Trigger finger
What is trigger finger ?
Trigger finger, also known as stenosing tenosynovitis, is caused by a size mismatch between a flexor tendon and the first annular pulley of its sheath, the A1 pulley, at the base of the finger in the palm.
When the tendon is too bulky or the pulley too tight, the tendon catches during movement, producing a painful clicking or snapping sensation. In more severe cases, the finger locks in a bent position and must be passively straightened.
Any finger can be affected, including the thumb. Trigger finger is more common in women, diabetic patients and those performing repetitive manual activities.
What is the treatment ?
Conservative treatment is always offered first. A corticosteroid injection performed under ultrasonic guidance into the tendon sheath resolves symptoms in the majority of patients. One or two injections may be given.
Surgery is offered when injections fail to provide lasting relief, when the finger is locked, or when symptoms recur rapidly.
How is the procedure performed ?
The procedure is performed under regional anaesthesia on a day-case basis (the patient goes home the same day). It takes approximately 15 to 20 minutes.
A small incision in the palm, over the A1 pulley, allows the surgeon to divide the pulley under direct vision, freeing the flexor tendon. Free tendon gliding is confirmed at the end of the procedure.
What is the recovery ?
Active finger movement is encouraged from the first days after surgery to prevent stiffness. Wound care is required for approximately two weeks.
Return to desk work is possible immediatly of after a few days, and to manual work within three to four weeks. Physiotherapy is not routinely required.
What are the risks?
Trigger finger surgery has a high success rate. Risks, though uncommon, include:
-
injury to a digital nerve, potentially causing numbness on one side of the finger
-
wound infection
-
residual stiffness if finger mobilisation is delayed
-
incomplete pulley release leading to persistence of triggering