What is a trigger finger, or stenosing tenosynovitis?
Stenosing tenosynovitis (trigger finger) is a condition that affects finger tendons and tendon sheaths. The tendons are in fact connectors between the muscle and the individual finger phalanxes. The tendon sheath consists of multiple circles that create a tunnel through which the tendon is running. The tendon sheaths exactly determine places through which the tendons slide.
In normal condition, the tendons smoothly slide inside these tunnels. However, in the case of a trigger finger, the tendon sheath, which is located at the base of the finger, becomes swollen and the tendon starts to "catch" during a movement. The movement of the finger becomes painful, the tendon becomes inflamed and swollen and subsequently the pain deteriorates. Over time, a bump can appear on the tendon and impair the bending of the finger.
What causes trigger finger (stenosing tenosynovitis)?
The cause is not always clear. Some trigger fingers are associated with other conditions such as rheumatoid arthritis or diabetes. Injury to the palm or finger can also be a trigger factor. In most cases, however, the cause is unknown.
Trigger finger symptoms
The condition starts with a pain in the base of a finger in the palm. This area is sensitive to pressure. We can often feel a painful bump in this area.
Trigger finger treatment
The trigger finger treatment depends on the severity of the symptoms. The aim is to eliminate the trigger finger and provide full moveability. To achieve this, it is necessary to remove the swelling around the tendon. Sometimes, fixing the finger and taking anti-inflammatory pills can help. Changing the hand activities is also an option. However, if a conservative treatment fails, a surgery is recommended.
Trigger finger treatment methods:
1/ Conservative treatment
At the beginning, especially if the symptoms are mild, a conservative treatment can be used. The patients can take anti-inflammatory pills that relieve the pain and tendon inflammation. Fixing the finger, thus preventing its bending and allowing the tendon to relax, can also help. In some cases, it is convenient to change the hand activities in order to minimize overloading the affected finger.
2/ Injection treatment
If a conservative treatment brings no relief, corticosteroid injections administered directly into the inflammation area can be an option. The injections can reduce the inflammation and relieve the moveability of the finger. However, the effect is only temporary.
3/ Surgical treatment
If conservative and injection treatments fail, a surgery is recommended. It is carried out under local anaesthesia, usually as a day-case surgery. The aim is to disrupt the swollen tendon sheath in the palm, thus freeing the tendon and providing a free movement of the finger. This treatment brings long-term results and the patient can immediately start rehabilitation exercises. The stitches are removed after two weeks. The exercises start immediately after the surgery. The stitches are removed after two weeks.
Course of the surgery:
- Anaesthesia: The surgery is performed under local anaesthesia, which means that the patient feels no pain in the hand area, but remains conscious. The local anaesthesia is applied directly to the palm where the affected tendon sheath is located.
- Accessing the tendon: After anaesthetising the hand, the surgeon performs a small incision, usually in the area where the finger "catches". This cut is about 1-2 cm long so that it allows access to the tendon and its sheath that causes the problem.
- Releasing the tendon (tendon sheath): The most frequent method is the so-called release surgery where the surgeon severs or cuts off the swollen tendon sheath. This will release the tendon and restore its smooth movement within the tendon tunnel. This process is known as tenolysis.
- Removing the bump: If an inflammatory bump develops on the tendon and impairs the movement, the surgeon can remove or reduce it so that the tendon can slide smoothly again.
- Closing the wound: After a successful release of the tendon, the surgeon stitches up the small incision with small surgical seams. The stitches are usually removed within 10 to 14 days after the surgery, depending on the speed of healing.
- Minimally invasive methods: In some cases, a minimally invasive method, where a needle is used for the tendon release, is applied instead of a traditional incision. This treatment, which is known as percutaneous release, leaves a smaller scar. However, it is suitable only for particular cases and has a higher risk of recurrence.
Trigger finger postoperative recovery
Full recovery usually takes 4-6 weeks, depending on the severity of the condition and healing speed.
