Trigger Finger/Thumb Release Surgery

This leaflet explains about trigger finger release surgery, what it is and how it can be treated.

What is trigger finger/thumb?

Trigger finger affects the flexor tendons in the finger(s) which makes it difficult to bend and straighten the affected digit. It can affect the thumb or any finger and more than one digit can be affected at the same time. It can also develop in both hands.

The tendons in your fingers and thumb are covered by a protective sheath and usually glide freely through tight tunnels called pulleys (A1 pulley is in the palm near the base of the finger(s) and thumb). Inflammation or swelling can develop within the tendon sheath, which means the tendon can no longer easily slide through the sheath’s pulley system and it can become bunched up to form a small lump (nodule). This can make bending and straightening the affected finger or thumb difficult and the finger may become stuck in a bent position. Trigger finger more commonly occurs in the thumb, ring and little fingers.

What causes trigger finger?

The inflammation and irritation of the tendon sheath is usually caused from overuse or injury. Around 2-3% of people develop trigger finger. When the cause is not known, certain factors increase the likelihood of developing it:

• Medical conditions like rheumatoid arthritis and diabetes.
• If you work manually and forcefully use your hands.
• Females and those over 40 years of age.

What are the symptoms?

• Pain at the site of triggering in the palm; this is below the base of the finger or thumb that is triggering. This is usually on the palm side of the ‘knuckle’ of the joint.
• Clicking or triggering – of the digit during movement or it can lock in a bent position. This tends to be worse in a morning. The digit may need to be straightened using the other hand.
• Stiffness especially in trigger thumb where movement at the end joint is reduced.
• Tenderness if you press over the site of pain at the base of the finger in the palm. You may feel a bump in the palm where the tendon is catching on the pulley.
• In more severe cases the finger may become locked in a bent position and you cannot open it. This needs an urgent review by the medical team.

What are the treatment options?

• Pain relief – over the counter medication such as anti-inflammatory gels. Check with you pharmacist if there is any reason you should not use it.
• Resting – avoid certain activities that cause irritation.
• Splinting – ‘Trigger finger splints’ which keep the affected digit straight can be used, especially on a night time. Trigger finger splints can be purchased online.
• Corticosteriod Injections into the tendon sheath around the painful nodule may improve symptoms. The injection is thought to work by reducing swelling of the tendon and allowing it to freely move again. This may happen within days or weeks of having the injection. The success rate can be lower than those with diabetes. This procedure carries a small risk of spontaneous tendon rupture.
• Surgery is recommended to improve pain and function allowing the tendon to move freely. This is offered to patients when conservative methods fail and for those with a ‘locked’ trigger finger when the finger is stuck in a bent position.

Surgical procedure

This is done under local anaesthetic as a day case procedure. The surgeon or the surgical care practitioner will make a small cut in the palm of your hand to release the tight band (A1 pulley) which is constricting the tendon causing it to click or become stuck. The wound will be closed using stitches. The procedure usually takes less than 30 minutes.

What happens before the operation?

Planning ahead

Once you have your date for surgery you can do several things to aid preparation for your operation and to improve your recovery. It is important to plan and make arrangements for how you will manage when at home. Stocking up your freezer with easy cook items (particularly if you live alone) as you may find daily tasks such as cooking more difficult after your operation.

Please take all rings and jewellery off your hand(s) prior to coming in to hospital.

Smoking

Smoking has been shown to delay wound healing and increase complications after surgery and will improve your long-term health. If you are interested in stopping smoking please speak to your GP for advice and services available.

Cancellation

If you are unable to attend your appointment, please contact us immediately so that we can offer your appointment to another patient.

Are there any complications with this operation?

All surgical procedures are associated with a degree of risk.

General complications:

• Pain – you can help this with taking pain killers.
• Bleeding or swelling during or after surgery.
• Infection of the wound (<1%). After your operation you should contact the surgeon if you get a temperature, notice discharge from your wound, feel unwell, or if your wound becomes red, sore or painful.

