Trigger Finger

Dr Senthil Velan.

MBBS, D Ortho, MRCS(UK) FRCS (Ortho),

FEBOT, Fellow European Board Orthopaedics and Trauma.

Consultant Shoulder, Elbow & Wrist Surgeon

Apollo Hospitals Ayanambakkam, Chennai, India.

Apollo Clinic, Annanagar.

For appointments Contact 082205009176/velansenthil78@yahoo.com

Trigger Finger

What is it?
The tendons that bend your fingers run through a tunnel or sheath. Trigger finger is caused by a thickening on the tendon, which causes it to catch as it runs in and out of the sheath. You can often feel this swelling in the palm as you move the finger. Patients complain of pain in the palm at the base of the affected finger and episodes of the finger being stuck, bent down. This can be relieved by pushing the finger out straight, causing a snap which can be painful. Patients often wake in the morning with the finger stuck down.

Picture showing Evidence of Trigger Right Ring Finger

What can be done?

There are two ways of treating the problem.

1. Steroid Injection - A small amount of steroid is injected around the tendon. This flattens out the swelling on the tendon allowing it to glide freely in and out of the sheath once more. A single injection is all that is needed in 50% of cases. A further 25% will respond to another injection (i.e. three-quarters of cases can be successfully treated in this way). The steroid injection does not work immediately. It causes no general side-effects but occasionally the skin around the injection-site can be made a little thinner. Thus two injections are the maximum.

   

   Steroid Injection into triggering site.

2. Surgery - This is needed if the steroid injections do not work. It involves a small procedure usually under local anaesthetic. A slit is made in the mouth of the sheath to prevent the tendon catching at this point. The condition can occur in the affected or any other finger again in the future. Surgey is more common in patients with multiple trigger fingers and in Diabetic patients.

Picture showing released Tendon from constriction.

Post-operative care

After the operation, you will be in a big bandage, but the fingers will be free to move. It is important to move all fingers and thumb straight away, as well as keep the hand raised (above the level of your heart) for at least 72 hours to help with swelling and stiffness.

This bulky dressing can be taken down at 72 hrs and a light sticky dressing applied to the wound. There will initially be some swelling and bruising, however, if you have any worries contact your G.P (i.e increasing pain, swelling, redness) The stitches are usually dissolvable. You will be reviewed in the Orthopaedic clinic at 2- 6 weeks. Timing of your return to work is variable according to your occupation and you should discuss this.

Infection

Any operation can be followed by infection and this would be treated with antibiotics.

Scar
You will have a scar on the palm. This will be somewhat firm to touch and tender for 6-8 weeks. This can be helped by massaging the area firmly with moisturizing cream.

Stiffness
About 5% (1 in 20) of people are sensitive to hand surgery and their hand may become swollen, painful and stiff after any operation (Complex regional pain syndrome).This problem cannot be predicted but will be watched for afterwards and treated with physiotherapy.

Nerve
The nerves running to the fingers can be damaged during the surgery and cause numbness in part of the finger. This is very rare.

Recurrence
As mentioned above, the triggering can recur. However this is rare.