Trigger finger - surgical procedure

What is trigger finger?

Trigger finger is a condition where chronic inflammation leads to a thickening of the flexor tendon sheath near the A1 pulley. This change hinders the smooth gliding of the tendons during finger flexion and extension.

The most common cause of the problem is overuse related to repeatedly performing bending and straightening movements of the fingers. Initially, symptoms may be less severe, but as the disease progresses, moving the finger becomes increasingly difficult.

A characteristic symptom is the finger clicking or snapping during bending or straightening. In more advanced cases, the finger may become completely locked. The symptoms may be accompanied by pain, which further limits hand function.

When is trigger finger surgery performed?

In the early stages of the disease, conservative treatment can be used. This may include anti-inflammatory drugs or steroid injections. The doctor decides on the appropriate method of treatment based on an examination of the hand and the severity of the condition.

Surgery is considered when conservative treatment does not bring the expected improvement, and the clicking, pain, or locking of the finger continues to hinder daily functioning.

The goal of the procedure is to create conditions for the flexor tendons to move freely again. As a result, the surgery can improve the finger's range of motion and reduce the pain and discomfort associated with the condition.

What does trigger finger surgery involve?

The procedure involves cutting the thickened A1 pulley and releasing the flexor tendons. Removing the obstacle that restricts their movement allows for freer bending and straightening of the finger.

The surgery is performed under local infiltration anesthesia. A pressure cuff is placed on the arm to keep the surgical field bloodless.

After cutting the pulley and releasing the tendons, the skin incision is closed with stitches. A thin drain is also left in the wound, which is removed the next day during the dressing change.

How to prepare for trigger finger surgery?

Preparation begins with a surgical consultation. The doctor examines the hand, assesses the finger's mobility, and the severity of the symptoms. Based on this, they qualify the patient for the procedure and present a treatment plan.

An ultrasound is often necessary. This examination allows for the assessment of the thickness of the A1 pulley. Before the surgery, the doctor will also order basic laboratory tests.

Medications that affect blood clotting may need to be temporarily discontinued. However, the method and timing of changing your treatment must be determined with your doctor in each case. Do not stop taking prescribed medications on your own. During your consultation, you must inform your doctor about all medications you are taking.

Before the surgery, you should also:

• stop using products containing nicotine,
• remove jewelry from the hand being operated on,
• remove artificial nails.

Recovery after trigger finger surgery

After the surgery, the hand is secured with a dressing. In the initial post-operative period, you should keep it elevated, roughly at heart level. Wearing the hand in a sling helps with this.

Positioning the operated limb in this way limits the development of post-operative swelling. Any drain left in the wound is removed the following day during the dressing change.

Stitches are usually removed after 10–14 days. Until then, follow the instructions regarding dressings and post-operative check-ups.

Return to daily activities should be gradual. The pace of increasing activity depends on the healing process, the range of motion in the finger, and the surgeon's individual recommendations.

Post-operative exercises

Regular exercises for the operated finger are an important part of recovery. These include bending and straightening the finger according to the instructions provided.

Exercises help maintain full finger mobility after the tendons have been released. They should be performed within the range and frequency recommended by the surgeon.

Do not increase the intensity of exercises on your own, especially if movement causes increased discomfort or if you have any concerns. Your approach should be adjusted to the healing stage of the operated hand.

What results can be expected after surgery?

The goal of the surgery is to release the flexor tendons so they can move freely again when the finger moves. This can eliminate the characteristic clicking or locking of the finger, reduce pain, and improve mobility.

The extent and rate of improvement vary by individual. Proper healing and regular performance of the recommended finger flexion and extension exercises are very important.

A final assessment of hand function should be made after recovery is complete. Removing the stitches does not always mean that the process of regaining full mobility is finished.

Scarring after trigger finger surgery

The procedure requires a skin incision, which is closed with stitches after the surgery. Consequently, a scar will remain at the surgical site.

Follow the dressing instructions until the stitches are removed. Further care for the surgical site should be determined with your surgeon and adjusted based on the healing process.

Contraindications for trigger finger surgery

The procedure is contraindicated in cases of:

• active skin infection in the area of the hand to be operated on,
• uncontrolled chronic conditions, such as diabetes or hypertension,
• blood clotting disorders.

Final eligibility is determined during a consultation. The surgeon evaluates the condition of the hand, the severity of the condition, test results, and the patient's overall health.