How it works: According to Dr. Edwards, stress produces chemicals in the body that increase inflammation. “With relaxation techniques, you have stress reduction and therefore decreased inflammation and less pain,” she says. Meditation also relaxes muscles that tense up with pain. Dr. Edwards suggests meditating for 20 minutes once or twice a day. For moments of acute pain, she also recommends “meditation minutes.” For example, take four to five deep breaths, counting to 10 with each inhalation and exhalation. “Just doing that four to five times a day can decrease depression and improve outlook,” she says.
The scenario listed above points to a diagnosis of trigger finger. In this condition, the disparity in size between the flexor tendon and the surrounding retinacular pulley system, most commonly at the level of the first annular (A1) pulley, results in difficulty flexing or extending the finger and the “triggering” phenomenon. Metacarpophalangeal locking should be included in the differential, where the collateral ligament or volar plate tethers on a prominent metacarpal head or osteophyte.
The referenced text notes that a series of two corticosteroid injections should be given before surgery is considered for A1 pulley release. Mention is also made of the possibility of diabetics being more resistant to injections, with surgical release being a cost-effective treatment for this patient population.
Illustration A shows the clinical appearance of this disorder.
Acne is often present. Acne conglobata is a particularly severe form of acne that can develop during steroid abuse or even after the drug has been discontinued. Infections are a common side effect of steroid abuse because of needle sharing and unsanitary techniques used when injecting the drugs into the skin. These are similar risks to IV drug abusers with increased potential to acquire blood-borne infections such as hepatitis and HIV/AIDS . Skin abscesses may occur at injection sites and may spread to other organs of the body. Endocarditis or an infection of the heart valves is not uncommon.