What is trigger finger?
The fingers and thumb of each hand have tendons which run along their length. These tendons connect the digits to the forearm muscles. The tendons function to bend and straighten the digits, when the forearm muscles contract (shorten). The tendons are surrounded by a tube or sheath, which secretes fluid to lubricate the tendons and allow smooth movement. Trigger finger is a common condition in which either the sheath becomes inflamed or the tendons develop swellings. This prevents the smooth movement of the tendon within the sheath, which is described as ‘Triggering’.
You may have noticed that your finger or thumb appears stiffer and may lock down or jam in the palm of your hand, particularly first thing in the morning. When you try and straighten the finger it may be painful and move suddenly with a click. You may also have noticed a swelling or nodule at the base of the finger that moves when you move your finger. In some cases the finger is swollen and painful.
What is the cause?
Here are the treatments available for trigger finger issues:
Night time splints:
can be worn at night to prevent the fingers becoming locked down during the night. These need to be specially made to fit your hand by a “Hand Therapist”.
50-60 % of patients can successfully be treated with an injection of steroid (cortisone) into the tunnel around the tendon. Studies have shown long term improvement of pain and locking with injection treatment. Some patients find that the effect of the injection wears off. In this case a further injection may be recommended or alternatively your surgeon may recommend surgical release.
In patients with rheumatoid arthritis the tunnel is released less frequently. Instead, if surgery is required the inflamed tissue (synovitis) around the tendon is removed and this often improves the pain and triggering. This is a more involved procedure and may be performed under general/regional anaesthesia.
In babies/children a general anaesthetic is required for surgery.
You should be fit to go home soon after the operation. The local anaesthetic will wear off after approximately 6 (6-36 hours) hours. Simple analgesia usually controls the pain and should be started before the anaesthetic has worn off. The bandage you will have on initially may make it difficult for you to eat and wash yourself, so you may need to arrange assistance.
You should keep your hand/arm elevated whenever possible over the first 48 hours after surgery. While sitting this is best achieved by placing your arm on pillows above the level of your heart. Light use of the hand is encouraged to maintain finger mobility.
Once the wound is well healed the scar and surrounding tissues should be massaged using small circular movements to reduce the sensitivity. You can rub simple hand cream or pure vegetable oil into the scar to soften it, for five minutes several times a day. There is usually no need for physiotherapy.
What are the potential complications
Infection, Delayed healing, Painful/Tender/Thickened scars and more:
Uncommon occurs in approximately 1% of operations and usually treated very successfully with antibiotics. Very rarely would require further surgery
Smokers and those with diabetes are more prone to this
the vast majority of patients complain of some discomfort around the scar but it generally resolves with time. Wound care and desensitization as directed by your physiotherapist/hand therapist will improve this.
small nerves that supply the skin around the scar may be injured giving a numb patch or unpleasant sensation round the scar. The use of magnification glasses (Loupes) by your surgeon and very careful dissection will be used to minimise this complication
Operations to the fingers may cause stiffness, this can be minimized by getting your hand moving as early as possible and working closely with your hand therapist if necessary.