Trigger finger treatment (stenosing tenosynovitis)

What is Trigger Finger Treatment?

Trigger finger is the common name for a condition called stenosing tenosynovitis, which causes one of your fingers or thumbs becomes stuck in a bent position. When the layer of protective tissue around your finger tendon (the cord that attaches muscle to bone) becomes irritated and/or inflamed, the tendon can no longer function properly, leading to pain and stiffness. In severe cases, your affected finger tendon can lock and remain in a bent position. It can affect any finger or your thumb and can be present in multiple digits at once.In cases where your trigger finger is only moderate, non-surgical treatments can usually resolve the problem. This may include resting your finger, anti-inflammatory medications, wearing a splint, steroid injections, or various stretching exercises. If these treatments don't make a difference and your finger stays in a locked position, your consultant may recommend trigger finger release surgery, which is performed under local anaesthesia and involves releasing the structure that is blocking your tendon's movement.

Trigger Finger explained

The tendons in your fingers are surrounded by a tissue layer known as the synovial sheath - a protective tube that keeps your tendons in place next to the bones of your finger or thumb. By producing synovial fluid, this sheath maintains a barrier of moisture, protecting and lubricating your tendons, which allows them to move freely.

When your tendon and/or the surrounding sheath becomes inflamed or swollen, your tendon becomes trapped in your tendon sheath, which can mean that your finger or thumb ends up being stuck in a bent position. Other symptoms of trigger finger can include:

• Painful clicking or snapping when bending or straightening your finger
• Pain that gets worse when your finger has been still, and improves after moving it
• Stiffness in your finger (particularly in the morning)
• Constant soreness at the base of your finger
• Bumps at the base of your finger (known as nodules)
• Popping or clicking as you bend and/or straighten your finger

Causes of Trigger Finger

Although there are no established causes of trigger finger, several factors may increase the chances of you developing the condition. This could include:Medical conditions

You are more likely to develop trigger finger if you have certain medical conditions that affect your tendons and joints, such as:

• Rheumatoid arthritis (a common condition that causes pain and stiffness in your joints)
• Diabetes
• Gout
• Carpal tunnel syndrome
• Tendonitis (when tendons become inflamed due to overuse)
• Infection
• Hypothyroidism (when your thyroid gland doesn't produce the right number of certain hormones)
• Dupuytren's contracture (a deformity that causes knots of tissue to form under your skin, pulling your finger into a bent position)
• Amyloidosis (an abnormal protein builds up in your organs, such as your liver)
• De Quervain's disease (a condition that affects tendons in your thumb, causing wrist pain)

Excessive hand activities

If you repeat certain movements with your finger or thumb over a prolonged period of time, such as grabbing objects or playing a guitar, it can lead to inflammation of your tendons and the development of trigger finger. Continuing to use your hand in the same way can aggravate the pain and lead to the locking of your finger tendon.

The condition is common among farmers, people who work in factories, musicians, or anyone who repeatedly bends and straightens their fingers due to activities and/or work. It is also possible for an injury to your hand to lead to trigger finger, given that impact to your finger can lead to swelling of the tendon and its surrounding sheath.

Your sex and age

Trigger finger is more prevalent in women, which can be due to a comparatively smaller synovial sheath, and most commonly shows up in people aged between 40 and 60.

What to expect at you initial consultation

Your consultant will ask you some questions about your symptoms and medical history, taking care to learn if there's anything that may have caused your symptoms, such as an injury or repeated stress on the finger. They will then conduct a physical examination, which may include the following checks:

• Asking you to bend and straighten your fingers while they feel the palm of your hand, as this helps them feel the catching of your tendon
• Checking for tenderness and/or pain when touching your affected finger
• Seeing if there's any thickening or swelling of the tendon sheath at the base of your finger
• Checking for a lump and whether it moves along with your finger

If your consultant finds that you have pain in certain areas of your finger, reduced motion, and/or evidence of locking, they should be able to confirm that you have trigger finger. Usually, no further tests are required, but in rare cases they may order an ultrasound scan, which can detect any changes in the look, size, or outline of your finger joint and will show if there's any inflammation on your joint or its surrounding synovial sheath.

Non-surgical finger treamtent

To start with, trigger finger treatment is normally non-surgical. Your consultant may recommend a variety of things you can do to improve your symptoms.

Rest

If you haven't had trigger finger for long or only have mild symptoms (i.e. your finger isn't locked in a bent position), it could be that resting your finger is enough to stop the inflammation around your tendon and synovial sheath. Before any other treatments, we will recommend that you avoid the movements that led to your trigger finger symptoms, as doing this can bring down the swelling and stop you from feeling pain and reduced movement.

Splinting

To stop your finger from moving, your consultant may strap your affected finger to a plastic splint, which is an effective way to ensure you don't keep aggravating the same tendon through various daily activities. If your finger is especially stiff when you wake up in the morning, you may be asked to swear the splint overnight.

Corticosteroid injections

Your consultant may prescribe a corticosteroid injection, which is a powerful anti-inflammatory agent that is injected into the base of your affected finger. This injection reduces the swelling in your tendon, enabling it to move freely once more. You might experience relief within a few days of the injection, but generally it takes a couple of weeks. Typically, you will only need one injection, but sometimes two are required to properly address the issue.

It has been estimated that corticosteroid injections work for 50 to 70% of people with trigger finger. However, if you have an underlying condition, such as diabetes or rheumatoid arthritis, it is less likely that this treatment will be effective.

