Trigger finger, also known as stenosing tenosynovitis, is a condition that can cause a finger or thumb to get stuck in a bent position, sometimes straightening with a snap. This occurs when the tendons that bend the fingers and their protective sheaths become inflamed or thickened, making it difficult for the tendon to glide smoothly through a narrow tunnel called the A1 pulley. Surgery for trigger finger is a common and generally successful procedure aimed at resolving this issue.
Understanding Trigger Finger Surgery
The goal of trigger finger surgery is to release the A1 pulley, a fibrous band that holds the flexor tendons close to the bone. By cutting this pulley, the surgeon creates more space, allowing the inflamed or thickened tendon to move freely without catching or locking. This procedure is typically performed on an outpatient basis, meaning patients can return home the same day.
Many individuals experience immediate relief from the catching and locking sensation after surgery. The success rate for trigger finger surgery is very high, often reported to be over 90%, and in some studies, as high as 97-99%. This makes surgery a reliable option when conservative treatments, such as rest, splinting, or corticosteroid injections, have not provided lasting relief.
The Possibility of Recurrence
While trigger finger surgery is highly effective, the condition can recur, though this is generally uncommon. Recurrence rates after surgery are typically low, ranging from 1-3% in many studies, though some research indicates they can reach up to 20%. Recurrence can manifest in two ways: either the same finger that was initially operated on develops trigger finger symptoms again, or a different, previously unaffected finger develops the condition.
Factors Contributing to Recurrence
Several factors can increase the likelihood of trigger finger recurring after surgery. An incomplete release of the A1 pulley during the initial procedure can cause continued friction and catching. Scar tissue formation around the surgical site can also impede tendon gliding, leading to renewed symptoms.
Underlying medical conditions play a significant role in recurrence risk. Individuals with conditions like diabetes, rheumatoid arthritis, or other inflammatory disorders are more prone to developing trigger finger, increasing recurrence risk in the same or different digits. For instance, diabetes can increase the risk of recurrence and may lead to a lower success rate for surgery in some cases.
Certain pre-surgical and occupational factors are also associated with an increased risk of recurrence. Receiving more than three steroid injections in the affected finger before surgery has been identified as an independent predictor of recurrence. Engaging in manual labor after surgery can also increase the risk, likely due to repetitive strain on the tendons. In pediatric cases, a younger age may also increase the risk of recurrence.
Addressing Recurrence
If trigger finger symptoms return after surgery, a structured approach is typically followed to manage the condition. Conservative treatments, similar to those used before the first surgery, are often attempted. These may include rest, splinting to immobilize the finger, nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and swelling, and corticosteroid injections.
If these conservative measures do not alleviate the symptoms, revision surgery may be considered. This procedure aims to re-evaluate the affected area and release any remaining constrictions or address significant scar tissue that might be hindering tendon movement. While revision surgery generally has good outcomes, its success rates might be slightly lower than those of the initial procedure.