“Trigger finger” refers to a finger that is locked into the position of a fist. It’s as if you were squeezing the trigger of an imaginary gun. Trigger fingers usually start off with just pain and stiffness, but may eventually lock in this way. The treatment for trigger fingers can as simple as a short-term course of anti-inflammatory medications, a splint, or an injection. But occasionally, a trigger finger release surgery can be required.
What is a trigger finger?
Trigger finger (or trigger thumb) is actually a type of inflammation of the tendon and its surrounding sheath. The fingers and their tendons are built kind of like a fishing rod. If you look at a fishing rod, it has guides that the fishing line goes through. Similarly, the bones of your fingers have pulleys that the tendons pass through. The tendons are a tight fit within these pulleys, without much wiggle room. This is actually important for the fingers to function well. But if the tendon becomes swollen or the pulleys become too tight, the tendon can’t fit through easily. This is when you start having problems. The first thing patients notice is pain and stiffness. The palm or the backs of the fingers hurt, and you can’t seem to make a strong tight fist. If it goes on longer, you may notice a clicking of the fingers when you make a fist. Your finger may get stuck in a closed fist position. Sometimes patients have to use their other hand to force the finger back open.
What causes trigger fingers?
Trigger fingers are incredibly common, because the offending inflammation can be caused by many different factors. There are many associated factors that can lead to development of trigger fingers. Hand overuse, injury, diabetes, carpal tunnel syndrome, obesity, rheumatoid arthritis, are all risk factors. It affects people of all ages, sexes, and races.
What are the treatment options?
Fortunately, there are several treatment options available for trigger fingers. Most cases of trigger finger can be treated without surgery, although surgery is occasionally necessary.
Anti-inflammatory medications
If you have a mild case of trigger finger, just using some anti-inflammatory medications like ibuprofen (Advil, Motrin etc.) or acetaminophen (Tylenol) for a few days can break the cycle of pain and inflammation.
Injections
An injection of steroid is very helpful for quickly relieving the swelling and inflammation around the tendon. Studies have shown that steroid injections can cure 80% or so of trigger fingers. There are a lot of very important structures in the area of the injection however – nerves, blood vessels (and the tendon itself!) that should not be injected. So it is important to get an injection from someone who knows how to inject the steroid precisely, around the tendon.
Splints
Splints are not as effective as steroids, and have to be used for 4-6 weeks to have an effect. However, they can be helpful if you are unable to have a steroid injection or tolerate medications like Ibuprofen.
Surgery
This is a quick 5-10 minute operation that can be performed under local anesthesia in the office, or with sedation in the surgery center. A small incision is made over the offending tendon, where the finger meets the palm, and the first pulley in the pulley system is opened up. This allows the tendon to move back and forth easily without catching or rubbing. You get a couple of stitches in the hand, a light dressing, and you can be back to everyday activities immediately.
Trigger fingers are great imitators. I can’t tell you how often residents have asked me to see a patient with an “unusually stiff and painful hand,” only to find on my exam that it is just a trigger finger causing all the symptoms. Often, trigger fingers will be present along with another hand condition, like carpal tunnel syndrome – so a comprehensive hand examination is critical.
What to expect on the day of surgery:
Trigger finger release surgery is an outpatient procedure that requires around 5 to 10 minutes per finger to perform. Most trigger finger surgeries are performed with either local or regional anesthesia. What this means is that your hand or your arm is numb during the surgery and you do not have any pain, but you will generally not require full general anesthesia.
What to expect after surgery:
Results
Surgery will immediately fix any locking or clicking you might have had. If your symptom was pain, this should resolve as well after a few weeks when the incision pain completely goes away. There will be some post-surgery swelling and stiffness at first, but this will resolve as well as you start using your hand.
The first few days
After surgery your hand will be in a light dressing, but your fingers will be free. Your finger will be numb for several hours after you return home because of the long-acting anesthetic that Dr. Nagarkar will use in surgery. It is critical that you start working on your fingers – closing them into a tight fist, and opening them all the way straight – immediately after surgery. Start these exercises on your way home from surgery. You should do this exercise 10 times per hour, or at every red light and during every commercial break (if you’re watching TV). Don’t squeeze a ball or do any other type of “strengthening” exercise – just close your fingers into a fist and open them up all the way.
Pain
Narcotic pain medications are rarely needed after a trigger finger surgery – usually anti-inflammatory over the counter medications like Ibuprofen and Tylenol are all you need.
Incision care
Your incision will be closed with two or three stitches. You will have a light dressing on your incision after surgery, which you should keep clean and dry. When you are showering, cover your hand with a plastic bag up to the elbow. Then, place a couple of rubber bands around the bag to prevent water from getting onto the dressing. You can remove the dressing four days after surgery, and wash your hand in the shower with regular soap and water. Then pat the incision dry and cover it with a band-aid.
Work
You should be able to return to desk work or light work the day after surgery. For work involving any manual labor or lifting over 10 lbs, you should plan on taking at least 2 weeks off.
Activities and exercise
You will be able to return to normal every-day activities, like writing, typing, and eating immediately after surgery. You can drive when you are no longer using narcotic pain medications and when you are able to fully and safely control your car. This often takes a few days to a week. Aerobic exercise can be started four days after surgery (when your dressing is removed). More strenuous exercise involving heavy lifting or any impact on the hands (like yoga or push-ups) should be stopped for at least 2 weeks.
Hand therapy
Most patients don’t require supervised hand therapy after this surgery. However, if you had several fingers that required surgery, you may need some help getting full motion back in your hand. In this case, Dr. Nagarkar will refer you to a certified hand therapist who can help you improve your hand function.
Follow-up visits
You will see Dr. Nagarkar in the office usually 7 – 10 days after surgery to examine the incisions, remove sutures, and ensure that you are healing appropriately. Most patients don’t require further visits, although we encourage you to contact us at any time if you have any questions or concerns.
To meet Dr. Nagarkar in person, schedule your consultation or call us.