Hand Dr ruled out Carpal Tunnel but suggested possible Trigger Finger

[Gatorchief]

I haven’t been able to get an appointment with a rheumatologist until Feb 2025! I live in a suburb of the largest city in my State and it would seem that there aren’t nearly enough Dr’s to treat autoimmune disease here. I’ve been seeing my PC and orthopedic Dr’s to begin treatment of PMR. This website has been my go to place fore sound advice and practical experience in the absence of professional care.

I had pain beginning to return in my left hand and fingers about 2 hrs before taking my morning does of prednisone so I split the 15mg dose up and took 10mg at 3 am and 5mg at 3pm. This did help a lot and the return pain was much less then before the split. The thing I noticed most was the pain was confined mainly to my two middle fingers. The Dr suggested we inject those fingers with steroid shots and report back in 3 months. I asked him if the injections would be additive to the 15 mg oral prednisone dose that I’m taking? His answer was “it shouldn’t affect it that much.”🤔 this is the first night complete since the shots and the fingers are pain free at my first prednisone dose this morning. I must admit that his answer on my question about the increase in steroid doses from the shots was concerning. Those shots typically last for months (if they work) any my worry is it like taking a 40-60 mg dose of steroids at one time? I’m enjoying being pain free for now but being vague about the Risk/ Benefits aspect does have me concerned. A friend of mine did have trigger finger and as his tendons tightened up he did have to have surgery to treat them. Mine are nowhere near as bad as his were, but which is the culprit ? PMR or Trigger Finger,, or Osteoarthritis in my left hand ? My right hand has very little pain and the hand Dr said I needed to see a Rheumatologist about that.🤣 Sorry about the long post. The 3am dose seems to leave me wide awake for an hour or so.

[DorsetLady PMRGCAuk volunteer]

Many on here have had steroid injections for other health issues whilst still on oral steroids for PMR/GCA without issues. To be honest I doubt you’ll notice much difference - you may feel your PMR is slightly less active for a while - but be rest assured in no way does it feel like taking 60mg oral Pred.

[Gatorchief in reply to DorsetLady]

Thank you so much, I feel so apprehensive about the prednisone as I’m sure it will be some time before I’m able to taper down to 7-5 mg dose. On the other hand without it I wouldn’t be able to get out of bed without help. Amazing drug.

[PMRpro Ambassador]

"Those shots typically last for months "

Not very often!!! The point is that the antiinflammatory effect lasts a lot longer than the steroid remains in your body. All the pred in a single dose is out of your system in about 24 hours - a half life is 2 to 3 hours, that is the time taken for the pred level to halve, effectively all out in 5 1/2 halflives - do the maths! They are particularly good to reduce acute inflammation where there is a load of inflammation causing a problem - it mops it up and hopefully it isn't replaced or it builds up again very slowly.

The longer effect of an injection is when the steroid is injected deep into a muscle and then it releases slowly over a period of about 3 weeks, forming a constant taper with the highest release being on Day 1 and then falling slowly. They can be used to manage PMR and even GCA but management can be a bit tricky as the injections MUST be administered on a timely manner.

[Gatorchief in reply to PMRpro]

So thankful for this explanation! My Hand Dr’s explanation was less then detailed.