By Michael Cohn, M.D.
What is a trigger finger?
Trigger finger (or thumb) is the term for a very common type of tendon entrapment. It can occur in any of the digits. It's also known as stenosing tenosynovitis.
Symptoms can include pain where the finger (or thumb) meets the palm, clicking on flexion and extension, or locking of the digit when fully flexed. The tendons connect the muscles of the forearm with the bones of the fingers and thumb. The tendons are held closely against the bone of the fingers by a pulley system, a series of rings, that form a tunnel through which the tendons glide.
The gliding is aided by a slick tendon lining called tenosynovium. Trigger finger occurs when the pulley at the base of the finger, or thumb, becomes too thick and constricting around the tendon, making it difficult for the tendon to move through the pulley, or the tendon develops a nodule or swelling of its lining (tenosynovium).
This creates a discrepancy between the size of the tendon and the size of the entrance to the tendon sheath. This size discrepancy creates resistance to the gliding of the tendon through the tendon tunnel, and often results in pain, popping or catching with movement. When the tendon catches, it produces inflammation and swelling, leading to a cycle of triggering, pain. On occasion, this will lead to joint stiffness.
What is the treatment for trigger finger?
The goal of treatment is to eliminate the catching or locking and allow full movement of the finger without discomfort. This may be accomplished by non-surgical interventions such as:
- Cortisone injection into the area around the tendon and pulley to reduce the inflammation
- Oral medications (NSAIDs or corticosteroids)
- Wearing a splint to restrict movement and irritation of the tendon
- Reducing activities that cause pain
If non-operative treatment measures do not relieve the symptoms, surgery may be recommended. The goal of surgery is to widen the opening of the tunnel so the tendon can glide through it more easily.
The surgery is typically done under local anesthesia, and sometimes in conjunction with intravenous (IV) sedation.
Traditional surgery includes an open approach to direct visualization of the entrapped tendon, with release of the tendon tunnel with scissors or a scalpel.
Dr. Cohn utilizes a minimally invasive technique with a tiny 1/4 inch incision in the palm (see image below of marked incision). The process is "percutaneous," accomplished by inserting a specialized instrument (shown upright) to release the tendon tunnel entrapping the tendon from gliding.
This 5-minute procedure is done under local anesthesia, with no medical clearance required, and no stitches. This minimally invasive procedure typically leads to less pain than traditional surgery, faster recovery, and no return office visit is required for removal of stitches. Return to light use of the hand immediately, and unrestricted full use of the hand after the small wound heals in 1-2 weeks.
What is the rehabilitation following percutaneous surgery?
Movement of the fingers should begin immediately after surgery. Normal use of the hand can usually be resumed when comfort permits.
The patient may experience pain, discomfort and swelling about the area of the surgery for the first 24 - 48 hours.
Immediately following the procedure, the hand is wrapped with a compressive bandage to aid in swelling reduction and minimize bleeding. After 2 days, this is removed and the incision with its steri-strip are covered with a band-aid which is changed daily. A small amount of hydrogen peroxide should be applied with a q-tip to the steri-strip when changing the band-aid, to keep the wound clean.
The hand should be kept dry until a scab forms over the incision area, then it can be treated normally.
The middle joint of the finger may have occasional soreness for several months following the procedure.
What are the possible complications of a trigger finger release?
Trigger finger release surgery is very safe and effective; however, there can be complications as with any procedure. There is a small chance of infection, recurrence of triggering, stiffness due to pre-existing joint stiffness or inadequate post-operative movement of the digits, and damage to nerves or tendons. If there is any concern after the procedure, call to discuss or schedule an office visit.