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Trigger finger or thumb release
A day-case hospital procedure to free a flexor tendon that catches or locks at the base of the finger or thumb – may be performed wide awake under local anaesthetic, or alternatively with sedation or a general anaesthetic.
At a glance
Anaesthetic
Local anaesthetic alone, or sedation or general anaesthetic
Where
The Avenue Hospital
Day case
Day case - home the same day
First post operative review
Approximately one week after surgery
Driving
When the local anaesthetic has worn off and your hand is comfortable
Post Operative Hand Therapy
Optional; routinely recommended for Workcover patients, and if there is a preoperative PIP joint contracture. Helpful if the finger is stiff.
Splinting
Not routinely
Pain relief
Usually paracetamol and/or ibuprofen
Return to normal activity
Early finger movement is encouraged; resume activities as comfort allows. There is no fixed heavy-loading restriction
What is trigger finger release?
Trigger finger (also called stenosing tenosynovitis) happens when a flexor tendon catches as it passes through a tight pulley – the A1 pulley – at the base of the finger or thumb. The tendon can click, catch, or lock in a bent position, sometimes needing the other hand to straighten it out.
Trigger finger release is an operation to free the tendon. Through a small incision at the base of the affected finger or thumb, the A1 pulley is divided. This gives the tendon room to glide smoothly again and stops the catching and locking. The other pulleys are left intact, so the tendon continues to work normally. It is a common, reliable hand operation with a quick recovery for most people.
Who is trigger finger release suitable for?
- People with trigger finger or trigger thumb confirmed by their symptoms and examination – clicking, catching, or locking of the finger
- People whose symptoms have not settled with non-surgical measures such as activity changes, a splint, or a corticosteroid injection
- People whose triggering has returned after a corticosteroid injection, or who have had more than one injection
- People whose finger locks and will not straighten, or only straightens with help from the other hand
- People who wish to have the procedure performed under local anaesthetic alone
- People who take anticoagulant (blood-thinning) medication - Dr Tomlinson does not cease anticoagulant medications for this surgery
A corticosteroid injection is often the first treatment for trigger finger and settles symptoms for many people. Surgery is usually considered when injections have not worked, when triggering keeps coming back, or when the finger is locking. Dr Tomlinson will talk you through the options at your consultation, and will administer a corticosteroid injection at the time of your appointment if appropriate.
What does trigger finger release surgery involve?
Through a small incision at the base of the affected finger or thumb, Dr Tomlinson divides the A1 pulley under direct vision, freeing the tendon so it can glide smoothly. The catching and locking usually stop immediately. The skin is then closed with absorbable sutures and a dressing is applied. You are discharged home that day. The local anaesthetic generally lasts 6-24 hours, during which areas of your hand and fingers will feel numb. Occasionally the local anaesthetic lasts as long as 72 hours.
Trigger finger release can be performed as wide awake hand surgery – using local anaesthetic only – so you do not necessarily need sedation or a general anaesthetic. If you would prefer to be asleep or sedated, we can absolutely provide you with that option. Your post operative review is approximately one week after surgery, when your wound and dressing are checked, and we provide you with further advice and information about the recovery process.
Alternatives to surgery
Surgery is one option for trigger finger or trigger thumb. Depending on your situation, the alternatives may include:
- Observation: mild cases can settle on their own without any treatment.
- Splinting: a splint can rest the finger and ease symptoms while catching or locking is mild.
- Corticosteroid injection: often the first treatment tried, and can be curative, especially for a first episode. Surgery is usually considered when injections have not worked, symptoms keep returning, or the finger is locking.
Dr Tomlinson will discuss which options suit your specific situation at your consultation.
Watch: Understanding Trigger Finger and Trigger Thumb
Frequently Asked Questions
Where will my surgery be done?
Why might I choose local anaesthetic rather than sedation or a general anaesthetic?
A procedure under local anaesthetic avoids the risks and recovery of sedation or a general anaesthetic. You don’t need to fast beforehand, you can eat and drink normally, you recover quickly, and you usually go home soon afterwards. For many people it’s also less expensive and more convenient.
How much time will I need to have away from work?
This depends on what your job involves. If your work is desk-based or administrative, you may be able to return relatively soon, often with some temporary modifications. If your work is physical — heavy lifting, manual labour or “on tools” — you’ll usually need longer. As a guide for this procedure: approximately one week away from office based work. Dr Tomlinson will give you advice tailored to your role at your consultation.
When will I be able to drive again?
Multiple things affect this: which hand was treated, how many fingers were treated, whether you’re wearing a bandage, whether you can grip the wheel and respond safely in an emergency, whether you are driving for personal or commercial purposes, the nature of the vehicle you are driving, and your pain levels and medications. You also need to be safely in control of the vehicle for insurance purposes – you should be able to grip the steering wheel strongly with both hands and be able to take evasive action in an emergency before you get behind the wheel. As a guide: plan not to drive for one week after the procedure. If your hand is comfortable and the local anaesthetic has worn off, you may be able to drive one day after surgery.
When can I do a full day of administrative or desk work?
Often from 1 week after surgery, particularly with some temporary adjustments (see below). Keeping your hand elevated and taking regular breaks helps reduce swelling and discomfort in the early days. While some patients return to work the day after surgery, there is value in resting and elevating your hand for 48 hours and taking it easy as you recover.
