The Top 10 Reasons for Stiff Fingers

Your hands are essential instruments for interacting with the outside world. Household duties, work, hobbies, and athletics may all become more difficult if you are unable to use your fingers and hands properly.


Stiffness in the fingers can be caused by a variety of factors, including:


Arthritis comes in various forms, and any of them might induce finger stiffness. Arthritis may be secondary to inflammatory conditions like Rheumatoid arthritis  psoriatic arthritis or secondary to trauma or age related degenerative changes.  When a joint’s natural smooth gliding is lost, mobility is generally restricted and this can become painful. Depending on the kind of arthritis, the bones in the hand which are most typically afflicted differ. For example psoriatic arthritis affects the end joints of the fingers next to the nail, rheumatoid arthritis has a higher tendency to affect the bigger knuckle joints first. Osteoarthritis ( degenerative) can affect all the 3 joints in the finger. There are staged treatment options available for stiff painful digits starting with medical management, hand therapy and splinting stepping up to surgical intervention if needed.


Many of the components of a finger might become stiff if they are damaged.

Inflammation of or injury to the tendons around the joint are caused by finger joints dislocations and “jammed fingers.” These injuries can induce permanent or even permanent alterations in the supporting ligaments’ typical flexibility, limiting joint mobility.

Swelling and bleeding from broken fingers (fractures) may be irritant to the tendons that run along the bones. The sharp edges of the broken bone can sometimes injure the tendons.  This may cause the tendons to scar to the bone, restricting their mobility and so affecting the joints that those tendons move.

Extensor tendons (straightening) and flexor tendons (bending) injuries in the finger might reduce their range of motion. The tendons’ control joints may lose motion or become stiff as a result.

Temporary plaster slabs/ casts or thermoplastic splints, early hand therapy and range of movement and in certain situations surgery to fix the fracture can help treat the injury.

Trigger Finger

Normally, the tendons that flex (flex) the fingers glide effortlessly in the tunnels through which they run. When the tendons develop a fullness or lump, they are unable to glide freely in the tunnel. The irregular mobility of the tendon may impede both bending and straightening (like a rope with a knot trying to move through a pulley). These can be treated with early splinting, hand therapy stepping up to steroid injections and in recalcitrant cases surgical intervention

Tendonitis is an inflammation of the tendons (tenosynovitis)

The smooth lining of the tendon (tenosynovium) can swell, restricting their mobility and consequently  the movement of the joints they govern. This is particularly problematic when the tendons run through narrow passageways in the hands or wrist. Osteoarthritis, psoriatic arthritis, and trauma or overuse is among conditions that can cause tenosynovium swelling. These too can be treated with early splinting, hand therapy stepping up to steroid injections and in specific cases surgical intervention


Splinting, casting, or bracing are sometimes used to treat finger injuries or surgery. Finger immobilisation for prolonged periods can cause changes in the tissues of the hand (skin, joint linings, ligaments), leading to thickening and scarring and loss of normal flexibility. Seeing the specialist hand therapist and having a clear treatment regime with early mobilisation avoids this.


Burns can harm not just the epidermis, but also the deeper tissues of the body. Damage secondary to deep scarring frequently causes alterations that result in stiffness.

Complex Regional Pain Syndrome (CRPS)

Complex Regional Agony Syndrome (CRPS) is a disorder characterised by swelling of the hand and fingers, as well as pain. Because of the increased discomfort, the combination causes not only alterations in the tissues that cause stiffness, but also a dread of moving the afflicted portions. This is a very difficult problem to treat and may need multidisciplinary input from hand therapists, pain management consultants and hand surgeons.

Diabetic Stiff hand syndrome

Scientists are still unsure why diabetes increases the risk for hand complications. Possible theories for this condition appear to be related to problems with your body’s collagen. Collagen is a protein that makes up tendons, joints, ligaments and other connective tissue in the body. Increased collagen production, decreased collagen break down, and changes to the composition of collagen can lead to abnormal gathering of proteins in your hands, which makes them more stiff.

Dupuytren’s contracture

It is a condition that affects adults where fibrous bands grow in and beneath the skin as a result of this condition. The capacity to straighten the hands or thumb is usually hampered as a result of these alterations.


