Trigger finger is a condition in which one of your fingers gets locked in a bent position and will straighten with a painful pop, click, or snap — like a trigger being pulled and released. Patients may also present with an inability to move a finger from a fixed flexed position. Sometimes, a bump or nodule may also develop at the base of your finger close to the palm. In advanced stages, it may not be possible to uncurl your finger without using the other hand. To make things worse, if the trigger finger involves your dominant hand, it will greatly interfere with your work and daily activities.
How is Trigger Finger Diagnosed and Treated?
According to Dr. Wayne Weil, a board-certified orthopedic surgeon with a clinical focus on hand surgery, the diagnosis of trigger finger relies on the history and clinical exam. A snapping sensation, click, or crepitus over the affected finger is all that’s needed to diagnose trigger finger.
The management of trigger finger can be non-surgical or surgical:
Non-surgical
In uncomplicated cases when symptoms have been present for just a short duration, Dr. Weil prefers using steroid injections to treat a trigger finger instead of surgery.
Steroid injection
Steroid injection is often a first-line treatment strategy for trigger finger. It is an easily performed and less invasive procedure as compared to surgery. The anti-inflammatory agent is injected into the tendon sheath at the base of your trigger finger. Nonetheless, a steroid shot has its pros and cons. Although steroid shots (not more than two) may benefit a lot of patients, symptoms can still return. In patients with long-standing or severe symptoms, Dr. Weil doesn’t favor steroid shots owing to subpar results.
Surgical
The surgical procedure for trigger finger is called trigger finger release, or tenolysis. Dr. Weil recommends surgical release when there is:
- No improvement with conservative management and/or steroid shots
- Permanently locked trigger finger
Open release is preferred over percutaneous release of the A1 pulley because the risk of nerve damage and tendon damage is significantly less with open releases. The goal of the procedure is to release the A1 pulley that is hampering tendon movement to allow the affected flexor tendon to glide freely through the tendon sheath.
Typically, the procedure is done as an outpatient. After prepping and numbing the area for surgery, a small incision is made in the palm in line with the affected finger. The skin is then retracted to get down to the whitish-colored tendon sheath while taking care not to damage any nearby nerves and vascular structures. The tendon sheath is divided (released) so the flexor tendon can glide with ease. Before closing the area, your surgeon will check your finger and hand movements. If all looks well, the area is finally washed and closed.
The Recovery Period and Outcome of Surgery
After surgery, Dr. Weil encourages patients to start moving their fingers right away.
Some degree of soreness in your palm lasting for a few days is normal. Using ice packs along with the prescribed postoperative medications can help ease the pain. Elevating the hand for the first 48 hours after surgery is beneficial as well.
