Trigger Finger Surgery - An Overview

What Is a Trigger Finger?

A trigger finger is one of the most common conditions in thumbs and fingers. It is also called stenosing flexor tenosynovitis. This condition is characterized by difficulty bending the finger as it is stuck in a bent position. It is caused by the inflammation of the tendon and lining surrounding the tendon, which aids in finger flexor function. People with this condition have difficulty bending or moving their fingers, which is associated with clicking sounds.

Who is More Prone to the Syndrome?

• Age: People in the age group 40 to 60 years.

• Sex: Females are more commonly affected than males.

• Injury: History of a previous hand injury to the hands or fingers.

• Ergonomics: People who use their hands and fingers repetitively, like musicians, farmers, computer engineers, and sportspeople.

• Systemic Illness: Conditions such as diabetes mellitus, rheumatoid arthritis, gout, amyloidosis, and carpal tunnel syndrome cause inflammation of tendons and stiffness of fingers.

What Are the Signs And Symptoms of the Disease?

• Not being able to flex the finger fully.

• Clicking or popping sound while moving the fingers.

• Pain in the palm at the base of the finger or thumb, particularly during gripping or clutching.

• Experiencing stiffness in fingers, especially during bending of fingers.

• Frequent swelling of the hand.

• Fingers or thumbs being locked in a bent position (in severe cases). With the aid of the other hand, slowly straighten the fingers or thumb.

What Are the Non-Surgical Options?

• The main aim of the treatment is to reduce the signs of inflammation and, relieve the patient from pain and swelling, perform typical day-to-day activities without any hindrance.
• Here are some of the non-surgical approaches doctors advocate before choosing the surgical procedure.
• Wearing Splint: While sleeping, fluid pooling is from the legs to the hands; as a result, there is pressure on tendons causing inflammation and swelling during the night. A splint is recommended to keep the finger straight and prevent the finger's bending during the night.
• Medications: Using NSAIDs (non-steroidal anti-inflammatory drugs) like Ibuprofen and Naproxen to reduce the pain and signs of inflammation.
• Steroids: Corticosteroid injections such as Cortisone helps to reduce the signs and symptoms.
• Exercises: Supervised exercises at home by a physiotherapist help reduce the locking of joints, edema, pain, and swelling and improve the joints' flexibility.

What Are the Surgical Options?

The surgeon will choose the surgical options when non-surgical options fail to provide relief for patients. Surgeons will evaluate the patient's condition and decide the best surgical procedure.

Presurgical Evaluation

• The surgeon will evaluate the patient's medical history to find out the presence of any systemic disease.

• Surgeons will evaluate the nature of pain, aggravating and relieving factors, duration of pain, at what time it occurs, how often it occurs in a day, and history of any injury.

• History of medications taken by patients to relieve pain.

• Once the surgeon completes the evaluation of the patient, he discusses the treatment options available and the precautions to be followed by the patient.

Surgical Procedure:

• Surgery is usually performed under local anesthesia, and patients can return home on the same day, but sometimes, patients may need to be in the hospital overnight.

• The operation usually takes two hours, and the patient is awake while performing the procedure.

Two types of surgical procedures are available for trigger fingers. They are

1. Open Trigger Finger Release:

• In this procedure, the surgeon makes a small incision on the finger's base and opens the tendon sheath to make it more comprehensive.

• This procedure allows for the easy movement of the finger without restriction.

• After the procedure, the incision is closed with stitches and bandages.

2. Percutaneous Trigger Finger Release:

• In this procedure, a needle is inserted below the finger's base to release the ligament and tendon without incision.

• As there is no incision in this procedure, the patient will not have any scars or wounds.

• However, this procedure is challenging and often risky as nerves and arteries might get damaged as they are close to the tendon.

• Many surgeons prefer the open trigger finger to the percutaneous trigger finger method.

What Are the Post-Operative Precautions Taken by Patients?

• After the surgery, patients might feel sore for a few days, but eventually, it will heal within two weeks if surgery is performed in an open method.

• The patient can move his finger quickly; however, they should avoid excessive stress and holding heavy objects until complete healing is achieved.

• Patients can start driving after three to five days.

• In the case of an open method, the wound area can be washed with mild soap and cleaned.

• Usually, resorbable sutures will be placed where patients need not come to the hospital for removal.

• In the case of percutaneous surgery, there is no scar, and the patient can start moving his finger within two days. However, in the open method, there is a scar on the palm, and the patient can resume normal activities after two weeks.

• Patients are advised to continue the Physiotherapy exercises after healing to improve the flexibility of their fingers.

What Are the Complications of Surgery?

• Infection.

• Severe pain.

• Loss of sensation due to damage to nerves.

• Stiffness of muscle.

• Wrong positioning of the tendon.

• Complex regional pain syndrome is associated with pain and swelling even after the surgery, which may resolve within a few months or sometimes remain permanent.

What if This Occurs in Children?

• There is no need for surgery in children as the condition will improve as the child grows.

• In children, simple stretches and splinting may help.

• However, the doctor's opinion and proper follow-up are necessary to monitor the condition.

Conclusion:

Surgery for the trigger finger helps to restore the functional activity of the finger and thumb. However, sometimes it is likely to reoccur in different fingers in patients with systemic diseases like diabetes and rheumatoid arthritis. In severe cases, even surgical correction is not possible.