They can  occur as a result of any type of injury or surgery. Finger stiffness can be caused by scarring of the epidermis or deeper tissues.

What are the options for treating tight fingers?

The reason of stiff fingers must be determined before the appropriate treatment can be decided. Hand surgeons are well-qualified to determine the cause of your tight fingers. Splinting, casting, bracing, medicines, surgery, and/or hand rehabilitation are some of the options for treatment.

To identify the next stages in your treatment plan, book in for a consultation.




Skier’s Thumb: An injury to the ulna collateral ligament of the thumb

Is There Anything I Should Know Regarding Skier’s Thumb?
• A ligament is the strong tissue that joins the bone of a joint together, provides stability and is commonly injured in skier’s thumb.
• This pathology was first identified in 1955 as a persistent ligament condition in Scottish poachers who regularly twisted the necks of hares, causing damage to their thumbs. At the time, the injury was known as “gamekeeper’s thumb.”
• Because of the rising popularity of downhill skiing and injuries to the thumb sustained following a fall, the phrase “gamekeeper’s thumb” has been supplanted with the more modern word “skier’s thumb.”
• A considerable proportion of skiing injuries include skier’s thumb.
• This damage must be surgically treated in extreme situations when the ligament has completely ripped.
• Because the ligament contributes to the thumb’s gripping function, its ultimate stability is critical.
• With adequate therapy, individuals with skier’s thumbs may be able to go to work or even ski in a short time.

Skier’s Thumb Causes:
Accidents on the slopes are the most prevalent source of injury to the tendon that produces skier’s thumb. Injuries to this ligament account for 8% to 10percent of total of all skiing incidents. A fall on to an open palm with a skiing pole in the palm, for example, generates the force required to strain the thumb and strain or rupture the ligament. A simple landing on an extended hand with an open palm does not normally produce much impact. The thumb, on the other hand, can be hurt if it slides into compacted snow at a fast speed.

A car accident in which the driver’s thumb is draped alone so over steering wheel is a less prevalent source of this injury. Skier’s thumb can be caused by any injury that causes the thumb to bend unusually backwards or to the side.

Symptoms of a Skier’s Thumb
These clinical signs may appear minutes to an hour after the damage has occurred.

• Pain in the web area between the thumb and the index finger at the root of the thumb
• Thumb swelling at MCP joint
• there is an inability to grip or a weakening of grasp; between thumb and index finger,
• Skin discoloration above the thumb that is blue or black in hue.
• Thumb ache that becomes worse as you move it in any direction

Diagnosis of a Skier’s Thumb
It’s important to see an hand surgeon if you have injured your thumb in a similar fashion.
Your surgeon will initially assess if you had any additional limb-threatening injuries before performing a more thorough examination of the thumb.

The surgeon will inquire as to how the injury occurred and add further questions like:
• Have you ever been injured in a similar way before?
• Have you ever undergone any form of hand or wrist surgery?
• Are there any pain relievers that you’re allergic to?
• Have you ever sustained a previous wrist or hand fracture?
• Are you a right- or left-handed person?
• What do you do for a living?
After that, the surgeon will conduct a physical examination.
• Its ligaments of the thumb close to the index finger side that are tested for laxity (looseness) in the following way: This test will include keeping the root of the thumb in place while delivering a lateral (sideways) push to the tip of the thumb to observe how far it will move. The motion of the damaged thumb will be contrasted to the motion of the unaffected thumb. This may be difficult to accomplish just after the injury due to pain (in which case the injury may be treated and then re-examined in a few days) and may be assessed after a local anaesthetic injection.

Treatment of skiers thumb:
The initial management of this injury depends entirely on the severity of the injury and degree of ligament damage .
Partial ulnar collateral ligament injuries are normally immobilised for 4-6weeks, however full ligament rupture frequently necessitates surgery. They may also be associated with a fracture/ boney injury and is best assessed with an x-ray.

A important variation seen with a severe injury , where the ligament gets trapped above other soft tissue and these do not heal unless treated surgically. If suspected clinically this is best assessed with an ultrasound scan.

Early identification can be treated satisfactorily with surgical repair, delayed presentations ( beyond 6 weeks) may necessitate ligament reconstruction using tendon grafts which is a bigger procedure.
After surgery and or a period of immobility in a plaster, your hand therapist and hand surgeon will then organise a bespoke splint and rehabilitation program. It usually takes a period of 6-10 weeks for this to heal fully.