The recovery is relatively short and the patient can usually return to the normal activities within several weeks.
After the surgery, the patient should keep the finger moving to prevent the development of scar tissue, which could impair the finger's moveability.
The surgery can be followed by a mild pain and swelling, which can be managed by painkillers and by lifting the hand above the heart level.
The doctor will recommend rehabilitation exercises, which also support speedy recovery.
Possible complications of trigger finger treatment
Although the trigger finger surgery is a relatively safe and simple treatment, certain complications can arise, as in any other surgery. However, these complications are rare. Possible complications of surgery include:
Wound infection
Although the surgery is minimally invasive, there is a risk of infection in the surgical area. It can appear as reddening, swelling, pain or discharge from the wound. In this case, it is necessary to take antibiotics.
Nerve injuries
The palm contains fine nerve endings, which can become unintentionally damaged during the surgery. This can lead to temporary or even permanent numbness, tingling or reduced sensitivity in the operated area of the finger or palm.
Scarring
Although the surgical incision is small, excessive scar tissue may develop and limit the finger's moveability, thus requiring further treatment.
Relapse
In some cases, the condition can return, especially if an insufficient amount of swollen tissue was removed during the surgery. The risk of relapse is higher with minimally invasive methods such as percutaneous release.
Bleeding or haematoma
The surgery may be followed by minor bleeding or haematoma, which can cause pain and swelling. In most cases, these problems are resolved spontaneously, but in rare situations, they may require a medical treatment.
Restricted finger moveability
The surgery may sometimes lead to restricted finger moveability, especially if sufficient rehabilitation has not been provided. Scar tissue or swelling can also sometimes affect the moveability of the finger.
Trigger finger surgery contraindications
Not all patients are suitable candidates for trigger finger surgery. There are certain health conditions and factors that can increase a risk of complications or make the surgery inappropriate. The main contraindications:
- Active infection: If the patient suffers from infection in the palm or finger area, the surgery is postponed until the infection is treated in order to reduce the risk of infection spreading.
- Blood clotting disorders: Patients with reduced blood clotting disorder (taking anticoagulants), can suffer from a higher risk of bleeding during and after the surgery. In these cases, the surgery must be carefully planned in cooperation with the doctor to minimize the risks.
- Diabetes: Patients with uncontrolled diabetes may suffer from bad wound healing and higher risk of infection. Before the surgery, it is necessary to ensure that the level of sugar in the blood is under control.
- Immune system disorders: Patients with a weakened immune system, for example after chemotherapy or chronic diseases, may be more susceptible to infections and complications connected with the surgery.
- Allergy to anaesthetics or other medicines: If a patient suffers from an allergy to the local anaesthetics or other medicines used during the surgery, it is necessary to choose alternative treatments or adapt the treatment to the patient's health condition.
Before each operation, the patient should undergo a thorough examination and consultation with the doctor who will assess all the risks and determine whether the patient is a suitable candidate for the surgery or not.
Frequently asked questions
What causes trigger finger?
- The cause of the trigger finger is not always clear. It is often connected with other conditions such as rheumatoid arthritis or diabetes; sometimes it can be connected with a finger or palm injury.
What are the symptoms of trigger finger?
- The symptoms include pain and sensitivity in the finger base, mainly in the palm area. A bump may develop on the tendon and cause "catching" of the finger during a movement; it is then difficult to straighten the finger.
How is trigger finger treated?
- The treatment comprises conservative methods such as anti-inflammatory drugs, fixation and corticosteroid injections. If these procedures fail, a surgery will permanently deal with this problem.
Is trigger finger surgery difficult and painful?
- No, the trigger finger surgery is performed as a day-case surgery under local anaesthesia. The surgery is short and the patient can go home immediately after the treatment.
How long does trigger finger postoperative recovery take?
- Full recovery usually takes 4 to 6 weeks during which regular rehabilitation is required to restore the moveability of the finger.