What workplace modifications might help?
Depending on your job, helpful temporary modifications can include:
– Half days or alternate days to begin with
– No heavy lifting
– Lighter duties or being off tools entirely
– More frequent breaks
– Using a headset instead of holding a phone
– Voice-to-text or dictation instead of typing
– Keeping the hand elevated at your workstation
– Avoiding repetitive gripping
– Help with carrying or moving items
– Moving temporarily to reception or phone duties if your role is normally manual
– Protecting the wound if your work exposes your hands to water or contamination (e.g. food handling, healthcare, wet trades)
We’re happy to provide a letter for your employer outlining recommended modifications.
I take a GLP-1 medication (such as Ozempic, Wegovy, Mounjaro or Trulicity) — how does this affect my procedure?
GLP-1 medications, used for diabetes or weight management, slow the emptying of the stomach. This can increase the risk of stomach contents being present during sedation or a general anaesthetic. In line with current ANZCA guidance, if you’re having sedation or a general anaesthetic you’ll be asked to follow a clear-fluid-only diet for 24 hours before your procedure, followed by the standard 6-hour fast. Please tell us and your anaesthetist that you take this medication — your anaesthetist will give you specific instructions. If your procedure is under local anaesthetic only, fasting is generally not required.
How long will I need to wear a splint?
You do not need to wear a splint after routine trigger finger surgery.
If Dr Tomlinson notices that you have a contracture of the proximal interphalangeal joint during your consultation, prior to surgery, then she will recommend that you see a hand therapist after surgery for splinting to assist with resolving this contracture.
Will I need to see a hand therapist afterwards? May I see one if I'd like?
It isn’t essential for this procedure, but you’re welcome to see a hand therapist if you’d find it helpful.
What pain medication will I need afterwards?
Usually simple pain relief – paracetamol and ibuprofen – is all that’s needed. We can prescribe stronger painkillers if you need them.
Risks & complications
General risks of hand surgery
- Bleeding and bruising; rarely, a collection of blood (haematoma) that may need draining
- Infection, which may require antibiotics or, rarely, further surgery
- Pain — usually temporary, occasionally persistent
- Swelling – common, and usually settles over weeks to months
- Scarring – scars are permanent and occasionally become thickened, raised or sensitive
- Allergic reaction to the local anaesthetic, antiseptic, dressings, tape or suture material
- Delayed or problematic wound healing
- Stiffness or reduced movement in the fingers, hand or wrist
- Injury to nerves, causing numbness, altered sensation or, rarely, a painful neuroma
- Injury to blood vessels (arteries)
- Injury to tendons
- Failure to fully relieve your symptoms, or symptoms returning over time (recurrence)
- Complex regional pain syndrome (CRPS) – an uncommon but significant condition causing ongoing pain, stiffness and swelling
- Cold intolerance – the hand becoming more sensitive to cold, usually improving with time
- The need for further surgery
- Blood clots in the leg or lung (DVT/PE) – uncommon in hand surgery, with a slightly higher risk after a general anaesthetic or prolonged immobilisation
Specific risks of this surgery
In addition to the general risks of hand surgery, this specific procedure includes the risks of
- Injury to the digital nerves, which run close to the pulley at the base of the finger and thumb, causing numbness or altered sensation
- Incomplete release, with triggering or catching that does not fully resolve
- Recurrence of triggering over time (uncommon)
- Stiffness, pain or difficulty fully bending or straightening the finger, usually but not always settling with movement and time
- Tenderness at the scar or in the palm, which usually settles with time
- Bowstringing of the tendon, particularly if you have other damaged pulleys in the hand
Anaesthetic
If you are having sedation or a general anaesthetic for this procedure, your anaesthetist will discuss the specific risks of anaesthesia with you separately.
Recovery & rehabilitation
First 48 hours
Keep your hand elevated for 48 hours to reduce bleeding and post-operative swelling. Local anaesthetic lasts 6–24 hours (occasionally 1–3 days); your hand will have numb areas during this time. Take simple analgesic medication as needed. Place a plastic bag over your bandage when showering to keep it dry. Once the anaesthetic has worn off and you are comfortable, begin gently moving the finger.
First week
Keep the dressing dry and intact until your post-operative review. You may use your hand for light activities, but listen to your hand and avoid anything that causes pain, such as lifting or gripping. Scar sensitivity and discomfort with lifting and gripping are expected in the first few weeks. You should find that your hand function is better each day.
Second week
Many people are using the hand fairly normally for everyday tasks, limited mainly by wound comfort rather than by any loading restriction. We recommend planning not to drive for one week. Many people return to desk-based work within days; if your work is physical or exposes the wound to water or contamination, you may need a period of lighter duties until the wound has healed.
6 weeks
Comfortable full grip strength may take several months to return, and deep-pressure tenderness over the wound can persist for weeks to months. The scar will feel tight and firm. Massage assists with improving scar mobility and minimising scar firmness.
3 months
The scar firmness will start to resolve after 3 months, and will take up to 12 months to settle.
Long term
Full, comfortable use of the finger is expected. Recurrence of triggering is uncommon. The scar continues to soften over the following months.