Specific complications:

• Scar tenderness, persistent pain and swelling (<5%). You can help scar tenderness and pain by massaging the surgical wound once it has fully healed. The scar usually becomes invisible over time.
• Stiffness may occur in the affected digit. It is important to follow your post-surgical instructions regarding movement to maximise function.
• Nerve or blood vessel injury (<1%)during the operation there may be disruption to one of the nerves causing numbness and altered sensation within the digit. This can be temporary or permanent.
• CRPS (complex regional pain syndrome) following surgery there is a small risk that your hand/finger may develop CRPS. This is a condition that can cause severe pain, sensitivity and stiffness for which the cause is not known. You may need further treatment including pain killers, physiotherapy and a pain team referral. It can take many months or years for symptoms to improve.
• Bowstringing (rare complication) – where the tendon is in the wrong position. You may need further surgery to repair the tendon.
• Persistent triggering post-surgery – if the release is incomplete. You may need further surgery.

Recovery after surgery

Recovery after surgery

Your hand will have a dressing over the wound and will be placed in a light bandage (wool and crepe). You should be able to move your fingers straight away. You may be given a sling to keep your hand elevated to reduce the swelling. You will go into a recovery room.  Once you are ready for discharge you will not be able to drive. If you are worried about anything, in hospital or at home, please contact the healthcare team number(s) below.

Wound management

You will be advised when you can remove the wool and crepe bandage, this is usually after 48-72 hours so you move your fingers easier. It is important to keep the wound and dressings dry until your wound check at your GP practice, this is usually 10-14 days after your operation. If you are unable to get an appointment at your GP surgery, please get in touch on the numbers provided at the end of this leaflet.

What you can do after surgery

• Elevation – keep your hand raised and bandaged for 48 hours after surgery to control the swelling.
• Movement – it is important to gently exercise your fingers/thumb, elbow and shoulder to prevent stiffness after surgery.
• Wound – keep this dry and clean until any stitches are removed.
• Do not put your rings back on your fingers until the swelling has settled.

Get in touch if you experience

It is normal to experience discomfort and swelling after this surgery. Get in touch if you experience the following in the weeks after surgery:

• Persistent pain, swelling or scar sensitivity.
• Significant stiffness in the wrist and/or fingers.
• The finger remains locked in a bent position and you cannot fully straighten it.
• Inability to use the hand for daily tasks.

Exercises

Following surgery, you can start to gently bend and straighten the fingers within the constraints of the bandages. Once these have been removed you can start the below exercises. The exercises can be uncomfortable but this will improve over time. The aim is to make a fist and be able to fully straighten the fingers.

Aim to practice these exercises every few hours between 5-10 repetitions as comfortable. 

Tendon gliding exercises

Isolated Tendon Gliding

Isolate the tip of your finger or thumb that you have had the surgical release. Hold firmly below the joint crease and bend and straighten your fingertip.

Bending the finger

Gently push your fingers or thumb towards your palm using your other hand.

Scar Care

Once your wound is healed and dry you can start scar massage. Use an unscented moisturising cream like E45, aqueous or Vaseline. Apply a gentle pressure to the length of the scar for a few minutes 3-4 times per day. This will help the scar in reducing tenderness and will flatten the scar.

When can I resume normal activities?

Activities

You can use your hand for light activities as comfortable to do so. Avoid excessive weight bearing through the hand and wrist, repetitive gripping and heavy lifting for 6 weeks after surgery. Returning to normal activities may be longer if you have had more than 1 digit released.

Driving

Generally you are safe to drive when your wound is healed and are free of dressings. You will need to ensure you are fully safe to drive and can grip the steering wheel. It is wise to discuss this with your insurance company before you return to driving.

Work

If you have a desk based job with light duties you may be able to return to work without leave. If your job is manual you may need longer 4-6 weeks off.

Where can I go for more information?

NHS Trigger finger – Trigger finger – NHS (www.nhs.uk)

The British Society for Surgery of the Hand – Trigger finger/thumb | The British Society for Surgery of the Hand (bssh.ac.uk)

Telephone