This Is MS Multiple Sclerosis Knowledge & Support Community

I've managed to set a new record in the hand surgeon's eyes: I have trigger finger in all ten digits! He knows I have MS, obviously, and is also aware of my many lesions on both my spinal column and brain. I've done the steroid shots in my knuckles (as fun as you might imagine) and things got better for a month and then they went back to the way it was before: pain, but not the classic trigger finger delay in extending the fingers.

The surgeon says surgery is the next step. The surgery sounds like its no big deal but I'd like to make sure I've explored all options before we go forward. MS has to be playing a role in this, right? Could MS be causing the inflammation causing the trigger finger? If so, is there anything I can do about it? My neurologist's take, FWIW, is that it's probably MS and I should take a bunch of gabapentin.

I keep reading about different nutrition regimens, all of which are gluten-free. I really, really don't want to give up gluten, but if it helps I will.

It seems like the vast majority of people with MS have leg/foot/walking problems so I'm having quite a bit of trouble finding anything on hand problems.

Christine

I had hand weakness/sensory issues following an acute attack about four years ago. The link below (I don't make any money off this) is for hand exercisers that worked wonders for me. Overall, I've found working out to be my best treatment plan. Best of luck.

http://www.prohands.net/products/

Patients with MS have an association with Ehlers-Danlos syndrome.

Ehlers-Danlos syndrome (EDS) is a group of connective tissue disorders caused by a defect in the synthesis of collagen (Type I or III). In the following study published in Multiple Sclerosis the researchers found a 10-11 time increased prevalence of EDS in MS patients. The researchers concluded that this association may be due to a possible causal relationship on a connective tissue level.

Ehlers-Danlos syndrome and multiple sclerosis: a possible association.
Vilisaar J, Harikrishnan S, Suri M, Constantinescu CS. 2008. Mult Scler. 4(4):567-70. doi: 10.1177/1352458507083187. Epub 2008 Jan 21.

“…Here we present an association of EDS with multiple sclerosis (MS)…This frequency suggests 10-11 times increased prevalence of EDS in MS patients compared with the general population…Suggested implications include a possible causal relationship on a connective tissue level with a higher susceptibility to MS in EDS…”



In the following study the researchers discuss the association between Ehlers-Danlos and trigger finger.

http://www.google.com/url?sa=t&rct=j&q= ... nhe5Gia5yw


Here is a quote from the study.

"Recent evidence suggests that a defect in type V collagen synthesis is causally linked to the
classic type of EDS.9 Type I collagen is the most abundant of total body collagen, and it is found in
fibrous connective tissues such as tendons. Type V collagen can stabilize type I collagen by coassembling with it. Defects in type V collagen synthesis produce grossly deformed collagen fibrils. Electron microscopy studies of collagen in EDS have detected abnormally thickened type I fibrils associated with a high degree of variability in width and shape, as well as spirals and
fragments.

Tissues cannot withstand even normal stresses in patients with collagen diseases.11 Patients with EDS are thus prone to developing tendon injury.8 Decreased collagen cross-linking leads to weaker tendon tissue that elongates more rapidly with force application.These tendons become fatigued after overuse and lose their basal reparative ability. Repetitive microtrauma will overwhelm the ability of the tendon cells to repair the fiber damage.3,12 Further microtrauma weakens the
collagen cross-linking, noncollagenous matrix, and microvasculature of the tendon.3,12 This leads to decreased blood flow, and further tendon activity results in local tissue hypoxia and impaired nutrition and energy metabolism-In our patient, tendon degeneration with fibrillation
of tendon fibers was believed to be the cause of triggering."


Patients with MS have elevated levels of an amino acid called homocysteine. Homocysteine has been shown to interfere with the formation of collagen. In the following study published in The Journal of Clinical Investigation the researchers stated, “It is concluded that homocysteine interferes with the formation of intermolecular cross-links that help stabilize the collagen macromolecular network.”

A collagen defect in homocystinuria.
Kang AH, Trelstad RL. 1973. J Clin Invest 52(10):2571-8.

“It is concluded that homocysteine interferes with the formation of intermolecular cross-links that help stabilize the collagen macromolecular network."


Under the thread "Some Interesting Connections" I discuss the reason for the elevated levels of homocysteine in MS.

Huh, that is extremely intriguing! Thanks.