerve is located on the palm side, called the carpal tunnel, and is basically responsible for delivering sensation to the thumb, index finger, long finger, and a portion of the ring finger. The median nerve provides an impulse to the muscles leading to the thumb. Since the syndrome affects the carpal tunnel (palm), it is referred to as carpal tunnel syndrome.

The problem can affect both hands. It can lead to swelling in the wrists which can further cause compression in the carpal tunnel. The problem causes weakness, numbness, and tingling on the part on the side of the thumb.

Causes of carpal tunnel syndrome

Excessive pressure on the wrist or the carpal tunnel can cause pain in the affected area. The inflammation can lead to swelling. It typically occurs due to an underlying condition, which causes swelling in the wrist, and also restricts the blood flow. Some common medical conditions that could potentially lead to a carpal tunnel syndrome include:

  • High blood glucose levels
  • Thyroid dysfunction
  • Retention of fluid due to pregnancy or menopause
  • High blood pressure
  • Autoimmune issues
  • Trauma or injury to the wrist
  • Fracture of the wrist

The condition can worsen if the patient does not seek treatment and continues to extend the wrist repeatedly. Recurring wrist motions cause swelling and compression of the median nerve due to the below causes:

  • Incorrect positioning of the wrists while using keyboards and mouse
  • Extended contact with vibrations from hand and power tools
  • Particular repeated motions that overextend the wrist, such as playing the piano, typing on the laptop, etc.

Risk of carpal tunnel syndrome

Some aspects that put a person more at risk for developing this syndrome than others, include:

  • Gender; women are three times more prone to this issue than men
  • Men and women between the ages of 30-60 years
  • Specific medical conditions, such as high blood pressure, arthritis, diabetes, etc.
  • Lifestyle aspects such as smoking, laidback physical attitude, high body mass index (BMI), high salt intake, etc.


  • occupations, including manufacturing jobs, assembly link work, construction work, and other professions that require excessive keyboard usage

Symptoms of carpal tunnel syndrome

The symptoms of carpal tunnel syndrome tend to appear in the nerve path due to the compression of the median nerve. Some common symptoms that can point towards a possible problem include:

  • Frequent sleeping of the hand and losing control of motion
  • Pain and numbness that moves up the arm
  • Wrist pain which hampers sleep at night
  • Weakened muscles of the hand

Diagnosis of carpal tunnel syndrome

A doctor can use all or any of these methods to diagnose carpal tunnel syndrome in a patient. These include:

  • A physical examination by extending pressure on the impacted area and checking the pain in different motions. The doctor will assess any signs of swelling, deformity, etc.
  • Medical history of the patient
  • Nerve conduction studies

In a general physical exam, the doctor checks the neck, wrist, shoulder, etc to detect any other reason for the pressure caused on the nerve. The doctor will also check the strength of the hand muscles and sensations to the fingers.

On the other hand, in a nerve study, the test provides a measurement of the conduction speed of the nerve impulses. If the nerve impulse moves slower than normal, the person may have carpal tunnel syndrome.

Treatment of carpal tunnel syndrome

The type of treatment for this condition depends on the pain and symptoms, as well as the intensity of weakness. In most cases, the condition can be treated with non-invasive techniques such as below:

  • Avoiding overextending the wrists in positions
  • Wearing wrist splints that help the hand to stay in place, even at night
  • Taking pain-relieving medication
  • Taking medications to reduce swelling
  • Treating underlying conditions such as diabetes, high blood pressure, etc.
  • Taking steroid injections in the carpal tunnel area to minimize swelling

On the other hand, surgery may be required if there is serious damage to the median nerve. The surgery to treat carpal tunnel syndrome involves removing the tissue band that crosses the median nerve to reduce the pressure on the nerve. However, the effectiveness of carpal tunnel syndrome surgery depends on the duration of the symptom, intensity of the problem, diabetes mellitus, weakness in the area, etc.

In the long-term, treating carpal tunnel syndrome with lifestyle modifications and therapy can provide relief from pain and even improve long-term symptoms. However, if the condition is left untreated, it can cause permanent nerve damage, disability, and loss of hand function.



A brain tumour is characterized by an abnormal mass or growth of cells in the brain. While some tumours may be benign and non-cancerous, there are others which are significantly malignant and cancerous. Basically, there are two types of brain tumours – one that originates in the brain and are called primary tumours; and second are the ones that begin in any other part of the body but spread to the brain – these types of tumours are called secondary metastatic brain tumours. However, the intensity of the condition depends on the type of tumour, the location and the rate of growth. These options also determine the course of treatment for a brain tumour.

Diagnosis of Brain Tumour

Based on symptoms per case, the doctor might suggest a few diagnostic procedures to study the conditions. The diagnosis methods for brain tumour include:

  • Neurological exam
  • Imaging tests
  • CT or PET scan
  • Biopsy
  • MRI scanning

Post diagnosis, depending on the size, location and growth of the tumour – the doctor will suggest a treatment method including surgery, radiation therapy, radiosurgery, chemotherapy and targeted drug therapy. However, in most cases, surgery is the primary mode of treatment of brain tumour.

