Digital nerve entrapment in the finger

 

I have developed a peripheral nerve problem as I move to retirement – it sort of doesn’t seem fair!

I was fishing during the Christmas break and I caught a wrasse or “rock cod” as we call them.

Wrasses can be beautifully coloured, but this one was rather dull, even ugly and we know they are inedible. As I was releasing the fish, a dorsal fin punctured my ring finger on the lateral side of the proximal interphalangeal joint. It bled profusely and really hurt at the time.  Over the  next few weeks it was clear that something had happened to  the digital branch of the median nerve in my ring finger.

Such a tiny nerve but a real pain!

I have no trouble moving and stretching my hand but if I do it with the elbow extended and particularly with my shoulder elevated or shoulder girdle depressed, it really ‘zaps’.  If I swim freestyle, dive into a pool, wave, pick up something off the floor, or weight bear on an extended wrist, it’s a real nervy twang in the innervation zone.  I found myself using the word ‘jolts’ recently and I thought ‘that can’t be too good!’.  If I palpate the spot where the fin entered, it really zings. I am starting to have a reluctance to do certain movements, though I wouldn’t call it a fear avoidance.

What’s going on in there ?

I am guessing that there is some perineural fibrosis at the fin insertion point – perhaps made more reactive via bacteria on the fin. I am thinking and hoping it can’t be an intraneural problem – nerves can usually slip and ‘get away’ from external forces, plus it didn’t react for two or so weeks.

I have been trying to gradually mobilise it – from repeated anecdotal experiences, I have reasoned that this has helped many people in the past.  Initially this seemed to help but not lately and I am seeking a surgical opinion.

What have I learnt so far from my ‘wrasse finger”

  1. A quick and unforgettable review of the pathway and innervation zone of the digital branch of the median nerve to the ring finger
  2. It really feels like ‘neural tension’ despite me rejecting the term two decades ago.
  3. How quickly language can be generated to understand something, ie from a ‘zap’ to a ‘jolt’
  4. Respect for the usual toughness of nerves – we hit them, squish them on underlying bone, stretch and they usually come up OK.
  5. A reminder of how a minor problem in tiny nerve can alter function.
  6. Order of movement assessment strategies made no difference in this particular situation (ie similar symptoms and range were achieved despite the order of arm movement).
  7. Wear gloves next time

I’ll  let you know how I go

-David Butler

CANBERRA 14 – 15 APRIL EP

WARRNAMBOOL 27 – 29 APRIL EP | GMI

NEWCASTLE 5 – 6 MAY MONIS

BENDIGO 25 – 27 MAY EP | GMI

NOOSAVILLE 15 – 17 JUNE EP | GMI

CAIRNS 10-12 AUGUST EP | GMI

PERTH 7 – 9 SEPTEMBER EP | GMI

PARRAMATTA 5-7 OCTOBER EP | GMI

MILDURA 19 – 21 OCTOBER EP | GMI

MELBOURNE 9 – 11 NOVEMBER EP3 | BUTLER, MOSELEY & PETER O’SULLIVAN

10 Responses to “Digital nerve entrapment in the finger”

  1. Jan Fisher

    Sorry to hear this. If you have some level of pain or discomfort or are just aware all the time that there is a problem then might sound mad but suggest a trial of mirror therapy. If it gets rid of the problem But it returns then you know there is underlying pathology. If it works then you have saved some more invasive treatment. If not then you have only lost a little time. Suggest a little and often eg beginning at 20 seconds. Hope all is well soon.

    Reply
  2. davidbutler0noi

    Hi Jan,
    Many thanks for your your concern and suggestion. I only have pain on stretch or palpation of what I surmise is an ectopic discharge spot. I can palpate a bulge in the nerve at this site. I couldn’t resist having a play with a mirror a few weeks back, but alas – no change at all.

    Best wishes

    David

    Reply
    • Jan Fisher

      Good you gave it a go. The brain has a way of remembering and keeping the pain message. I stopped mouth pain with a mirror but tthe pain kept returning. Had an abscess. Lost a tooth. Sigh. Hope you get some answers soon.

      Reply
  3. davidboltononoi

    Sorry to hear sunshine and I think I know how you feel about it being unfair……Maybe there’s another powerful nugget to add to your list being, the often neglected role of the “issues in the tissues” in persistent pain states. Even very minimal tissue “Unhappiness” can be a main driver in pain and suffering…….

    Reply
  4. davidbutler0noi

    Thanks for the emails and responses. I was about to get an ultrasound with the thought that there may be operable perineural fibrosis when I realised that
    that I was fixed ! Not from repeated and rather specific nerve mobilisation exercises but from a vigorous week of boating and fishing where I was looking after two people, having fun, but really working the arm in context variable and needed postures . Hmmm …never too old to learn!

    David

    Reply
  5. Rana Sunder

    This is a really helpful juxtaposition of a view from the expert/clinician and the client/sufferer!
    I have a similar client who has a similar pain in his finger, however his pain also refers “upstream” to his forearm and spreads to his other fingers- with no initial incident of pain.
    I’d assume my client has some more central processes going on rather than a simple nerve entrapment- thoughts?

    Reply
    • davidbutler0noi

      Hi Rana,

      Sorry I missed this post.

      From that clinical data, I would suspect some enhanced central processes. Although I would consider possible nerve root involvement here.

      Best wishes

      David

      Reply
  6. Oscar

    Hi did you ever get over this?
    If so, how?

    I cut my 4th finger in the same spot with glass and getting the same sudden jolts of pain when I move the finger a certain way or not touch the cut.

    Reply
  7. davidbutler0noi

    Yes Oscar – completely gone and I had forgotten about it until your post!

    As I reported above, it went with time, understanding, little fear, and repeated nerve mobilisation. Presuming have no glass in the site, then it is quite possible it will just go.

    David

    Reply

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