Trigger finger is the common name for a hand condition your doctor might call stenosing tenosynovitis. It happens when something inflames a band of tissue called a “pulley,” which holds the tendon to the finger bone, most often in the ring finger or thumb. This narrows the space in the tube, or “sheath,” around the tendon and causes stiffness and pain.
If you have trigger finger, you might feel a little bump that catches when you use the finger. Eventually it can lock your finger into a bent position.
It isn’t clear what causes trigger finger, but repeated or strenuous hand movement seems to play a part. And you’re more likely to get it if you have rheumatoid arthritis, diabetes, or gout.
Your doctor might recommend treatment with rest, splints, exercises, anti-inflammatory pills, and steroid shots. If these methods don’t work, and your trigger finger prevents you from doing the things you normally do, you and your doctor might discuss surgery.
Before Surgery
If your finger is locked in a closed position, you may need exercises, splints, or physical therapy to get it unlocked before surgery. This depends in part on the specifics of your case and how your doctor plans to approach the procedure.
On the day of surgery, a health care professional will mark the correct finger (the mark may be on the arm) with special ink and, if possible, extend the finger to make it easier for the surgeon to get to the “A1 pulley” that is the usual cause of the problem.
Medical personnel will tie a tourniquet halfway up your upper arm. They will spray your hand with skin-numbing liquid and inject you with local anesthetic so that it’s numb. In special cases, your doctor could decide to use general anesthesia so you’re “asleep” during the surgery.
Your arm will be carefully positioned and secured so it doesn’t move.
During Surgery
The goal here is to release the A1 pulley at the base of your trigger finger, so the tendon can slide more easily. Your surgeon will use either a needle through the skin or a scalpel through a surgical cut in your palm to cut it free.
Though pulleys are important in the hand, you have many of them, and the release of the A1 isn’t likely to cause future problems.
Once the pulley is released, the surgeon will ask you to move your finger to test how well it moves. If everything looks good, the surgeon will close up the surgical cuts. You may have two or three stitches.
After Surgery
You should find your finger easier to move almost right after surgery. In general, your doctor will encourage you to use it as soon as you can. You’ll start with lighter movements and work toward being able to do harder ones. Your doctor will likely prescribe anti-inflammatory drugs and a sling to raise your hand above your heart to keep it from swelling.
You’ll get your stitches taken out around 10 days after surgery, and it could take 4 to 6 months before all soreness and stiffness are gone. Your doctor might recommend that you do hand exercises or physical therapy if you still have pain after that.
Some form of this surgery has been done for about a century, and the success rate is over 90%.
There are possible problems like tendon or nerve damage, infection, and scarring. And some studies show the success rate is lower in people with diabetes. But in general, the surgery works well and the condition returns in only about 3% of cases.