Trigger finger exercises

Along with rest and anti-inflammatory injections, your consultant may recommend trigger finger physiotherapy treatments. This would involve a range of gentle stretching exercises that aim to decrease the stiffness around your tendon and encourage improved range of motion, which will mean less tenderness and pain in your finger.

How to prepare for Trigger Finger Surgery

If your trigger finger is severe, and conservative treatments have not worked, your consultant may recommend trigger finger surgery. Ahead of the procedure, they will explain what you need to do to prepare.

Discuss medications with your consultant

Your consultant will ask you about any medications that you are taking. If you are on any blood-thinning medications (aspirin, warfarin, anti-inflammatories, etc.), they may ask you to stop taking them two weeks in advance to avoid unwanted bleeding during and/or after your trigger finger surgery.

Gather supplies

For the first few days after your procedure, you'll be encouraged to rest your finger and avoid any unnecessary activities, so you won't be able to make quick trips to the shops. Before coming to hospital for surgery, then, be sure to gather any supplies you might need for when you're recovering at home.

Stop smoking

Smoking can negatively influence your recovery from trigger finger surgery, so we encourage you to stop smoking at least a week before the treatment. If you would like some help with smoking cessation prior to surgery, or have any questions, get in touch with your consultant.

Arrange transport home

After your trigger finger surgery, you won't be able to drive, and anaesthesia and/pain medication may make it unsafe for you to get public transport home on your own.1 So, ahead of surgery, please see if one of your friends or family members can take you home, or arrange a taxi.

What happens during trigger finger surgery?

Trigger finger release surgery is performed under local anaesthetic, which means your surgeon will make an injection into your palm that numbs the surrounding area, so you won't feel anything. They may also give you a sedative to ensure you stay relaxed throughout the procedure, which only takes between 15 minutes to half an hour. This is an outpatient surgery; you'll be able to go home on the same day as your procedure. There are two types of surgery for trigger finger: percutaneous release and trigger finger release surgery.

Percutaneous release

This procedure uses a needle to treat your affected tendon, so you won't have a scar after the treatment. Your surgeon will begin by injecting a local anaesthetic into the area, ahead of using ultrasound imaging to safely guide a special needle into the sheath around your tendon and break up tissue that has become constricted and/or inflamed around the tendon sheath, allowing your tendon to move freely through its sheath (or tunnel) once again.

Trigger finger release surgery

This type of surgery involves a small incision at the top of the palm of your hand, underneath your affected finger. Your surgeon will then locate the tendon sheath and divide your A1 pulley, which sits where your finger meets your palm and is responsible for flexing and extending your tendons. When this area has become inflamed and starts to block movement in your finger, removing a part of it allows your tendon to glide more easily through your synovial sheath.

Before closing the small incision, your surgeon may test to see if your finger can easily bend and straighten without clicking. Once they are happy that normal movement has returned, they will close the incision and cover your finger in a bandage.

Trigger finger surgery: recovery timeline

How long it takes you to fully recover from trigger finger surgery depends on the type of surgery you have and how many fingers were operated on, along with other factors, like your age and overall health. Generally, your finger will heal after a few weeks, but you may experience some swelling and/or stiffness for up to six months.

What happens immediately after surgery?

If you have had trigger finger release surgery, as opposed to percutaneous release, you may feel some pain after your surgery. If this is the case, we will provide you with pain relief medication to make sure you are comfortable. We'll give you a sling to wear for the first few days to encourage healing, and you should be able to move for finger almost immediately.

One to seven days after surgery

For the first 48 hours, we recommend that you keep your hand elevated in a sling and rest it as much as possible, taking anti-inflammatory and pain medication whenever needed. After this period, you'll be able to use your hand for light activities (dressing, brushing your teeth, etc.). You will initially have to shower with a plastic covering over your hand until your bandage is removed after four or five days.

If you have a desk job or another role that doesn't require intense gripping movements, it could be that you can return to work almost immediately. You may need to take around three to four weeks off if your job involves manual labour. You should be able to drive again when you can comfortably grip the steering wheel, which usually takes three to five days.

One to three weeks after surgery

During this period, you may be able to make a return to playing sports, provided you can confidently maintain a good grip and your wound has completely healed. To speed up your healing process and make sure your finger regains full strength and mobility, you may be given a series of hand physiotherapy exercises. This might involve exercises like passive joint motion (stretches) or tendon differential tendon gliding (bending your knuckles while keeping the middle and end joints straight)

Potential risks and complications of trigger finger surgery



Trigger finger release surgery is an extremely common procedure. Complications can occur, but these are very rare. Your consultant will explain all the risks to you beforehand, along with answering any questions you might have, so you can be fully informed decision before deciding to proceed with surgery.

General complications of any operation

• Pain
• Bleeding
• Infection in the surgical wound
• Unsightly scarring
• Blood clots
• Difficulty passing urine
• Chest infection
• Heart attack or stroke

Specific complications of trigger finger release surgery

• Stiffness in your finger that received surgery
• Inability to straighten your finger despite surgery (if you couldn’t straighten the finger completely before surgery, you might not be able to do so after)
• Soreness and/or swelling at the site of your surgery
• Persistent locking or clicking
• Bowstringing (when your tendon curves away from the bone, leading to reduced range of motion)
• Infection
• Digital nerve injury (numbness and tingling along part of your finger)