Trigger finger, medically known as stenosing tenosynovitis, is a condition where a finger or thumb becomes temporarily stuck or locks when bent. This occurs due to inflammation and thickening of the tendon and its surrounding protective sheath, making it difficult for the tendon to glide smoothly. The affected digit can also experience pain, stiffness, and a catching sensation. While initial management often involves conservative methods, surgery offers an effective solution when these approaches are unsuccessful.
When Surgery is Considered
Doctors typically consider trigger finger surgery when non-surgical treatments have not provided lasting relief from symptoms. These conservative measures often include rest, activity modification, splinting, and anti-inflammatory medications. Corticosteroid injections into the tendon sheath are also a common initial treatment. Surgery becomes a recommendation for persistent and severe symptoms such as ongoing pain, significant stiffness, or continuous locking that interferes with daily activities. If conservative efforts fail to resolve the issue, surgical intervention may be advised.
Surgical Approaches
Two primary surgical methods are used to address trigger finger: open surgery and percutaneous release. Both procedures aim to widen the constricted tendon sheath by releasing the A1 pulley, allowing the tendon to move freely. These procedures are generally performed in an outpatient setting under local anesthesia.
Open surgery involves a small incision in the palm to directly access and release the A1 pulley. Percutaneous release is a less invasive technique that uses a needle to puncture the skin and release the pulley. Ultrasound imaging may be used during percutaneous procedures to guide the needle.
The Procedure Steps
Before the procedure, the surgical area on the hand is cleaned, and a local anesthetic is administered to numb the area. A tourniquet might be applied to the upper arm to control bleeding, and the specific finger or thumb to be operated on is marked.
For open surgery, a small incision is made in the palm. Through this incision, the surgeon identifies the A1 pulley, a fibrous band that has become thickened. The A1 pulley is then carefully released, allowing the flexor tendon to glide without obstruction.
In a percutaneous release, a needle is inserted through the skin, often guided by ultrasound, directly to the A1 pulley. The needle is used to break up the constricting tissue of the pulley, freeing the tendon. After the release, the surgeon moves the finger to ensure the tendon can glide freely and the catching sensation is gone.
Once the release is confirmed, the incision for open surgery is closed with sutures, while for percutaneous release, only a small bandage is typically needed. The entire procedure is usually brief, often taking about 10 to 20 minutes per finger.
Post-Surgery Care and Healing
Immediately following surgery, a dressing or bandage will be applied to the hand, and patients are often encouraged to move the treated finger gently to prevent stiffness. Pain medication may be prescribed to manage any discomfort, and elevating the hand can help reduce swelling.
The initial soreness in the finger and palm typically subsides within a few days to a few weeks, though mild swelling and stiffness can persist for several months. Stitches, if used in open surgery, are usually removed about 1 to 2 weeks after the procedure. Light activities can often be resumed within days, while more strenuous tasks may require several weeks of recovery.
Gentle finger exercises are an important part of rehabilitation to maintain flexibility and prevent scar tissue from limiting movement. Massaging the surgical scar once it has healed can also help keep the tissue supple and reduce tenderness. Trigger finger surgery has a high success rate, often exceeding 90%, in resolving the locking and pain.