Trigger finger release is one of the most common surgeries we perform at Proliance Hand, Wrist and Elbow Physicians because trigger finger is one of the most common ailments of the hand. A classic trigger finger presents as a click or locking sensation in the afflicted finger as the hand goes from a grip position to an open palm or vice versa. It can be associated with other conditions, like diabetes or carpal tunnel syndrome, but it can also be present as an isolated issue. Trigger fingers can be particularly bothersome in the morning as they often become “stuck” overnight.

Why is my finger catching in the first place?

Trigger fingers are thought to be the result of damage to the flexor tendon due to overuse. To understand the fundamental problem, it is necessary to understand the basic anatomy of flexor tendons in the hand. I find it most helpful to think of a New York City subway system where the subway cars, i.e. flexor tendons, travel through an underground tunnel, i.e. tendon sheaths. It’s not hard to imagine the problems that can result if the arching tunnel is perfectly sized to fit a certain sized subway car and someone tries to drive a subway car that is much taller through the same tunnel. Classically, this mechanical irritation leads to thickening of the flexor tendon and/or tendon sheath which can be felt in the palm as an area of swelling with a small, moving nodule. With enough friction and a large enough nodule, the finger goes from just painful to painful clicking to painful locking where the finger is no longer able to fully mobilize on its own without using the other hand to force the finger open or closed.

Is surgical trigger finger release the only option for treatment?

Trigger fingers can be treated with a variety of conservative options prior to performing a formal trigger finger release surgery. The simplest form of treatment is to avoid the activities that cause the finger to trigger in the first place. While it seems obvious, authors from Dalhousie University recently described a group of patients that pursued conservative management without splinting or steroid injections and about 52% of patients experienced symptom relief after an average of about 8 months. For those of us with less patience, researchers at Massachusetts General Hospital evaluated nighttime splinting in patients with less than 3 months of symptoms and in the early stages of triggering and found that 55% had resolution of symptoms at three months. Unfortunately, many patients present with late-stage trigger fingers, i.e., the finger must be manually unlocked with the other hand, and in that case the best option is to pursue corticosteroid injections. There have been many studies regarding steroid injections and trigger fingers and the results have varied widely over the years. One of the most recent studies suggests that the long-term symptom relief from a single corticosteroid injection for single digit triggering may be as low as 45%.

What about surgery to perform a trigger finger release?

Trigger finger release surgery is a very common and safe procedure that is performed anywhere from 23,000 to well over 30,000 cases per year in Medicare patients alone. The procedure used to be performed under general anesthesia, but more and more hand surgeons and patients alike are opting for local anesthesia with or without a tourniquet given the fewer anesthetic complications associated. Local anesthesia is what the dentist uses to provide many services from filling in cavities to more involved procedures like crown placements. The success rate of trigger finger release surgery has been reported between 90 and 100% with a very low complication rate between 5-12%. Using our prior subway tunnel analogy, the simplest explanation for this procedure is that the surgeon opens the top of the tunnel to allow taller subway cars to pass through. The recovery tends to be quick with near-immediate relief from the clicking or locking sensation and full return to activity about four to six weeks after surgery.

How Can Proliance Hand, Wrist and Elbow Physicians Help?

A consultation with Proliance Hand, Wrist and Elbow Physicians can help determine if your hand suffers from trigger fingers. Our highly trained occupational therapists are onsite at our Kirkland and Bellevue offices for your convenience to see your hand surgeon and therapist quickly and conveniently. Whether it is time to try a splint or a steroid injection or surgery to get that bothersome trigger finger under control, our staff can help you make an appointment at any of our five convenient Eastside locations.

 



About the Author:

Samuel E. Galle, M.D. is a board-certified orthopedic surgeon with subspecialty fellowship training in conditions of the hand and upper extremity. He has published numerous peer-reviewed articles and surgical technique videos. He lives in Kirkland, WA with his wife, two kids and one especially spoiled Cavalier King Charles Spaniel.