Trigger Finger – Treatment
A steroid injection into the palm of the hand is the first treatment option, this will permanently settle the condition in up to 75% of patients
If the injection is not successful, subsequent ones are increasingly unlikely to be so. It is only those who don’t respond to the injection who will go on to need surgery. The object of surgery is to open up the tight collar snagging the tendon. We don’t cut out the nodule itself because that would weaken the tendon.
This surgery is highly successful, it has a 95% cure rate and risks are minimal. However, patients who have trigger finger in one digit are prone to having it in others too.
The surgery is usually performed under local anaesthetic as a day case. Once the area is numb a tourniquet is inflated around the upper arm to give a blood-free zone in the hand. An approximately 1cm transverse cut is made at the base of the affected finger or the thumb. The mouth of the tunnel through which the tendon passes is cut to open up the tight collar. The tourniquet is released and any bleeding is controlled. Fine stitches are used to close the skin and a dressing applied.
Following the surgery simple painkillers may be required for a few days. The dressings are removed after two days and the wound is covered with an Airstrip or similar. The fingers should be kept moving, pressure against the wound avoided and it should be kept covered and dry. After two weeks the stitches are removed.
Small children, usually under 1, can present with their thumb joint stuck bent because they have a nodule in the tendon which won’t pass into the tendon sheath to allow the thumb to straighten. This is called Congenital Trigger Thumb. Initially this is managed conservatively by asking the parents to massage and gently try to stretch the thumb straight. If the joint remains bent then a surgical release is performed under general anaesthetic
Like any operation, there are small risks. The scar in the hand is occasionally tender and the finger can be stiff. The most serious complication, which fortunately is very rare, is an injury to the nerves, which can cause loss of feeling in the fingertip. There is a small risk of infection and very occasionally the surgery doesn’t successful relieve the symptoms.