Trigger finger — stenosing tenosynovitis of the flexor tendon — is exactly what it sounds like: a finger that catches or locks as you bend or straighten it, sometimes releasing with a painful snap, sometimes requiring you to manually straighten it with the other hand. It happens when a nodule forms on the flexor tendon and cannot pass smoothly through the fibrous pulley at the base of the finger. Most people spend weeks or months writing it off as a minor nuisance before they come in. By the time they do, the locking is more frequent, the snap is more painful, and the finger is beginning to stay locked for longer stretches.

The thumb is the most commonly affected digit, followed by the ring and middle fingers. It is significantly more common in people with diabetes, rheumatoid arthritis, and in women in the sixth decade of life — but it appears without any of those predisposing factors in people who perform repetitive gripping, including gardeners, construction workers, and fishermen who spend hours working rod handles and lures. Morning is typically the worst time, as the tendon tightens overnight and the first flex of the day meets the most resistance.

Trigger finger is very treatable at every stage, but early treatment is simpler. A corticosteroid injection into the tendon sheath at the A1 pulley resolves the condition completely in a large majority of cases when caught early — among my most reliably effective office procedures. For cases that don't respond, a minor outpatient release of the pulley is curative with an extremely high success rate and a short recovery. The message: do not normalize a finger that catches. It will not resolve on its own.

De Quervain's is a load problem. The two tendons running through the first dorsal compartment of the wrist are under significant tension any time the thumb is abducted — moved away from the hand — especially when that movement is combined with ulnar deviation of the wrist, bending toward the little finger side. That combined position is exactly what happens when you lift a baby by sliding your hands under their arms with thumbs extended, when you hold a phone and scroll, when you grip a fly rod and cast, or when you perform certain repetitive manual tasks for hours at a time. I developed a mild case myself years ago. I know the mechanism from both sides of the examination table.

Prevention comes down to two principles. The first is load management: breaking up repetitive thumb abduction tasks, modifying grip mechanics where possible, and building in recovery time before cumulative irritation crosses the threshold into inflammation. For new parents this is genuinely difficult — the frequency of infant lifting is dictated by the infant, not the parent — but small adjustments like consciously keeping the thumb adducted and close to the hand during lifts rather than extended outward can meaningfully reduce the tendon load.

The second principle is early recognition. De Quervain's responds very well to treatment in the first few weeks. The Finkelstein test we covered last issue is something you can perform on yourself anytime you notice soreness developing on the thumb side of the wrist. A positive result at that early stage, combined with activity modification and a brief period of splinting, can stop the progression before it becomes a chronic problem requiring injection or surgery. The window is real, and it is worth acting in it.

I operate on fishing injuries with enough regularity that they form a recognizable subset of my practice, particularly in the warmer months along the Carolina coast. The spectrum runs from hook-through-finger injuries — which arrive looking dramatic but are usually straightforward if handled correctly — to more consequential trauma from falls on boat decks and docks, lacerations from fish handling, and overuse injuries of the wrist and forearm from extended casting sessions. What unites almost all of them is that they were foreseeable, and most were preventable with modest changes in technique, equipment, or habit.

Hook injuries deserve specific mention because field management is almost universally wrong. The instinct is to pull back out the way the hook entered. For a barbed hook, that approach causes more tissue damage than advancing through the skin, removing the barb, and backing it out. The string-yank technique — looping a line around the bend of the hook, pressing down on the shank, and snapping sharply parallel to the skin — works reliably for embedded hooks that have not cleared the barb. These are worth knowing before you need them, not after.

For the Alaska trip, the fishing environments span saltwater deck fishing in Resurrection Bay and fly fishing on remote rivers — two completely different risk profiles. Deck fishing means wet surfaces, lines underfoot, and the demands of managing large fish. River fishing means current, unstable footing, and the specific wrist loading pattern of extended fly casting that I mentioned in the De Quervain's discussion this week. Planning for both means thinking about grip protection, footing, and the capacity to manage an injury far from immediate medical care. More on that in the weeks ahead.