Prevention of Skier’s Thumb
• During all falls, skiers should be trained to intentionally drop the ski pole. When skiing without a ski pole in hand, falling on with an outstretched hand should reduce the risk of harm.
• Riders also should be encouraged to utilise poles with finger groove grips rather than those with wrist straps or closed grips.
• If you keep your thumbs and fingers outside the steering wheel during a car collision, you can avoid getting skier’s thumb. Since most drivers are conditioned to grasp the steering wheel like a ski pole, this new pattern will need deliberate effort.
When Should You Seek Medical Help?
If a person develops any of the signs of skier’s thumb after an accident, they should seek immediate medical care and follow the surgeons recommendations for further management.

If you have injured your thumb please organise a review with a hand surgeon and book your consultation.


Do you have fingers bent it with thick cords in your palm- you may have dupuytren’s contracture.


Dupuytren’s contracture is a conditions that gradually develops over time. The tissue beneath the skin  of your palm is affected by this condition. Tissue knots accumulate beneath the skin, eventually forming a strong cord capable of pulling your fingers into a bent posture.

The affected fingers are unable to fully straighten, making routine tasks like placing your hand in your pocket, putting on gloves, and shaking hands more difficult.

Dupuytren’s contracture impacts daily activities in the later stages of the condition and is generally common in males of Northern European heritage. There are various modalities of treatment available for the management of the conditions once the condition progresses.


Dupuytren’s contracture may present as nodules or bumps in the hand which may stay without changing for a long while. The lumps are generally firm and stuck to the skin of the palm. Skin can seem thicker and puckered. You may sometimes also see little pits next to the nodules. The nodules gradually progress to form cords in the palm and extend into the fingers and they may sometimes be mistaken as tendons to one or more  fingers. Once significantly bent this interferes with day to day activities. In the initial phases this can be managed non operatively. As they progress they pull the fingers into the palm and this makes it difficult to straighten the fingers and may require surgical intervention. Lumps and cords can develop on the soles of the feet (plantar fibromatosis) or the genital location in men (Peyronie’s disease). Occasionally, the disease will cause thickening on top of the knuckles called a knuckle pad (or Garrod’s pad).


If you do notice lumps in your hand its sensible to get it examined by a hand surgeon and if its dupuytren’s contracture then your doctor can guide you through the various non operative or operative options currently available to manage your stage of the condition.  It is important to be aware that even with the treatment the disease is nor curable. However with the right hand surgeon and hand therapist , you will be advised on realistic goals, managing the disease and they will ensure you understand the disease and the short and long term expectations.



Do you get tingling, numbness or pins and needles in your little and or ring finger?…. you may have Cubital Tunnel Syndrome

What is cubital tunnel syndrome, and how does it affect you?

Cubital tunnel syndrome occurs when the ulnar nerve becomes inflamed, swollen, and or irritated. Ulnar nerve is an important nerve starting in your neck which passes through the “cubital tunnel” (a ligament and bone tunnel on the inner aspect of your elbow) as it makes it way from your upper arm into your forearm and eventually into your hand.

Cubital tunnel syndrome generates pain that is similar to the sensations you get when you strike your elbow’s “funny bone.”

Causes of cubital tunnel syndrome?

Cubital tunnel syndrome can develop if a person frequently (repetitive) bends their elbows for example, when pulling, reaching, or lifting, leaning heavily on their elbow, or suffers an injury to the area. Cubital tunnel syndrome can be caused by arthritis, bone spurs, or past elbow fractures or dislocations or sometimes by the presence of abnormal muscle in the region of the tunnel.

What are the symptoms of cubital tunnel syndrome?

Cubital tunnel syndrome manifests itself in a variety of ways.

The most prevalent symptoms of cubital tunnel syndrome are as follows:

  • Numbness and tingling in the hand, especially in the ring and little fingers, when the elbow is bent.
  • Hand pain.
  • Aching pain on the inside of the elbow
  • Muscle weakness in the affected arm and hand causes clumsiness and a weak grasp.
  • Numbness and tingling at night.

How can you know if you have cubital tunnel syndrome?

