Trigger Finger Release Surgery

What is Trigger Finger?

Trigger finger is a painful condition where your fingers or thumb lock or `click` when you bend them.

It can affect any finger, although it is mainly found in the little finger, ring finger, or thumb. unfortunately, it can affect more than one finger.

Also known as stenosing tenosynovitis, trigger finger ultimately affects the tendons in hand and when these tendons become swollen or inflamed, it can make the finger or thumb catch, which results in a clicking sensation and difficulty in bending or straightening your fingers and thumb.

Trigger finger is most commonly found in the right hand because more people are found to be right-handed.

Trigger Finger Release causes, treatment and surgery

Getting Technical

Our fingers bend and move freely due to the tendons connecting muscles to the bones of the finger.

Supporting movement, these tendons run along the length of the bone and remain in place by tunnels of ligaments.

There is a fluid-like coating known as tenosynovium, which helps the tendons glide effortlessly through the ligaments reducing friction when fingers are moving.

However, when inflammation or swelling of the tenosynovium occurs, trigger finger/stenosing tenosynovitis/flexor tendonitis is caused, and you will find that the affected finger or thumb will then remain in the bent position.

Unfortunately, your finger or thumb may return to a straightened position, but it will do so with a snap, similar to releasing a trigger on a gun, hence where the name Trigger Finger comes from.

Causes of Trigger Finger

The leading cause of trigger finger occurs when the tendon or tenosynovium becomes inflamed or swollen. Because of this build-up of pressure, the tendon can no longer slide easily through the protective sheath (designed to keep tendons lubricated), so instead, it bunches up and forms a small lump known as a nodule.

This nodule then makes it difficult to bend your finger, or in most cases, it causes a “catching” of the finger where it stays stuck in a bent position, before suddenly realising the finger straight.

Other causes trigger finger can be derived from:

  • Repetitive hand and wrist movements
  • Activities that require prolonged gripping at work or at play (this can often be very high risk depending on the activity and person)

Trigger finger is most commonly found in women and people over 40, as well as found in those with other medical conditions such as rheumatoid arthritis, hypothyroidism, diabetes, and certain infections such as Tuberculosis.

Symptoms of Trigger Finger

  • Pain at the base of the finger or thumb
  • Tender to touch or put pressure on
  • Stiffness in finger or thumb with limited movement
  • Clicking sensation when you move the affected finger or thumb
  • Inflamed tendon nodule
  • Finger locks with the inability to straighten
  • Bent finger suddenly releases and straightens

If the condition persists and remains untreated, your finger can get stuck in a bent position, and then suddenly pop back, as well as eventually doing nothing at all, neither bending or straightening.

Long term complications are also not uncommon where you may find permanent swelling and contracture in the affected digit, as well as the possibility of tearing or rupturing of the tendon completely.

Diagnosis

Initially diagnosed by your GP, trigger finger is based on your medical history as well as a physical examination.

You may also, at this stage, be referred to an orthopaedic hand surgeon like the team at The Manchester Hand Surgeon for a closer examination to evaluate the condition and check the severity of the case.

Treatment

Treatment of trigger finger varies and will depend on the severity of the symptoms and how long you have had the condition.

Non-Surgical Treatments

Non-surgical treatments can provide an effective way of supporting trigger fingers, reducing the symptoms, and in some cases eradicating the problem (in other cases, these treatments can only offer short-term solutions).

Splinting – taping your affected finger or thumb to a plastic splint can help to ease the pain slightly as it helps to reduce the amount of movement in your finger or thumb. As trigger finger tends to be worse in the morning, we may advise you to wear your splint overnight. We would recommend this to a short-term treatment plan.

Treating underlying medical conditions. It may be possible to treat trigger finger by treating other medical conditions, such as diabetes or arthritis initially.

