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Trigger Finger

Trigger Finger

What is Trigger finger?

  • Finger movements are powered by muscles in the forearm. The Muscles are connected to the fingers by tendons.

  • To stop the tendons from ‘bow stringing’ when the fingers bend, there are ’pulleys’ in fingers.

  • If there is swelling around a tendon, the tendon becomes thicker, or the pulley narrower – the tendon cannot glide freely through it’s pulley.

  • The tendon starts to catch, click or even lock in the pulley.

  • Every time this happens there is more injury and inflammation around the tendon, that makes the situation worse

What is it?
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What causes Trigger finger?

  • The most common cause is overuse, that causes inflammation.

  • Some people are prone to swelling and inflammation (synovitis) around their tendons. For example those with rheumatoid arthritis.

  • An injury to the finger or hand.

  • There can be a structural predisposition, such as unusually shaped tendons or pulleys.

What are th causes?

How does it present?

  • If usually starts with tenderness at the base of the finger that is aggravated by pressure or bending of the finger.

  • Clicking develops when the finger bends.

  • The finger can get stuck in the bent (or straight) position. It is usually possible to pull the finger straight, but it hurts.

  • The finger can even get permanently stuck

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How does it present?
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What can be done?

  • Avoid activities that causes clicking or pain in the finger. (Gripping, pinching etc.)

  • Wearing a splint that stops the finger from clicking (it is usually fitted by a hand therapist).

  • Consider taking an anti inflammatory.

  • A steroid injection around the tendon can resolve the issue, or at least give relief for a while.

  • Successful injection is less likely in Female sex (odds ratio1.87), Quinnell stage IV- locked (OR 16.01), heavy physical work (OR 1.6), a third steroid injection (OR 2.02) and having carpal tunnel syndrome (OR 1.59)

What can be done?

When is surgery needed?

  • When non operative treatments (mentioned in the previous slide) is unsuccessful.

  • Surgery is usually the best option if

    • –Triggering has been present for a long time

    • –There is a history of multiple previous trigger fingers that have failed non operative treatment.

    • –If the finger ’locks’ or remain ’locked’.

  • If you would prefer a definitive cure for the problem.

When is surgery needed?

How does surgery work?

  • This kind of surgery is usually done under local anaesthetic with or without sedation (‘twilight anaesthetic’)

  • It is done as day case surgery in a hospital,

    • –but you cannot drive after the procedure and

    • –you should not be home alone on the night of the surgery.

  • Antibiotics are usually not necessary at the time of surgery.

How does surgery work?

What do we do in surgery?

  • The operation is done by an small incision at the base of the affected finger

  • The first (A1) ‘pulley’ around the tendon is released so that the tendon can glide freely

  • The wound is sutured and a dressing is applied.

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What do we do in surgery?
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After the Surgery

In Hospital

  • There will be a bandage on the hand.

  • It is important that the hand remains elevated ‘higher than your heart’ to help limit swelling

  • Usually the finger is still numb from local anaesthetic.

  • It is usual to leave hospital an hour or two after surgery

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At Home

  • It is usual for the finger to feel numb for about one day after surgery, due to the local anaesthetic.

  • Continue to elevate your arm until swelling in your fingers subside.

  • Please remove the outer bandage 2 days after surgery, but keep the wound dry and covered until the sutures are removed

  • Move your fingers (making a full fist and straightening your fingers out fully about 10-20 times a day).

  • Keep the wound dry, covered and clean.

  • An appointment usually arranged with my practice nurse at about 1-2 weeks after surgery.

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After the surgery

The recovery

  • The wound usually heals over 1-2 weeks and any sutures are then removed

  • Self care (washing, dressing, eating) with the operated hand – usually around 5 days

  • Driving: when you are able to control a steering wheel with your operated hand and you are not taking strong pain relief anymore (usually 5-10 days post surgery)

  • Most moderate activities(equivalent to lifting a pot of the stove or pouring a full kettle) can usually be tolerated by 4-6 weeks,

  • Scarring  in the palm, where the pulley in has been divided can be slightly thick and tender for months (3-6).

  • Golf, fishing, cycling etc.: usually around 2-3 months, but it can be longer (6 months)

The recovery

What can go wrong?

  • Infection occurs rarely (1% of the time). It is rarely severe.

  • There may be ongoing pain from scarring, or other worn out joints in the area (that were not obviously a problem at the time of doing the surgery).

  • Sometimes the scar tissue can be very sensitive and thick, limiting finger movement.

  • Rarely there can be damage to a nerve to the finger, resulting in tingling, numbness and sensitivity in the finger.

  • Very rarely (around one in a thousand) a severe pain reaction, (CRPS) can develop, which can be disabling for years.

  • Rarely, the finger can continue to click and further releases may be needed.

What can go wrong?

What can you expect the final outcome to be?

What can you expect?

A full recovery is usually expected from a trigger finger release.

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