Trigger finger is a common condition in which the tendons in the thumb develop swellings. ‘Triggering’ occurs when the swelling catches on the entrance to the tunnel that the tendon runs in at the base of the thumb, stopping it moving the thumb effectively. You may have noticed that your 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 thumb it may be painful and move suddenly with a click. You may also have noticed a swelling or nodule at the base of the thumb that moves when you move your thumb. In some cases the thumb is swollen and painful.
What is the cause?
Here are possible treatments for trigger thumb issues
Cortisone injection 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 we do not recommend steroid injections and 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 thumb 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, Painful/tender/thickened scars and more:
Infection – Uncommon occurs in approximately 1% of operations and usually treated very successfully with antibiotics. Very rarely would require further surgery
Delayed healing – Smokers and those with diabetes are more prone to this
Painful/Tender/thickened Scars – 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.
Nerve injury – 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
Stiffness – Operations to the thumb 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.
Incomplete resolution of your symptoms
CRPS – complex regional pain syndrome, this is an uncommon but serious complication. It can on rare occasions leave you with a less function hand with on-going pain stiffness and swelling. See section on CRPS. The exact incidence or rate of CRPS after surgery is unknown. It probably occurs in a significant form in approximately 1-2% of cases