Trigger Finger Surgery

What is a trigger finger?

Tendons connect muscle and bone together. The muscles that move the fingers and thumb are in your fore arm. Long tendons called flexor tendons extend through the wrist and attach to the small bones of your fingers and thumb.

In the finger a tendon sheath surrounds the tendons and the bones creating a tunnel. When the fingers are moved the flexor tendon slides through this snug tunnel.

The flexor tendon can become irritated or inflamed as it slides through the tunnel.
This can cause the tendon to thicken and a nodule to form narrowing the space
within the sheath that surrounds the tendon. A ‘trigger finger’ is where the tendon
becomes stuck or unable to slide through the tunnel and the finger is unable to
straighten.

Who gets trigger finger?

Trigger finger is more common in females between the ages of 40 and 60.

If you have diabetes, rheumatoid arthritis or an under active thyroid gland you are more likely to get trigger finger. Strain on hand caused by activity or work can also cause trigger finger.

What symptoms does it cause?

Symptoms usually start without any injury, but can follow a period of heavy hand use.
The symptoms include:

• a tender lump in the palm of your hand
• swelling
• a catching or popping sensation in your finger or thumb joints
• pain when bending or straightening your fingers.

Sometimes more than one finger can be affected.

What tests do I need?

The orthopaedic consultant / doctor or specialist nurse can ascertain if you have trigger finger by examining your hand in clinic. You will not usually require an x-ray.

What are the treatment options?

Non-surgical

• Rest – a referral to an occupational hand therapist for a splint to be made. This will help keep your finger / thumb in a position to prevent further triggering. The splint will initially be kept on for three weeks.
• Medication – a non-steroidal anti-inflammatory suggested by your doctor or pharmacist can be used to relieve the pain. Check with your doctor first to ensure you are able to take these.
• Injections – a corticosteroid injection into the tendon sheath can be administered. This is not guaranteed to be effective and if two injections do not help, then surgery will be recommended.

Surgical

Surgical treatment is a day-only procedure and is conducted using a local anaesthetic.
Fasting is not required for this procedure.

If you have been recommended for a general anaesthetic by your doctor for any
reason, you will need to attend a pre-admission appointment to have your medical
history assessed by the nursing staff.

The goal of the surgery is to widen the tunnel so that the tendon can slide through
more easily.

A small incision is made into the palm of the hand. The tendon sheath is cut releasing
the tightness and when healed will allow the tendon to move freely once again.

Please complete the 'My checklist to be ready for surgery'.

What complications could occur?

Complications can occur but are rare. If you have diabetes, are elderly or if you smoke
your recovery may be slower.

• Persistent “triggering” where the finger continues to get stuck. This could be due to incomplete excision of the tendon sheath
• Bow stringing of the sheath due to the tendon sheath being too slack
• Infection
• Nerve injury
• Regional pain syndrome
• Complex regional pain syndrome
• Painful scar
• Stiffness in the affected finger
• Recurrence.

What can I expect after my operation?

Wound - Your incision will be closed with 2 – 3 stitches per incision and will be dressed with a large bulky dressing which you will need to keep dry.

Going home - As this procedure is usually done using a local anaesthetic, it is anticipated you will be discharged from hospital shortly after you return back to the ward.
Sometimes you are referred to the Occupational Hand Therapy Unit for follow-up.
Make sure you have organised someone to pick you up from hospital.

Activity - You are not to lift anything with your operated hand for two weeks, not even a kettle or pot. This is to ensure that healing can take place.
Your activity can increase after you have seen your GP to have the stitches removed (see follow-up plan), however, you are still to do NO heavy lifting for another 4 weeks.
(Yes you can pick up a kettle now—but nothing heavier).

Follow-up plan - At two week after surgery you will need to make a follow-up appointment to see your GP to have the bulky dressing taken off, your stitches removed and a simple Band-Aid applied.
At six weeks after your surgery you will have an appointment to see your surgeon. Your surgeon will check the wound, movement of your fingers and thumb and the sensation in your hand.
The surgeon may refer you to the OT hand therapist if you require further treatment.

Acknowlegements

Staff of Mater Hospital Brisbane.

For more information about Mater Hospital Brisbane—South Brisbane, please call Reception on 07 3163 8111.

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