Brain Tumour Surgery

A brain tumour surgery might appear as a frightening procedure, but it is the most effective method to treat brain tumours while causing minimal damage. Brain tumour surgery is primarily used in treating malign tumours and in the case of malignant tumours – are used in combination with other treatment options such as radiation and chemotherapy. The basic goals of brain tumour surgery include:

  • Remove all or most of the tumour
  • Relieve symptoms caused by the tumour and enhance the quality of life
  • Relieve the intracranial pressure created by the tumour
  • Remove a part of the tumour to slow the growth
  • Drain any build-up of fluid in the brain
  • Make other treatments such as chemotherapy accessible
  • Help diagnose a brain tumour

The type of surgery and surgical method varies per case. However, brain tumour surgery is performed only when the tumour is located in a place which is accessible easily. The basic surgery is performed to remove as much of the tumour as possible and relieve symptoms. This type of brain tumour surgery is called Craniotomy. ‘Crani’ implying skull and ‘otomy’ meaning cutting into; therefore a craniotomy involves cutting into the skull to remove the tumour.

The doctor will perform several tests before the surgery and would restrict all non-steroidal anti-inflammatory medicines, as well as blood thinners. Other lifestyle habits such as tobacco, alcohol, smoking, etc. also will be restricted. During the night before the surgery, the patient is asked to avoid eating or drinking anything.

A craniotomy is performed while keeping the patient under the influence of general anaesthesia. Then a portion of the scalp is shaved to make an incision to enter the skull and remove a piece of bone to access the area of the brain over the tumour. The surgeon opens the outermost layer of the brain tissue, locates the tumour and then removes/resects it. Once, the tumour is removed, the surgeon replaces the part of the brain or bone; this is called a flap which is secured with small metal brackets. Once, this is replaced, the surgeon stitches the scalp.

In a conventional craniotomy, the surgeon relied on pre-operative scans and their knowledge of anatomy to locate and treat the tumour. However, in stereotactic surgery, the surgeon relies on a computer to locate the tumour and guide them to it. A craniotomy involves using different tools to remove the tumour, such as:

  • A scalpel
  • An ultrasound to shrink the size of the tumour and then remove it through a suction process
  • A microscope to differentiate between healthy cells and tumour
  • A blue fluorescent light which enables the surgeon to clearly see the edges of the tumour

Craniotomies differ in size and complexity. In some cases, the surgeon may perform an awake craniotomy where the lesion is very close to a critical area of the brain such as speech. In this surgery, the patient is asleep till the bone opening but is awakened later to help the surgeon precisely map areas of risk. The patient is asked to read, talk or move a part of the body, while a probe is placed on the brain surface to detect the area correctly. This process is also called, Brain Mapping and helps to identify sensitive areas of the brain which need to be avoided and protected.

In some cases, the tumours are small and thus, can be easily removed from the brain tissue. But in many other cases, it is very difficult to separate the tumour from the surrounding tissue or they tend to be located in sensitive areas of the brain – which makes the surgery risky and complicated. In the latter case, the surgeon aims to remove as much a part of the tumour which is not risky and is relatively safe. Even removing a portion of the brain tumour helps to relieve symptoms. However, like other surgeries, even brain tumour surgery has risks associated with it.

Risks of a Brain Tumour Surgery

Some of the common risks linked to brain surgery, specifically a craniotomy include:

  • Bleeding
  • Infection
  • Blood clots
  • Anaesthesia reactions
  • Stroke
  • Seizures
  • Swelling of the brain
  • Nerve damage
  • CSF leak
  • Loss of some mental functions

Overall, a brain tumour surgery is highly effective and often the primary course of treatment; though the recovery period may extend up to 8 weeks with several follow-up appointments.

Demystifying the social stigma – epilepsy is a ‘disease’ and ‘curable’

Demystifying the social stigma – epilepsy is a ‘disease’ and ‘curable’

Let us all burn some ignorance and educate the society and fight against the  age old popular belief that  – epilepsy is not  curable. Today it has been established epilepsy is curable if addressed properly.  A dark spell of ignorance has been prevalent among both literate and illiterate segment of the society that epilepsy is non-curable and caused by God’s wish or a demon’s negative influence. A strong social stigma, followed by lack of adequate education and awareness has led to the occurrence of such irrational set of beliefs.

Certain facts will demystify the unknown, ushering a new light towards this prejudice. Atleast 70% of epilepsy patients can be cured and drugs can be withdrawn. Although 1/3rd i.e. 33% to 36% of patients can be troublesome, however with continuation of medication for a longer time and interventions of other techniques like surgery, neuro stimulations etc. epilepsy can be curable. Epilepsy is a proper disease, backed by scientific reasons and is very much curable. Epilepsy could be caused by genetic predisposition, however that’s only a very minor proportion of about just 5% to 10%. More than 90% of epilepsy is not caused genetically and results out of head injury, stroke, and lot of other diseases like tuberculosis, infections, and trauma. Infact any disease of the brain can lead to epilepsy.

