Melbourne Hand Surgery

Trigger finger and thumb

Trigger finger is a very common condition that causes pain and/or locking of the affected finger. The affected finger is usually able to be bent into a fist with the other fingers, but when the hand is straightened the affected finger straightens with a "click' or visible give, or it stays bent. Triggering of the thumb (trigger thumb) can also occur.

In the excellent video below Dr Kerrigan explains about the symptoms and treatment of trigger finger (both non-surgical and surgical). Note: this video is from the United States, so the names of the pain medications mentioned will likely be unfamiliar to you.

Causes

Most cases of trigger are not due to anything in particular, but trigger finger is more common in people with rheumatoid arthritis, osteoarthritis, pregnancy, diabetes, hypothyroidism and end stage kidney disease.

Diagnosis

Your hand surgeon will be able to diagnose the condition by talking to you and examining your finger. No X-rays or special tests are required.

Injection treatment

injectionsyringehandCorticosteroid injections are commonly used to treat trigger finger. Up to three injections are given, spaced 6-12 weeks apart. Injection therapy is very successful and is done as an office procedure. A single needle is placed through the palm, near the base of the affected finger(s). Time off work is not required.

It can be beneficial to wear a splint on the affected finger to reduce pain and minimise inflammation while the corticosteroid injection is taking effect. Wearing a splint may help to resolve the problem in the early stages.

What is it like to have the injections?

The following video was created by NSW Hand Surgeon Stuart Myers to teach general practitioners how to administer injections for trigger fingers. It shows a patient having an injection and also describes the anatomical basis of trigger finger. Please note: this video shows a medical procedure (trigger finger injection).

 

Percutaneous trigger finger release

Trigger finger release can be performed as an office procedure using a percutaneous (no incision) technique. A local anaesthetic injection is administered to numb the treatment area, and a needle is passed through the skin to release the "pulley". Not all patients who have trigger finger or trigger thumb are suitable for the percutaneous technique, but it is an effective treatment that allows some patients to avoid having to go to hospital for surgery. 

In the following video Dr Donald Ditmars talks about percutaneous trigger finger release and demonstrates the procedure on a patient. Please note that this video shows a medical procedure (including some bleeding):

 

At Melbourne Hand Surgery we ask all patients to lie down for a percutaneous trigger finger and thumb release. We use a smaller needle to perform the release than is shown in this video and we apply a less bulky dressing. Because local anaesthetic is administered to your hand you will not be able to drive home after this procedure, but you can take a taxi or use public transport - or have a friend or family member take you home. 

Open surgical treatment

Trigger finger release surgery is performed through a 2cm incision on the palm with extremely high success rates. It is performed as day case surgery and can be done as wide awake hand surgery. The triggering is cured immediately with surgery and recurrence in the same finger is extremely unlikely.

woman in rain yellow jacket handsThe incision needs to be kept clean and dry for approximately one week after surgery. I recommend keeping your hand elevated where possible during this time to minimise swelling and speed recovery. Post operative pain is generally minimal, with any discomfort being satisfactorily managed with paracetamol. Your hand is not immobilised after surgery.

What can go wrong (complications)?

It is uncommon to have complications from trigger finger surgery. Possible complications include infection, damage to nearby structures (the digital arteries, digital nerves and tendon), failure to improve, pain, scarring, skin contour irregularities, allergy, bleeding, changed skin sensation and unsatisfactory results.

FRACS

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