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?

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?

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

How does it present?

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 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?

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?

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.

What do we do in 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

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.

After the surgery

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

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?

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