Scientifically, epilepsy can be coined as a neurological disease bringing some changes in the behaviour of the patient, with or without losing consciousness. Epilepsy is a repetitive process, hence again being named epilepsy. There are several forms of epilepsy. A common type of epilepsy is loss of consciousness and shaking of legs and hands which is called atonic epilepsy. And sometimes there is manifestation of biting tongue and involuntary passage of urine and stool even in the presence of consciousness. This is the commonest of all types. Shaking of one part of the body, either hands or legs and twitching of facial muscles in the presence of consciousness can also be witnessed. It may also happen that patients become transiently unresponsive for some seconds and minutes and regains consciousness after a point. Another type is cessation of ongoing activities, for example, a child who is writing, suddenly stops and again re-starts.

Epilepsy in today’s date is more hyped by social stigma than its actual severity. In our society if anyone suffers from epilepsy, then without consulting a doctor it is brushed under the carpet. Especially there is suppression of the news if a woman suffers from epilepsy in the fear of immense difficulty in marriage. Experts have opined that epilepsy is a proper curable disease just like any other disease and there is nothing to get ashamed of. His key messaging says, “not only the doctors, it is an equal responsibility of social workers as well to drive enough education, awareness and demonstration behind the scientific mechanism of the illness. There is no genuine reason to create such a hue and cry and taboo around it’’

Management of stroke at CMRI

Management of stroke  at CMRI

Facility of Stroke in CMRI

After a stroke has occurred, the first 20 minutes are crucial in maximizing the patient’s chances of survival. The Calcutta Medical Research Institute or CMRI in Kolkata completely understands the gravity of this situation. With comprehensive, state of the art neurological facilities, CMRI is one of the best in the country when it comes to treating a stroke. The stroke unit at CMRI specializes in the fields of spine and brain surgery to give patients the best possible care.

CMRI’s Stroke Clinic includes, among other things, a dedicated thrombolysis facility. Thrombolysis is how major blood clots, which cause Ischemic Strokes, are dissolved to prevent or minimize damage to organs, muscles, and tissue. Additionally, the Neuro Intensive Care Unit at CMRI has the most specialized care for those who have suffered serious issues with the brain. Rather than a general ICU, the Neuro Intensive Care Unit is specifically catered to neurological emergencies, including a stroke, so that a patient can be assured of accurate and timely treatment and care.

Also available, as part of the facility, are Stroke and TIA Clinics, crucial in the after-care of strokes. A TIA, or a Transient Ischemic Attack, is a form of mini-stroke that lasts for significantly less time, but exhibits similar symptoms. Treating these TIAs early is crucial in preventing a stroke, which has more lasting consequences. CMRI’s specialized team is able to identify these symptoms and treat them early to prevent major mishaps from any neurological issues.


  • What are some tell-tale signs that someone is suffering a stroke?

Unless a medical professional is present at the scene, accurately spotting the symptoms of a stroke may be difficult. However, there are some signs a family member, relative or bystanders can look out for. The victim of a stroke may feel suddenly lightheaded and weak, have difficulty standing or seeing, and lose balance and coordination. They may also have issues with their vision and severe headaches.

Typically, spotting the symptoms of a stroke follows the FAST rule. The acronym refers to Facial Drooping, Arm weakness, Speech being slurred, and after which it is Time to call for help.

  • What are the types of strokes that can occur?

There are two main types of stroke that may occur- Ischemic Stroke and Hemorrhagic Stroke. While in an Ischemic Stroke, a blood vessel supplying blood to the brain is blocked, in a Hemorrhagic Stroke, which is more dangerous, there is bleeding in and around the brain due to a blood vessel bursting. It is estimated that the vast majority of strokes – around 87% – are Ischemic.

  • What is the recovery time from a stroke?

The recovery from a stroke can vary widely depending on its seriousness, the age of the victim, and more. There may also be some complications they may have suffered, which can lengthen the recovery process. The majority of recovery from any stroke happens in 6 months to a year after the stroke has occurred.

  • How are strokes treated?

In the immediate aftermath of suffering a stroke, patients are given medication to remove blood clots, surgery, and radiology, while those suffering a Hemorrhagic Stroke may need immediate surgery. Following the immediate risk, however, there is also a lengthy rehabilitation process for those who have survived a stroke.

  • Are some people more at risk than others?

Yes. Those with very stressful lifestyles are at risk for a stroke. High blood pressure, smoking, diabetes, and sedentary lifestyles, which can lead to obesity, are also contributing factors for a stroke. Diabetes and other medical issues, which lead to strokes, can be managed early to prevent the same.

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