In addition to a comprehensive medical history and physical examination, diagnostic tests for cubital tunnel syndrome may include:

Nerve conduction tests: This test determines how quickly signals flow down a nerve to determine whether the nerve is compressed or constricted.

Electromyogram (EMG): This test examines nerve and muscle function and can be used to assess the ulnar nerve-controlled forearm muscles. If the muscles aren’t working properly, it could be a symptom of an issue with the ulnar nerve.

X-ray: This procedure is used to examine the bones of the elbow to see if you have arthritis or bone spurs.

Clinical examination is key however and its important you consult a surgeon for this.

What is the treatment for cubital tunnel syndrome?

Stopping the activity that is causing the issue is the most effective treatment for cubital tunnel syndrome.

The following non operative treatments are generally recommended as first line treatment :

  • Rest and avoid any activity that aggravates the problem, such as bending the elbow.
  • A nighttime splint or foam elbow brace.
  • The use of an elbow pad.
  • Medicines that reduce inflammation.
  • Gliding exercises for the nerves.

It is essential that you see your surgeon and the therapist who can then guide you on the appropriate treatment plan tailored for you.

If these therapies don’t have the desired result, your surgeon may recommend surgery to you.

When do I need to contact Hand and Wrist Surgeon?

If you have any of the following symptoms, contact your Hand and Wrist Surgeon:

  • Pain or difficulty moving that interferes with your normal everyday activities.
  • Treatment either does not help or makes the pain worse.
  • Arm or hand numbness, tingling, or weakness

Do you get pain in your wrist when lifting your child? You may have de Quervain’s tenosynovitis

The tendons in your wrist are affected by De Quervain’s tenosynovitis, which is a painful ailment. It happens when the two tendons at the base of your thumb swell. The sheaths (casings) that cover the tendons become inflamed and cause a narrowing of the passage through which the tendons run. This causes pain specifically with certain repetitive movements like lifting your child.

Although the actual aetiology of de Quervain’s tenosynovitis is unknown, any activity that requires repeated hand or wrist movement, such as gardening, golf, or racket sports, or lifting your child, might aggravate the condition.


Sharp or dull Pain and swelling or discomfort at the base of your thumb is the most common symptom of de Quervain’s tenosynovitis. You may also have soreness up your forearm. The discomfort may grow gradually or unexpectedly. This can become quite intense and restrict your function.

Other symptoms are:

  • The base of your thumb hurts.
  • The base of your thumb is swollen.
  • When you’re performing something that requires grabbing or pinching, it’s difficult to move your thumb and wrist.

When you move your thumb, it feels sticky. If you wait too long to cure your problem, the discomfort may move to your thumb, back into your forearm, or both. Pinching, clutching, and other thumb and wrist actions worsen the discomfort.


Chronic wrist overuse, alterations in your hormone levels, swelling and repetitive movements are the most common causes of de Quervain’s tenosynovitis. Lifting a youngster into a car seat is one regular activity that causes it. Lifting large grocery bags by the handles is another possible cause.

You are more prone to de Quervain’s tenosynovitis:

  • If you are a woman (new mothers develop it about 6 weeks after delivery
  • If repetitive hand and wrist motions are a part of your hobbies or employment.
  • If our wrist has been injured, tendon mobility can be restricted by inflammation and swelling.


Your doctor may do a simple test to diagnose de Quervain’s tenosynovitis. The Finkelstein test is what it’s called. You begin by bending your thumb so that it lays over your palm. Then you close your fingers around your thumb and create a fist. Finally, you bend your wrist in the direction of your little finger. De Quervain’s tenosynovitis is characterised by discomfort or pain near the base of the thumb.

Other tests, such as X-rays, are typically not required to diagnose the problem but may at times be helpful to differentiate other causes.


De Quervain’s tenosynovitis is treated by lowering discomfort and swelling. Treatment options include:

  • Heat or ice can be applied to the affected region.
  • Using a nonsteroidal anti-inflammatory medication (NSAID) either topically to the region or in oral tablet form (if not contra indicated- asthma/ allergies/ stomach ulcers etc.) can help with the pain
  • Activity modification by identifying movements that cause discomfort and oedema and avoiding them. Those that need repetitive hand and wrist motions should be avoided at all costs.
  • To rest your thumb and wrist, wear a splint as advised by your hand therapist or hand surgeon
  • steroid injections are quite effective and are often used to manage the problem and are usually injected under ultrasound guidance into the tendon compartment.

