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. 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. After a while, 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 your risk goes up 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.
Which Fingers Are Most Affected by Trigger Finger?
According to Joseph Gil, MD, an orthopedic surgeon in Rhode Island who specializes in hand, wrist, and upper extremity care, the middle finger is most often affected by trigger finger, but it's also common in the ring finger and thumb.
How to Prepare for Trigger Finger 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.
Before surgery, your doctor may order some basic blood tests to check that you are in good health, says Vinay K. Aggarwal, MD, consultant orthopedic & sports injuries specialist at Kailash Hospital.
Follow your doctor's instructions carefully about eating, drinking, and taking medications before surgery. You may need to stop eating or drinking for several hours before the surgery, depending on the type of anesthesia being used. Your doctor will also tell you if you need to pause any blood thinners or other medications.
On the day of surgery, a health care professional will mark the correct finger (the mark may be on the arm) with special ink. If possible, they may also stretch the finger to help the surgeon reach the "A1 pulley," which 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 a local anesthetic to numb the area. 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.
What Happens During Trigger Finger Surgery?
The goal here is to release the A1 pulley at the base of your trigger finger, allowing the tendon to 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 for hand movement, 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.
What Is Recovery Like After Trigger Finger Surgery?
You should find your finger easier to move almost right after surgery. "Recovery is quick as the finger starts gliding easily once the tight pulley causing triggering is released," says Aggarwal.
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. "Patients with less rigorous occupations, such as clerical work, could return to work as early as the next day after surgery," Gil says. "However, patients with a more rigorous occupation, such as construction work, may require three to four weeks of recovery prior to returning to work."
Your doctor will likely prescribe anti-inflammatory drugs and a sling to raise your hand above your heart to keep it from swelling.
Keep the bandage on your hand until your doctor tells you it's okay to remove it — usually about two to three days after surgery. Once your doctor says it's safe, gently wash the area every day with warm, soapy water, and pat it dry. Avoid using hydrogen peroxide or alcohol, as these can slow down healing. If the incision leaks a little or rubs against your clothing, you can cover it with a clean gauze bandage. Change the bandage each day, and keep the area clean and dry.
You'll get your stitches taken out around 10-14 days after surgery, and it could take four to six months for all the soreness and stiffness to go away. Your doctor might recommend that you do hand exercises or physical therapy if you still have pain after that. Gil also encourages patients to do scar massage, which helps improve the appearance and long-term healing of the surgical scar.
What Complications Can Occur After Trigger Finger Surgery?
There are a few problems linked to trigger finger surgery, according to Aggarwal. There's a chance of injuring a skin nerve, which can make your finger feel numb for some time after the surgery, he says.
Gil adds that there's a very low risk of infection. Possible signs of infection include increased pain, swelling, warmth, redness, pus drainage, red streaks near the incision, swollen lymph nodes, or fever. If you notice any of these, contact your doctor right away.
There is also a very low risk of scar sensitivity (when scars become oversensitive, tender, and/or painful to touch) or finger stiffness, Gil says. "Waiting too long to have surgery can raise the risk of joint stiffness," he says.
What Is the Success Rate of Trigger Finger Surgery?
Trigger finger surgery usually has a very high success rate when done properly by a competent surgeon, Aggarwal says.
"Studies report a 90%-100% success rate," Gil says. As more people choose to have this surgery while they're awake under local anesthesia, surgeons can check if your finger moves smoothly before you leave the operating room. This helps improve success rates even more, he explains.
Keep in mind that results can vary from person to person. Your outcome may depend on things such as how severe your condition is and your overall health. Research suggests that younger age, higher levels of pain before surgery, psoriatic arthritis, and allergic conditions such as asthma and eczema may be linked to lower success rates.
Takeaways
Trigger finger most often affects the middle finger, thumb, and ring finger. If rest, splints, exercises, anti-inflammatory medications, or steroid shots don't help, your doctor may recommend surgery. Recovery is usually quick — many people can move their fingers right after the procedure and return to light work within a day or two. But complete healing can take a bit longer. The surgery has a very high success rate — typically between 90% and 100% — and complications are unlikely.
Trigger Finger Surgery FAQs
What will happen if a trigger finger is not treated?
In some people, trigger finger can go away on its own without treatment. But it may also worsen if left untreated. Over time, your finger may become locked in a bent position, making it harder to do daily tasks.
How soon can you use your hand after trigger finger surgery?
You can usually start using your hand for light tasks soon after surgery. Your doctor will encourage you to begin with gentle movements and gradually work up to your normal activities. It may take about three to four weeks before you return to full activity and start taking on more physically demanding tasks, such as lifting heavy objects.
Can you drive yourself home after trigger finger surgery?
No, anesthesia and pain medicine will make it unsafe for you to drive yourself home. Ahead of the surgery, ask someone to drive you home.
