Trigger finger, medically known as stenosing tenosynovitis, is a common condition where a finger or thumb gets stuck or catches when trying to straighten it. This painful snapping sensation occurs because the flexor tendon becomes inflamed and develops a nodule that cannot glide smoothly through the narrow sheath it passes through. The tendon is obstructed at the A1 pulley, a thickened band of tissue at the base of the finger in the palm. Treatment ranges from simple rest to various surgical interventions aimed at relieving the obstruction.
When Is Surgical Intervention Required?
Surgery is typically pursued after conservative, non-surgical management options fail to provide lasting relief from locking and pain. Initial treatments focus on reducing inflammation and restoring smooth tendon movement. This approach often includes rest, splinting the affected digit, and using non-steroidal anti-inflammatory medications.
The most common and effective non-surgical step is a corticosteroid injection, which delivers potent anti-inflammatory medication directly into the tendon sheath. While a single injection is successful in up to 60% of people, symptoms may return, and a second injection is sometimes attempted. Surgery is considered the definitive treatment when steroid injections do not resolve the clicking or the finger becomes permanently locked. The goal of any surgical procedure is the same: to release the tight A1 pulley and create enough space for the flexor tendon to glide freely.
The Minimally Invasive Office Procedure
Trigger finger surgery can be done in the office using percutaneous trigger finger release. This minimally invasive technique is performed in a specialized clinical setting, bypassing the need for a formal operating room or Ambulatory Surgery Center. The procedure is completed under local anesthesia administered to numb the palm at the base of the affected finger.
The surgeon uses a specialized instrument, often a large hypodermic needle or a small micro-scalpel, to divide the A1 pulley. This instrument is inserted through a tiny puncture site in the skin, which is why the procedure is called percutaneous, meaning “through the skin.” The surgeon uses palpation or ultrasound guidance to precisely target the thickened A1 pulley while avoiding the flexor tendon and adjacent nerves.
Release is confirmed when the finger can be flexed and extended without catching or snapping. Since this method involves only a puncture or micro-incision, it requires no stitches and leaves virtually no scar. This office-based approach is faster, less expensive, and involves minimal disruption compared to a procedure requiring an operating room. Patients can often use the hand for light activities almost immediately after the release.
Traditional Open Trigger Finger Release
The alternative to the minimally invasive office procedure is the traditional open trigger finger release, which is a highly effective and long-standing surgical technique. This open approach is usually performed in an outpatient surgical facility, such as an Ambulatory Surgery Center, or a hospital operating room setting. It uses local anesthetic, but sometimes a light sedation is provided for patient comfort.
The surgeon makes a small incision, typically about one centimeter long, in the palm crease at the base of the affected finger. This incision allows for direct visualization of the A1 pulley and surrounding structures, including the flexor tendon and digital nerves. Using a small scalpel or surgical scissors, the surgeon carefully cuts the A1 pulley to fully release the constriction on the tendon.
Direct visualization minimizes the risk of damage to nearby nerves and arteries, ensuring the pulley is completely released. This method may be preferred for patients with certain anatomical variations, previous hand surgery, or complex trigger finger cases, such as in patients with rheumatoid arthritis. The small wound is closed with sutures, which are typically removed one to two weeks later.
Post-Procedure Care and Activity Timeline
Immediate post-procedure care focuses on managing minor swelling and discomfort, regardless of the technique used. Patients are advised to keep the hand elevated above heart level for the first 24 to 48 hours to minimize swelling. Pain medication is prescribed as needed, and a small dressing is applied to the puncture site or incision.
The timeline for returning to activities varies based on the surgical method and the patient’s occupation. Following a percutaneous release, patients can often return to light activities, such as typing or writing, within a few days. A full return to normal activity is generally expected within two to three weeks. Since there is no open wound, the recovery is often accelerated.
For the traditional open release, the presence of sutures means a slightly longer initial recovery. Stitches are removed in one to two weeks, and patients should avoid heavy gripping, pushing, or lifting anything heavier than one or two pounds for up to four to six weeks. Gentle finger exercises are encouraged almost immediately after either procedure to prevent stiffness. Most patients achieve a full return of strength and motion within six weeks, though minor soreness and swelling can take several months to fully resolve.