When should you see a hand surgeon?

if you’re already tried:

  • Avoid utilizing the thumb that is affected.
  • Using ice on the affected area
  • non-steroidal anti-inflammatory medications

If you’re still having difficulties with pain or function a hand surgeon can help advise you on the various non operative options, recommend a good hand therapist and guide you on the surgical option should the non-operative options fail. The operation when required is curative.



Are there surgical options for painful Arthritis in the hand and wrist?

Arthritis in the hands may be debilitating, causing pain, deformity, and functional impairment. It is important to distinguish if the arthritis is due to degenerative changes commonly seen with age and wear and tear, or if it’s due to an underlying inflammatory pathology like rheumatoid arthritis, gout, psoriasis, etc. 

The first line of managing the symptoms is always nonoperative. However, the help of a rheumatologist is usually required for the initial medical management of inflammatory pathology.  Activity modification, medication and gentle therapy and splinting with the help of an experienced hand therapist are the cornerstones of non-operative management. 

The next step up the ladder is to consider steroid injections preferably under image control (ultrasound or x-ray) and this can help tide over an acute phase of the symptoms. 

When the disease progresses, pain increases, movement may become restricted, and function may become impaired. Surgical options can then be considered to restore the damage caused by hand arthritis is uncommon. It is important to discuss the risks versus benefits of each option with your surgeon who help you navigate the many surgical options and choose the operation best suited to your needs and requirements.

Surgical options:

Denervation involves as the name suggests cutting the nerves that supply that joint and thus decreasing the perception of pain. It does not involve any bone or joint sacrifice but requires an operation, nonetheless. Has a reported success of about 60-70% and last for about 3-5 years. It does not treat the underlying pathology but temporarily helps with the pain.

Keyhole surgery can be useful in staging the degree of the disease and thus help plan further interventions, in some cases partial removal of the joint, joint debridement or even arthrodesis can be facilitated arthroscopically. If feasible this usually involves smaller scars and quicker rehabilitation but bear in mind this is not suitable for all patients.

Fusion or Arthrodesis entails removing the worn-out joint surfaces and fusing the joint’s bones together (usually with some form of metal work- plates, screws or wires) resulting in a joint that is stronger, more stable, and practically pain-free, but with the compromise of loss of movement in the joint. This is usually reserved for younger individuals who are engaged in high-demand physical or athletic work.

Arthroplasty is the process of removing a damaged joint and replacing it with a prosthetic joint. The objective is to alleviate discomfort while also restoring form and function to the hand. However prosthetic joints do not completely mimic normal joint movements nor does joint replacement surgery significantly improve on any lost motion in stiff joints contrary to expectations. They do permit early range of movement and return to activities but are associated with wear and tear and thus failure with loosening of the components and joint dislocations. In the right patient for the right indication, they do perform well.

Whether arthrodesis or arthroplasty is performed depends on the joint that must be treated, as well as the patient’s age, functional demands, and tolerance for stiffness etc.

If you have pain in the joints of your wrist or your finger joints, contact Mr. Mathew who can help tailor a treatment plan specific to your needs.


Carpal Tunnel Surgery: What To Expect

What is carpal tunnel release surgery, and how does it work?

Carpal tunnel release (CTR) is one of the most common hand operations, and the results are usually curative. Major complications are extremely uncommon.

The transverse carpal ligament is a tight band deep in the palm at the level of the wrist. This ligament forms the roof of a  tunnel bordered by the small bones in the wrist. This tunnel allows passage of 9 tendons and one nerve ( the median nerve) from the forearm into the hand. Any pathology that decreases space within the tunnel can compress the median nerve and cause symptoms of carpal tunnel syndrome. While it may seem illogical to purposely cut a ligament to improve hand function, long-term outcome studies have demonstrated continuous improvement of symptoms with few side effects.

The surgery is nearly always done as an outpatient procedure (i.e. you will go home the same day). We’ll go over what to expect before, during, and after surgery in this section.

What should I do to be ready for surgery?

