Trigger Finger

What is a trigger finger?
The mechanism that allows you to bend your fingers consists of a muscle (in the forearm) and a tendon (sinew). The tendon provides the link between the muscle (placed in the forearm where there is more space) and the bone in the finger to which it is attached.

In the finger the tendon runs in a sheath. This is designed to provide lubrication for the tendon to allow it to glide with a minimum of friction. This sheath is strengthened by pulleys. The pulleys keep the tendon in the optimal position, close to the bone. The mouth of the tendon sheath is in the palm.

In trigger finger the smooth running of the tendon is damaged. The sheath becomes thick, and the tendon can develop a nodule inside it. When you straighten you finger the nodule catches at the mouth of the sheath until it releases, with an accompanying click. The condition is not dangerous. Any finger can be affected.

What treatment is available?
There are two main types of treatment.

1. Injection.
The surgeon injects a small amount of locally active steroid (cortisone) next to the point at which the tendon is catching. This can be successful, especially in early cases. There are small risks of infection, of nerve and tendon injury and of thinning of the skin overlying the injection site.

2. Surgery.
What will the surgery aim to do?
The pulley is opened up to allow the tendons to pass freely. The surgery is normally carried out under local or general anaesthetic as a day case.

What kind of scar will I have?
All surgeons make a slightly different incision. This incision can be straight or in a zigzag pattern over the palm. You will have stitches in the wound and a bulky dressing. The stitches will be removed 10 to 14 days after the operation.

What should I do after the operation?
Your hand will be bandaged. A bulky bandage is not usually needed for long. We normally ask that your practice nurse reduce the post op dressing after 48 to 72 hours.  You can then start to move your fingers actively.

 We recommend that you take painkillers regularly for 48 hours after the operation. After this, take painkillers as required. If at this stage you have increasing pain you should seek medical advice. 

Please keep the wound clean and dry.  At five days after the operation you can get the wound in running water.

Do I need to do anything else?
You should move your fingers as soon as possible. When the stitches are removed, massage the wound with cream (E45, Neutrogena, Atrixo). Later on you may need a few sessions of physiotherapy.

How long will I be off work?
Desk job: Two weeks at most
Light manual: Four weeks
Heavy manual: Four to six weeks
Driving: On average one week

What complications can occur?
This surgery is normally safe and trouble free. The risks of complications are low. They include infection, abnormal and prolonged pain response (CRPS), nerve and tendon injury, recurrence, inflammation and prolonged swelling