Trigger Finger Release

What is trigger finger?

Trigger finger (stenosing tenosynovitis) is a condition where one of the flexor tendons in the hand catches as it glides through a pulley at the base of the finger. The tendon becomes thickened, or the pulley becomes tight - usually both - and the smooth gliding motion is lost. The finger clicks, catches, or locks as it bends and straightens.

It can affect any finger and sometimes the thumb. It’s more common in women, in people over 40, and in patients with diabetes. Often there’s no obvious cause.

Symptoms

• A clicking or snapping sensation as the finger bends or straightens
• The finger catching or locking in a bent position, sometimes needing to be straightened with the other hand
• Pain or tenderness at the base of the finger, in the palm
• A small, firm nodule that can be felt in the palm
• Stiffness that is often worst in the morning

Diagnosis

Trigger finger is diagnosed from the history and examination. No imaging or other tests are required.

Non-surgical treatment

Most cases respond well to non-surgical management, particularly in the early stages:

• Corticosteroid injection - a targeted injection into the tendon sheath is highly effective for most patients, especially for a first episode. One or two injections will resolve symptoms in a large proportion of cases.
• Activity modification and splinting - occasionally helpful for mild symptoms.

Surgery is offered when injections have failed, when the finger is locking repeatedly, or when symptoms recur.

Surgical treatment - trigger finger release

The operation is a simple and reliable procedure to divide the tight pulley at the base of the finger, allowing the tendon to glide freely again.

• Performed as day surgery at Townsville Day Surgery or Mater Hospital Pimlico
• Usually under local anaesthetic in the hand - you’re awake, the hand is numb, and there’s no sedation required
• A small incision (about 1-2 cm) is made in the palm, the pulley is divided under direct vision, and the skin is closed
• Takes around 10 minutes
• You go home with a light bandage

Recovery

• Day of surgery - home the same day, full finger movement encouraged straight away
• Week 1 - some soreness, bandage removed, stitches out around 10-14 days
• Weeks 2-4 - most patients back to desk work within a few days; manual work within 2-3 weeks
• Weeks 4-6 - full recovery of grip and dexterity

The triggering itself stops immediately. Some tenderness at the incision site can persist for a few weeks.

Hand therapy is rarely needed after trigger finger release, but is available through NQ Hand Care Clinic if required.

Risks

• Scar tenderness - common in the first few weeks, settles
• Stiffness - uncommon, usually responds to hand therapy
• Infection - rare
• Injury to the nearby digital nerve - rare
• Recurrence - very rare once the pulley has been divided