At-home treatments – such as resting the hand and avoiding repetitive gripping actions. Strengthening and stretching exercises may also help and placing ice over the affected digits can help to reduce any swelling or inflammation. We would generally recommend resting for 2 to 4 weeks, and if you are applying ice, to do so 3 to 4 times per day for 5 -15 minutes each time.

Non-steroidal anti-inflammatory drugs and corticosteroid injections – medicines such as ibuprofen can be good at helping to reduce the swelling you experience in your fingers and thumb.  Or you can opt for liquid corticosteroids which are stronger and again help reduce swelling and inflammation.

These liquid corticosteroids are injected into your tendon sheath at the base of the affected digit. These particular injections can be beneficial and reduce the swelling in the tendon enough so that you can move your finger/thumb with ease again. You will begin to feel relief from this medicine a few weeks after the injection.

However, these injections are only effective for 50-70% of people suffering from trigger finger, and they are even less effective for those who have rheumatoid arthritis and diabetes.

In some cases, corticosteroid injections can permanently improve trigger finger; however, what we often find is that the problem does return after a time.

Surgical Treatments

If you find that the non-surgical treatments are failing to help relieve the symptoms or if symptoms persist for six months or more, or your quality of life is adversely affected, we may recommend that you undergo surgery to release the pressure on the tendon.

It is rare for trigger finger to return once surgery has been carried out. However, you will still need a period of rest and recuperation after the operation.

Surgery will typically be carried out under local anaesthetic and is a day surgery taking approximately 20-30 minutes.

Percutaneous trigger finger release surgery

This surgery is a minimally invasive procedure performed under local anaesthesia where we make an incision (about an inch long) at the palm of your hand (or in some cases, a needle can be used at the base of the affected digit, achieving minimal scarring). The surgeon will then slice through the ligament to reach the tendon, releasing the tight portion of the flexor tendon sheath.  The wound is then closed and tidied with stitches and covered with bandages.

Note: for those patients who have rheumatoid arthritis, this surgery may not be suitable as often the finger tends to drift sideways. In such cases, we will recommend a tenosynovectomy procedure that involves removing part of the tendon sheath altogether. Your surgeon will, of course, provide full treatment plans and options suitable to you at your initial appointment.

Post-Operative Care

You should be able to move your thumb or finger immediately after surgery, with dressings usually removed after a few days.

We would expect the full movement to return two weeks after surgery, and any discomfort and pain should settle and pass within a week or two.

Full recovery with no signs of trigger finger is typically found after 3 months.

Driving – this is dependent on you and your recovery. We typically recommend returning to driving 3-5 days after surgery, or when you feel it is safe to do so.

Sports – we recommend returning to sports 2-3 weeks post-surgery. Allowing the wound to heal and your grip to strengthen and return to normal.

Returning to Work – You will be able to write and use a computer immediately; however, returning to work full time will depend on the work you do. We will recommend light manual duties for the first few weeks, with those job roles involving manual labour requiring up to 4 weeks off.

Recovery may be longer if more than one digit has been operated on.

The Manchester Hand Surgeon

At The Manchester Hand Surgeon, we will organise post-surgery appointments to check on the wound and how your finger or thumb is healing after surgery.

Any stitches will be removed at this time, and we will provide you with full details of your aftercare and any specialist hand therapy (physiotherapy and occupational therapy) that may be required.

Tailoring your treatment plan to you.

Children and Trigger Finger

It is not uncommon for children and even babies to be diagnosed with trigger finger. However, as bones and the body are still developing trigger finger in children will most often improve over time.

If the symptoms are severe or persistent however, surgery may be considered under general anaesthetic.

Risks of Surgery

Trigger finger release surgery is one of the safest hand and wrist procedures available. However, with any surgery, there are some risks.

  • These can include:
  • Infection
  • The scar may be tender
  • Stiffness or further pain in the affected digit
  • Nerve damage
  • Tendon bowstringing
  • Pain and swelling in your hand (complex regional pain syndrome)

Your surgeon can discuss all of the risks with you before any surgery takes place.

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