Trigger finger and thumb release

What is trigger finger?

The flexor tendons to the fingers and thumb pass through tunnels on the front of the digits. The tendon fits perfectly inside this tunnel and, if it develops any irregularity, it tends to catch and snag in the tunnel.

Initially, this is experienced as a click or flick of the digit (hence 'trigger' finger) but in more advanced cases, the finger may lock in flexion (bent) and may need to be pushed back to a straight position. This is often painful.
Triggering may be associated with arthritis, may follow surgery to the hand (when swelling may tip a marginal triggering into symptoms) or may simply be a consequence of wear of the tendon.

Some cases will resolve spontaneously and the triggering disappears after a few weeks. Mild cases can be treated with an injection of a very small quantity of steroid into the tendon tunnel. This relieves any tendon irregularity and may be enough to ensure easy gliding and resolve the triggering. More severe cases and digits that lock painfully generally require surgery.

What does this involve?

The surgery is performed under local anaesthesia as an outpatient. A small cut is made in the palm over the area known to be tight. This part of the tunnel is opened so that the tendon irregularity does not stick. The skin is then closed with sutures which are removed after two weeks.

When will I recover?

It is good to elevate the hand for one or two weeks after surgery. A sling is provided but it need not be used at all times as long as the hand is held above the level of the heart.

It is also important to keep the fingers, or thumb, moving through a full range after the surgery so as to prevent any sticking and scarring at the site of surgery. In most cases this resolves the symptoms completely and recurrence is very rare.

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