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Treatment for Trigger Finger

Trigger-finger

TREATMENT

Nonsurgical Treatment

Initial treatment for a trigger finger is usually nonsurgical.

Rest. Resting your hand and avoiding activities that make it worse may be enough to resolve the problem.

Splinting. Wearing a splint at night to keep the affected finger or thumb in a straight position while you sleep may be helpful.

Exercises. Gentle stretching exercises can help decrease stiffness and improve range of motion in the involved digit.

Medications. Over-the-counter medications, such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs), can help relieve pain and inflammation.

Steroid injections. Corticosteroid, or cortisone, is an anti-inflammatory agent that can be injected into the tendon sheath at the base of the trigger finger. A steroid injection may resolve the triggering over a period of one day to several weeks. If symptoms do not improve with time, a second injection may be given. If two injections do not help the problem, surgery may be considered. 

Steroid injections are less likely to be effective in patients with diabetes, but may still help avoid surgery. They can cause a short-term rise in blood sugar, so glucose levels in diabetic patients should be monitored after injection.

 
Steroid injection into A1 pulley

Photo and illustration show a steroid injection into the A1 pulley.

Reproduced from JF Sarwark, ed: Essentials of Musculoskeletal Care, ed 4. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2010.

Surgical Treatment

If your finger does not get better with nonsurgical treatment, you may wish to consider surgery. Surgery is elective. The decision for surgery is based on how much pain or loss of function you have in your finger. If, however, your finger or thumb is stuck in a flexed or bent position, your doctor may recommend surgery to prevent permanent stiffness.

Surgical procedure. The surgical procedure for trigger finger is called “tenolysis” or “trigger finger release.”

The goal of the procedure is to release the A1 pulley that is blocking tendon movement so the flexor tendon can glide more easily through the tendon sheath. Typically, the procedure is done in an outpatient setting with an injection of local anesthesia to numb the area for surgery.

Surgery is performed through either a small open incision in the palm or with the tip of a needle. The A1 pulley is divided (released) so that the flexor tendon can glide freely. Although pulleys have an important function in the hand, releasing the A1 pulley should not cause problems in the future.

 
Trigger finger release surgery

During trigger release surgery, the A1 pulley is cut (dotted blue line).

Reproduced and adapted from JF Sarwark, ed: Essentials of Musculoskeletal Care, ed 4. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2010.

Complications. Complications can occur with any type of surgery. Your doctor will discuss the risks with you before surgery and will take specific measures to help prevent complications.

The most common complications following surgery for trigger finger or trigger thumb include:

  • Stiffness in the involved finger.
  • Inability to straighten the involved finger. If you were not able to straighten your finger completely before surgery, you might not be able to do so afterward.
  • Temporary soreness or swelling at the site of surgery

Less common complications include:

  • Persistent locking or clicking. This may indicate that more of the pulley needs to be released or may be caused by another problem in your finger.
  • “Bowstringing.” In a small number of cases, the tendon may “bow” away from the bone, resulting in reduced range of motion. Bowstringing occurs when one of the more important pulleys is released.
  • Infection (rare)
  • Digital nerve injury. This may cause numbness or tingling along part of the finger.

Recovery. Most patients are encouraged to move their finger immediately after surgery.

It is common to have some soreness in your palm. Elevating your hand above your heart can help reduce pain and swelling.

Although your incision will heal within a few weeks, it may take from 4 to 6 months for swelling and stiffness in your hand and fingers or thumb to go away completely.

If stiffness, swelling, or pain persist after surgery, your doctor may recommend seeing a hand therapist.

Outcome. Patients who have surgery experience significant improvement in function as well as relief from the pain of a trigger finger. Still, if a contracture or loss of motion was present before surgery, complete range of motion may not be restored.

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