Trigger finger (stenosing tenosynovitis) occurs when the flexor tendon sheath in the palm narrows, causing the affected finger to catch or lock when bent. The surgical solution, a trigger finger release, involves cutting the A1 pulley (a band of tissue at the base of the finger) to allow the tendon to glide freely. While the procedure is highly effective, the recovery process often raises questions about the necessity of formal rehabilitation. The need for specialized physical therapy, often called hand therapy, is not universal and depends on a patient’s individual circumstances and healing progression.
Determining the Need for Formal Physical Therapy
The decision to pursue formal, supervised physical therapy is highly individualized and typically made by the operating surgeon based on post-operative progress. For many patients with an uncomplicated procedure and a short history of the condition, self-managed exercises at home are sufficient to restore full function simply by adhering to basic mobility instructions.
Formal Hand Therapy becomes necessary when a patient exhibits specific complications that hinder recovery. These complications include persistent joint stiffness, chronic swelling, or limited range of motion that does not improve with self-directed exercises. Patients whose finger was locked for an extended period before surgery are also more likely to be referred. The specialized techniques a therapist uses can address issues that simple home exercises cannot fully resolve.
Essential Self-Managed Post-Operative Care
Every patient must engage in self-managed care protocols immediately following the procedure. Managing swelling is a priority in the first few days, which involves keeping the hand elevated above the heart, particularly during the first 48 to 72 hours. Applying ice or a cold pack to the surgical area for short, regular intervals also helps reduce post-operative inflammation and discomfort.
Wound care begins after the initial surgical dressing is removed (usually within one to three days), requiring the incision to be kept clean and dry. Patients should wash the area gently with mild soap and water, avoiding immersion until the sutures are removed (around ten to fourteen days post-surgery). Early, gentle movement is also initiated immediately to prevent the formation of restrictive scar tissue, or adhesions, around the released tendon.
Patients must perform gentle active range-of-motion exercises, such as making a full fist and fully straightening the finger, multiple times throughout the day. These movements, known as tendon gliding exercises, encourage the flexor tendon to slide smoothly through the newly opened pulley system. Consistent repetition helps maintain joint mobility and prevents stiffness. Avoiding heavy gripping or lifting anything heavier than a small household object is necessary for the first two weeks to protect the healing surgical site.
Specific Goals of Hand Therapy
When formal Hand Therapy is prescribed, treatment focuses on specific objectives that go beyond the basic mobility achieved through self-care. A primary goal is managing the surgical scar, which can become thick or adhere to the underlying tendon, restricting movement. The therapist instructs and performs scar massage techniques, applying firm pressure to the incision site in circular and linear motions once the wound is fully closed. This technique helps to soften the scar tissue and prevents it from tethering the tendon.
Advanced range-of-motion work includes passive stretching and joint mobilization techniques to address lingering stiffness in the small joints of the finger. These hands-on techniques gently push the joints past the point achievable by the patient’s own strength. Once full mobility is restored, the focus shifts to strength restoration. This involves specific exercises using therapeutic putty, resistance bands, or small weights to rebuild grip and pinch strength, which can be weakened by the pre-operative condition and post-operative rest.