Trigger Finger / Thumb
Other common names
Who does it affect?
Anyone, from babies to the very elderly
Why does it happen?
The tendons in the fingers that cause the fingers to bend (flex) may develop a nodule.
Finger flexor tendons travel in a slippy sheath along the finger, and the tendon slides in and out as the finger bends and straightens. The sheath lubricates the tendon and also prevents bowstringing of the tendons as the finger bends. In cases of trigger finger a nodule develops on the tendon. As the finger bends the nodule passes out of the sheath into the palm. As the finger straightens the nodule attempts to pass back into the sheath but becomes locked at its mouth, preventing the finger from fully straightening. The finger may be forcibly straightened with a click but should be avoided.
Locking of the finger/ thumb. The fingers fully bend (flex) but on attempting to straighten they lock with a bend. Occasionally the symptoms are not as dramatic as this but the patient may notice clicking or even feel a nodule at the base of the finger/thumb.
A nodule may be felt at the base of the finger/thumb. Occasionally the finger/thumb is locked in a flexed position.
Usually none as the condition is well understood and recognised. Occasionally an ultrasound scan may be of benefit in cases of uncertainty.
Babies that are affected have a 90% chance of the condition settling by 12 months old. If it fails to settle after this and is troublesome, then surgery is offered. Also if the thumb is locked in a child then this should be operated on early to prevent joint problems
In adults, a steroid injection into the sheath may lubricate and also damp down the inflammation. Steroid injections can be repeated once. Further attempts may damage the tendon and surgery would be advised after one or two failed injections. It is essential for injections to be performed anatomically correctly by an experienced surgeon, fully knowledgeable of the fine inner structures of the hand such as the nerves and tendons.
Surgery is performed as a day case procedure usually under local anaesthetic and takes about 10 minutes.
Local anaesthetic is administered. Once numb the skin is incised and then the underlying fat is retracted. Care is taken not to injure nerves and blood vessels to the digit. At the base of the wound is the flexor sheath. The mouth of this structure (A1 pulley) needs to be released to allow the tendon and its nodule to glide in and out without catching. The nodule is not removed. The skin is sutured and a bulky dressing is applied.
You can go home soon after the operation. The anaesthetic will wear off after approximately 6 hours. Simple analgesia (pain killers) usually controls the pain and should be started before the anaesthetic has worn off. The hand should be elevated as much as possible for the first 5 days to prevent the hand and fingers swelling. Gently bend and straighten the fingers from day 1. The dressing should be removed soon after your operation. The wound is cleaned and redressed with a simple dressing. The sutures are removed at about 10 days.
Return to normal routine
Keep the wound dry until the stitches are out at 10 days.
Return to driving: The hand needs to have full control of the steering wheel and left hand the gear stick. You are advised to avoid driving for at least 7 days or until the sutures (stitches) are removed.
Return to work: Everyone has different work environments. Returning to heavy manual labour should be prevented for approximately 4 - 6 weeks. Early return to heavy work may cause the tendons and nerve to scar into the released ligament. You will be given advice on your own particular situation.
Overall over 95% are happy with the result. However complications can occur.
General risks (less than 1% each):
- Neuroma (nerve pain)
Reflex Sympathetic Dystrophy - RSD (<1% people suffer a reaction to surgery with painful stiff hands, which can occur with any hand surgery from a minor procedure to a complex reconstruction).
- Failure to completely resolve the symptoms (less than 1%) - this may be due to failure to completely release the area that is catching. This is rare but may be released again.
- Injury to the blood vessels and nerves to the finger (less than 1%) - this may leave one side of the finger numb. If this occurs, the wound should be explored and if injured, the nerve repaired.