This leaflet will help answer some of the questions you may have about trigger finger or thumb and possible surgical release. It explains the benefits, risks and alternative to the procedure. If you have any further questions or concerns, please do not hesitate to speak to a doctor, therapist or nurse caring for you.
What is trigger finger ?
Trigger finger is the term used to describe the catching of a finger or thumb as you bend and straighten it. Trigger finger is caused by a thickening around the tendon which bends your finger or thumb. It is more common in women than men and may be linked to diabetes.
What are the symptoms of trigger finger ?
It may feel like your finger or thumb is clicking or it may catch and stay bent. Sometimes the only way to straighten your finger is by straightening it with your other hand. Sometimes it can be sore and painful when direct pressure is placed over the thickening in the palm of your hand.
Why should I have trigger finger released?
Treatment is needed if the triggering of your finger is causing discomfort or stopping you from being able to perform normal daily activities.
What happens during the surgery?
Come prepared with a book or some music to listen to whilst you wait for your turn. You should take all your medications as normal unless otherwise instructed. Please inform the doctor of any blood thinning medication you take and about any allergies you may have. You do not need to starve for this procedure unless you are having this under a general anaesthetic. Surgery for trigger finger aims to remove the fibrous tissue which is affecting the movement. You will routinely have the procedure done under wide awake local anaesthetic no tourniquet (WALANT) technique. The local anaesthetic injection ( the only painful bit of the operation) will numb your finger and allow the surgeon to make a small cut over the area of your palm, and then release the thickening in the tissue that catches the tendon as it glides. The surgeon will then check that the tendon and your finger move smoothly ( you will feel some pushing and pulling but this will not hurt). The wound will then be sutured and then dressings will be applied over the wound.
What are the risks?
Infection: any operation can be followed by infection which can be treated with antibiotics.
Scar: you will have a scar that will be somewhat firm to touch and tender for six to eightweeks.
Stiffness: can occur if the hand is not used and exercised after the operation. This is usually very temporary and can be treated with exercise given by the hand therapist.
Nerve damage: can occur during your surgery which results in either a painful spot in the scar or some loss of feeling in the hand. This complication is very rare but may require a further operation to correct.
Blood vessel injury: damage to the blood vessel can occur during surgery as the blood vessel lies close to the thickened ligament. Damage to the vessel is very rare and can be immediately repaired.
Pain: ongoing discomfort is rare, but possible, following any surgery in the hand.
Loss of function: you will have a temporary loss of function and things will be a little more difficult to do following surgery while the dressings are in place. In rare cases there may be a permanent loss of function.
Are there any alternatives to surgery?
A steroid injection around the tendon where it is catching can reduce swelling on the tendon and allow it to glide freely again. About 50% of people will notice a substantial improvement with one injection but others might need another. About 75% of people get complete relief from their symptoms with this treatment.
The injection takes from a few days to weeks to work. It generally causes no side-effects but occasionally thinning of the skin or loss of skin colouring can occur around the site of the injection.
Even if the steroid injection works the triggering can come back. This is less common with surgery. With both surgery and steroid injections the triggering can happen on another finger.
Will I feel pain?
You will either be given local anaesthesia that will make just one finger or part of your hand numb that will cause you to sleep. The team will provide you with appropriate pain medication to help reduce any pain you might have after your surgery.
It is important that you take your pain relief on a regular basis for the first few days. When taken regularly the medication is kept at a constant level in your body and will control your discomfort more effectively. Any medication given to you will be explained before you leave the hospital.
What should I look out for at home?
Please rest for the remainder of the day and the following day to help you recover from the surgery. Avoid gripping or grabbing objects especially if hot or very cold. The anaesthetic will take up to 4-5 hours to wear off. You do not need to stay in bed. Gently moving around your home will help your blood circulation and help to prevent blood clots. Ensure you move your shoulder and elbow. Take your painkillers before the anaesthetic wears off.
Swelling: you can help to prevent or reduce swelling in your fingers by placing your arm on a couple of pillows when you are sitting or resting. You will also be given a sling. Wear this when you are not seated or resting. Any redness or increasing pain not settling with the painkillers prescribed needs clinical review to rule out any problems.
Dressings: you will have a padded bulky dressing over your wound. It must remain in place for at least 3 days at which point the bulky dressings can be taken down by yourself and the sticky plaster is left intact. Please do not get this wet till the sutures are removed or wound checked at day 12-14 from the surgery . If necessary, cover it with a plastic bag tied at the wrist or a large rubber glove.
Follow up appointments
You will be given a follow-up appointment to have your dressings and stitches removed, which will either be with the dressings nurses. Your surgeon may recommend that you attend hand therapy for a splint or exercises usually after the first 7 days. You will also have a follow-up appointment scheduled with the surgeon usually at 2 weeks for a face to face review.
These appointments will be given to you before you leave the hospital on the day of your surgery.
If we are unable to schedule any of the appointments that day, we will send you details of the appointment by letter.