Trigger thumb, medically known as stenosing tenosynovitis, is a common condition where the thumb or one of the fingers catches or locks in a bent position. This “triggering” sensation happens when the flexor tendon becomes irritated and inflamed, causing it to struggle passing through a narrow tunnel called the A1 pulley. When non-surgical treatments fail to resolve the painful locking, surgery is often recommended to restore smooth, painless movement. This intervention is designed to alleviate the constriction around the tendon, offering a definitive solution for chronic symptoms.
When Surgical Intervention is Necessary
A physician recommends surgery only after conservative measures have proven ineffective in managing symptoms. Initial treatments focus on reducing inflammation and include rest, splinting, and nonsteroidal anti-inflammatory medications. The most common non-surgical step is a corticosteroid injection delivered near the tendon sheath at the base of the thumb.
These injections are often effective, but symptoms can return or may not provide sufficient relief for severe cases. If a person experiences persistent pain, chronic locking, or an inability to fully straighten the thumb after one or two rounds of conservative treatment, surgery becomes the next option. The severity of the locking and the duration of the symptoms are the main factors guiding the decision toward a surgical release.
Understanding the Surgical Procedure
The goal of the operation is to permanently widen the tunnel through which the flexor tendon glides, eliminating the constriction that causes the thumb to catch. This is achieved by releasing, or cutting, the thickened A1 pulley. The procedure is brief, often lasting only a few minutes, and is performed on an outpatient basis.
The two main approaches are the open release and the percutaneous release, both performed using local or regional anesthesia to numb the hand. The traditional open release involves a small, transverse incision, usually less than a centimeter long, made in the palm at the base of the thumb. This allows the surgeon to directly visualize the A1 pulley and carefully divide it, ensuring the tendon can move freely.
The percutaneous release is a less invasive technique that uses a large-bore needle or a specialized surgical probe inserted through the skin to divide the constricting A1 pulley without making a formal incision. While this method can lead to a quicker return to light activities, the open approach may be preferred to ensure a complete release and reduce the risk of injury to nearby digital nerves.
The Recovery Process and Expectations
Patients can expect immediate relief from the triggering or locking sensation once the local anesthesia wears off. The surgical site will be sore and may experience swelling and bruising for several days. Pain management is handled with over-the-counter pain relievers or a short course of prescribed medication as needed.
The hand should be kept elevated for the first 24 to 48 hours to minimize swelling. Wound care involves keeping the small incision site clean and dry, with stitches typically removed ten to fourteen days after the operation. Gentle movement of the thumb is encouraged almost immediately to prevent stiffness and promote tendon gliding, though excessive force should be avoided.
Light activities, such as writing or using a computer, can often be resumed within a few days, but limitations on lifting and gripping are necessary for several weeks. Patients are advised to avoid strenuous use of the hand, including heavy lifting or repetitive forceful movements, for up to four to six weeks. While many people regain full function quickly, some may require hand exercises or physical therapy to resolve any residual stiffness.