Release of trigger finger

Trigger finger is a painful condition in which a finger or thumb clicks or locks as it is bent towards the palm.

Symptoms

Pain at the site of triggering in the palm (fingers) or on the palm surface of the thumb at the middle joint, usually in a person over the age of 40.
Tenderness if you press on the site of pain.
Clicking of the digit during movement, or locking in a bent position, often worse on waking in the morning. The digit may need to be straightened with pressure from the opposite hand.
Stiffness, especially in trigger thumb where movement at the end joint is reduced.

Cause

Thickening of the mouth of a tendon tunnel leads to roughness of the tendon surface, and the tendon then catches in the tunnel mouth. People with insulin-dependent diabetes are especially prone to triggering, but most trigger digits occur in people without diabetes. Triggering occasionally appears to start after an injury such as a knock on the hand.

Treatment

Trigger finger and trigger thumb are not harmful but can be a really painful nuisance. Some mild cases recover over a few weeks without treatment. The options for treatment are:

Avoiding activities that cause pain, if possible
Using a small splint to hold the finger or thumb straight at night. A splint can be fitted by a hand therapist, but even a lollipop stick held on with tape can be used as a temporary splint. Holding the finger straight at night keeps the roughened segment of tendon in the tunnel and makes it smoother.
Steroid injection relieves the pain and triggering in about 70% of cases, but the success rate is lower in people with diabetes. The risks of injection are small, but it very occasionally causes some thinning or colour change in the skin at the site of injection. Improvement may occur within a few days of injection, but may take several weeks. A second injection is sometimes helpful, but surgery may be needed if triggering persists.
Percutaneous trigger finger release with a needle. Some surgeons prefer to release the tight mouth of the tunnel using a needle inserted under a local anesthetic injection, but others feel that open surgery is more effective. The needle method is not suitable for all cases and all digits.
Surgical decompression of the tendon tunnel. The anesthetic may be local (injected under the skin at the site of operation) regional (injected in the armpit to numb the entire arm) or a general anesthetic. The wound will require a small dressing for 10-14 days, but light use of the hand is possible from the day of surgery and active use of the digit will aid the recovery of movement. Pain relief is usually rapid. Although the scar may be red and tender for several weeks, it is seldom troublesome in the longer term. Recurrence of triggering after surgery is uncommon.

Frequently Asked Questions

Q: What would happen in the long run if I receive no treatment?

A:
If the trigger finger is not released surgically, then the involved finger(s) will progressively become more rigid and contracted and eventually, the patient will not be able to extend the finger at all. If many fingers are involved, loss of function of the entire hand may occur.

Q: What are the possible complications of surgery?

A:

Infection: any operation can be followed by infection which can be treated with antibiotics.

Scar: you will have a scar that will be somewhat firm to touch and tender for six to eight weeks.

Stiffness: can occur if the hand is not used and exercised after the operation. This is usually very temporary and can be treated with exercise given by the hand therapist.

Nerve damage: can occur during your surgery which results in either a painful spot in the scar or some loss of feeling in the hand. This complication is very rare but may require a further operation to correct.

Blood vessel injury: damage to the blood vessel can occur during surgery as the blood vessel lies close to the thickened ligament. Damage to the vessel is very rare and can be immediately repaired.

Pain: ongoing discomfort is rare, but possible, following any surgery in the hand.

Loss of function: you will have a temporary loss of function and things will be a little more difficult to do following surgery while the dressings are in place. In rare cases there may be a permanent loss of function.

Q: What should I look out for at home after surgery?

A:

Dizziness and tiredness: if you have had a general anaesthetic you might feel dizzy and tired when you go home after the operation. Please rest for the remainder of the day and the following day to help you recover from the general anaesthetic. For more information, see our leaflet Having an anaesthetic. The anaesthetic will take up to 24 hours to wear off. You do not need to stay in bed. Gently moving around your home will help your blood circulation and help to prevent blood clots.

Swelling: you can help to prevent or reduce swelling in your fingers by placing your arm on a couple of pillows when you are sitting or resting. You will also be given a sling. Wear this when you are not seated or resting.

Dressing: you will have a padded dressing over your wound. You may also have a partial plaster cast that will prevent you from moving your wrist. You will be told on the day of your surgery when that will be removed. Your surgeon will decide the amount of time the dressing should remain in place. Often it must remain in place for at least one week. You will most likely have stitches in your hand or wrist. Those are usually removed within 10 – 13 days. Please do not let your hand get wet. If necessary, cover it with a plastic bag tied at the wrist or a large rubber glove.

Follow up appointments: You will be given a follow-up appointment to have your dressings and stitches removed, which will either be with the plastics dressings nurses or with hand therapy. Your surgeon may recommend that you attend hand therapy for a splint or exercises. You will also have a followup appointment scheduled with the surgeon. These appointments will be given to you before you leave the hospital on the day of your surgery. If we are unable to schedule any of the appointments that day, we will send you details of the appointment by letter.

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Hand Surgery