Private trigger finger release

Trigger finger happens when there is a problem with the tendons or the sheaths which cover them, due to swelling or inflammation. The causes of trigger finger are not known, but it is more common in women, people over 40 and those with particular medical conditions (such as Dupuytren’s contraction, diabetes and arthritis).

Where there is swelling or inflammation, the tendon may snag within its protective sheath. This can result in:

• A clicking sound
• Difficulty bending the affected digit over time
• A bent digit suddenly ‘popping’ straight again
• An inability to straighten a finger or thumb which has become bent

The thumb, little finger and ring finger are the digits most commonly affected. Trigger finger can affect more than one digit and can occur in both hands. It is more common in the right hand, but this is probably because most people are right-handed.

For a lot of people trigger finger gets better on its own. However, if episodes are regular or have resulted in the permanent bending of a finger or thumb which gets in the way of everyday life, a check-up by a GP is recommended and he or she may advise a range of treatment depending on the severity of the condition.

There are levels of treatment depending on the severity of the condition, and these include:

• Avoiding activities which cause pain combined with taking non-steroidal anti-inflammatory drugs
• Strapping the affected digit to a plastic splint to restrict movement
• Corticosteroid injections
• As a last resort, surgery

Surgery releases the sheath around the tendon to allow it to move again. There are two types of surgery:

• Open trigger release surgery, where the surgeon injects local anaesthetic in to your hand and makes an incision in one of the natural creases in your palm, carefully cutting the tendon sheath to make it wider. Your wound will be stitched and bandaged. This is the preferred method
• Percutaneous trigger release surgery, where the surgeon will again inject local anaesthetic into your hand but this time inserts a needle into the base of the affected digit to slice through the ligament to get to the tendon. While this method means no wound, it is slightly more risky than open trigger release surgery and may not be as effective at resolving the problem

If you have rheumatoid arthritis these procedures may not be right for you, in which case your surgeon will use another technique which removes part of the tendon sheath to allow the tendon to move again.

The operation takes about 20 minutes.

Trigger finger release surgery is a day case procedure carried out under local anaesthetic, so there is no need for a stay in hospital. The anaesthetic will leave your hand numb and you may be bandaged, so you should arrange for transport to take you home – you will not be able to drive.

You should be able to move the treated finger or thumb straight away. Dressings can come off after a few days and within a couple of weeks you should have full movement.

You may be able to write and use a keyboard immediately and after three to five days, when you feel safe to do so, you can resume driving.

Once your wound has healed and you have built up your grip, you can play sports – this usually takes about two to three weeks.

You may not need to take any time off work if you have a desk job or one with very light manual duties, but if your job involves manual labour you may need to plan for up to four weeks off.

Recovery periods may be longer if you have had more than one finger or thumb treated. You will be given instructions when you leave us about how to clean and care for your wound. You may require physiotherapy or occupational therapy if your condition was severe before the operation.

Tigger finger release is a safe operation and complications are rare but may include:

• Infection
• Pain or stiffness
• A tender scar
• Nerve damage
• Tendon bowstringing (where the tendon is in the wrong place)
• Complex regional pain syndrome (which usually resolves itself after several months).

A pre-operative assessment is our opportunity to ensure that the procedure for which you have been referred is right for you. We’ll explain your treatment to you and make sure that you are well enough to go ahead with it. It is also your opportunity to meet the team who will care for you and to ask any questions.