You may be requested to go without food and drink on the day of surgery, depending on the type of anaesthesia used (more on this below). This usually means no food or drink after midnight the night before your procedure if you are having a general anesthetic.

Ask your surgeon for advice if you typically take drugs in the morning.

On the day of operation, what should I expect?

 CTR can take place in a hospital, an ambulatory surgery facility, or even a clinic or a doctor’s office.

Documentation: Prior to surgery, you may be asked to sign certain paperwork, the most significant of which is the informed consent form. The concept of informed consent is that you and your surgeon have reviewed the risks and advantages of surgery and that both the physician and the patient agree to proceed with surgery.

Anesthesia: Anesthesia for CTR can be provided in a variety of ways, including the following:

A breathing tube is used in conjunction with general anaesthesia.

Sedation is a type of anaeshetic that makes you sleepy but you dont have a breathing tube inserted and is used in combination with some form of local anaesthetic for pain relief.

Local anesthetic with tourniquet.

WALANT: wide awake local anesthetic no tourniquet.Anesthesia administered locally (usually with lidocaine with adrenaline, similar to what is used for numbing your mouth for dental work)


By far the most common technique used in my practice is WALANT, it has the minimal risks and permits quick recovery and early return home.

All of these methods have advantages and downsides, which your surgeon and/or anesthesiologist will likely address on the day of surgery or during an office visit prior to surgery.

Fasting is essential for general anaesthesia and sedation, and an IV line must be established prior to operation. There is no need to fast if the surgery is performed with only local anaesthetic, and you will be awake throughout the process.

Patients frequently worry that if they are awake, they will feel the pain of the operation. You should feel no pain during the operation after the initial injection of lidocaine. You may feel the surgeon move your hand, and you may even feel touch, but the lidocaine blocks pain very well.

What may I expect following surgery?

 Following surgery, engage in the following activities:

You’ll be sleepy after surgery if you’ve had general anesthesia and sedation, and you’ll need a ride home. For the rest of the day, you should plan on resting.

You should plan on doing only light activities for the rest of the day, regardless of the type of anesthetic you received (walking, eating, reading, TV).You’ll start to feel increasing pins and needles in your hand and fingers as the anesthetic wears off. The operation can cause numbness that lasts anywhere from a few hours to a day.


 Carpal tunnel release is a simple outpatient procedure that has a high success rate. The operation can be performed under general or local anaesthetic. Techniques that are both open and endoscopic are used. The endoscopic technique is more risky and reserved for specific indications only. Elevation and over-the-counter pain medications  are used to manage pain following surgery.

You could be back in a few days or weeks, depending on your job. Light activities week 3 , heavy activities week 6.


Causes And Treatment Of Trigger Finger, A Common Hand Problem

With the internet at your fingertips, most adults use this resource to get information about their perceived  disorder or injury. Often the wealth of information can be overwhelming and at times misleading.  It’s interesting however to note that not all patients comprehend what’s going on within their bodies to cause a particular disease or set of symptoms. This article will provide you with a better understanding of the anatomy and pathophysiology of the condition known as trigger finger, as well as a brief discussion of the causes and possible treatment options.

A tendon is like a piece of rope that connects muscle to bone. Each finger has three tendons that work in harmony and permit precise movement of the finger to facilitate fine activities like writing, picking up a coin, turning a key and also more composite movements like gripping a hammer or lifting your shopping.

If left unchecked, as you bend your  finger the two tendons on the palm side of the finger would naturally bow string away from finger. To prevent this and improve the efficiency of the tendon, there are little pulleys along the finger. 

However at times this awesome mechanism runs into problems and the tendon  that bends your finger has difficulty fitting through the tight sheath, or pulley, that holds it close to the bone near the base of your finger in the palm. When this happens the finger may lock or get stuck bent and you then have to physically straighten it and when this happens it is referred to as a “trigger finger”. This resembles the pulling and release of the trigger of a gun and hence the name. It occurs when inflammation narrows the space within the sheath that surrounds the tendon in the affected finger.

When you bend your finger, you may feel a little bump in your finger at the level of the base of the finger, usually at the level of the distal crease in the palm. As you bend and straighten the   finger and the tendon glides you may feel the little bump (nodule)  glide up and down. This usually relates to a reactive nodule on the tendon which Hueston and Wilson proposed was due to chronic repetitive friction between the flexor tendon and the enclosing sheath They compared this with the fraying that occurs at the end of a piece of thread after it has been passed numerous times through the eye of a needle. Pathology studies have shown that the inner lining of the pulley also gets significantly thickened and narrows the space available for the tendon to glide and causes it to catch and lock. Triggering can also occur in the thumb.

Morning symptoms appear to be the most severe. Nobody knows why trigger finger develops in some people but not others, or in one finger but not the others. Conditions like diabetes and thyroid disease, like rheumatoid arthritis, have an increased association  with developing one or more trigger fingers. Trigger fingers can be quite painful, and most patients seek therapy because of the pain and loss of use of the finger. In the very severe cases the affected finger may stay locked and bent and can be very painful to straighten out.

Splinting and hand therapy is the first step in the ladder of treatment options available. A good therapist can make a custom made splint that stops you bending the digit completely but permits glide of the tendon. This is effective in a large number of cases but requires up to 6 weeks of treatment. Combination with topical or oral anti-inflammatory medications( providing no contraindications like allergy, asthma or stomach ulcers etc) can help manage the pain and inflammation.

If splinting fails or the symptoms have been present for a while, Long-acting corticosteroid injections are the next step up on the ladder in initial management of the symptomatic trigger digit. Injection of the involved flexor tendon sheath provides long-term relief of symptoms in 80% of affected digits with up to 2-3 injections. The injections can be done in clinic or by a radiologist under ultrasound guidance. A recent article in the bone and joint journal has suggested that the small dose of a single injection into the digit is acceptable and does not increase your susceptibility to COVID-19. It is however advisable to have a minimum 2 week interval between your vaccination and a steroid injection. The injection can be painful and it is not advisable to drive immediately after the injection. You may need some initial additional painkillers.

If non-operative treatment fails, surgery is the final step in the ladder. This can be performed in a number of ways but the main goal is to release the so-called A1 pulley, which is where the tendon becomes caught. The tight pulley is separated after surgery, allowing your tendon to move without catching. 

The surgery can be  performed using a local anaesthetic and a needle to divide the pulley through the skin (percutaneous trigger finger release) under ultrasound guidance by a radiologist in an outpatient room. This method has slightly better short term results in experienced hands  but the long term outcomes are so far better in the open group.

Open trigger finger release is performed in a procedure room or operating room using a local anaesthetic (with or without a tourniquet on the arm) and making an incision divide the pulley under direct visualisation. The procedure takes only a few minutes and stitches are usually applied to close the wounds. The wounds take about 2 weeks to heal up but may be sore for up to 6 weeks. 

It’s noteworthy to observe that different treatment strategies have different success rates. About 80% of the time, a series of up to two injections is deemed to be successful. If conservative treatment fails or you decide to proceed to surgery, open surgery has a success rate of about 95 percent, while percutaneous surgery has a success rate of roughly 80 percent. 

Infection, nerve damage (to the digital nerves that run next to the flexor tendons and supply sensation to your fingers), tendon damage, failure to relieve symptoms (due to incorrect diagnosis or unusual cause of the triggering), loss of motion after surgery, continued tenderness, stiffness and swelling and complex regional pain syndrome are all risks associated with trigger finger surgery, as are many other hand surgeries. The chances of developing any of these issues are low, (1-5%).

The important points to remember  after surgery, regardless of how it is done, are to keep the bandage clean and dry, and to begin bending your fingers as per the hand therapists advise. While awake, you’ll need to work on finger motion every hour. Elevate your hand as much as possible over the first 48 hours. You can immediately begin using your hand for light activities (up to 1-2 lbs of lifting). The sutures (if there are any) will be removed 10-12 days following the surgery. It is common for the area at the base of the finger to be uncomfortable for up to two months, although most people return to normal activities within two to three weeks.

In summary, splinting and hand therapy are a good first line treatment for trigger finger. Long acting corticosteroid injections are the mainstay in the initial management of this pathology. Surgery is curative and has very good long term outcomes but is best reserved for when non-operative management fails. It is important to remember that we can’t speed up biology and that we have to respect the soft tissues and give them time to heal. Movement is good, heavy lifting however is not advised till the healing is complete.