Trigger Finger Release

Trigger finger
Reproduced with permission from OrthoInfo. © American Academy of Orthopaedic Surgeons. http://orthoinfo.aaos.org.

Trigger finger release is a treatment option for patients with inflammation and swelling around the tendons that bend the finger, a condition known as stenosing tenosynovitis, or “trigger finger.”

Tendons that bend the finger glide through a protective covering called the tendon sheath. The sheath is like a tunnel and helps reduce friction as the tendons glide through. When inflamed, the tendon is no longer able to glide freely through the sheath.

Painful snapping or locking of the finger or thumb, also known as “triggering,” occurs when the finger or thumb is bent and the swollen portion of the tendon is caught on the opening of the sheath. Straightening the finger or thumb may require using the non-affected hand to manually pull the finger back into an extended position, causing another painful snap as the swollen portion of the tendon passes back through the sheath.

Continue reading for more information about trigger finger release surgery. To learn more about the causes and symptoms of trigger finger, click the button below:

trigger-finger

Surgical Treatment Option: Trigger Finger Release

During trigger finger surgery, the tendon sheath is cut.
Reproduced and adapted from Griffin LY (ed): Essentials of Musculoskeletal Care. 3rd Ed. Rosemont, IL. American Academy of Orthopaedic Surgeons, 2005.

Trigger finger release is a surgical procedure that involves releasing the opening of the tendon sheath to relieve the constriction of the tendon as it passes though the sheath.

A small incision (approximately one inch) is made in the palm at the base of the affected finger. The tendon sheath is opened, and additional removal of thickened tendon lining and other surrounding tissue may be necessary.

The incision is closed with nylon sutures, a dressing and an ACE wrap that allows for motion of the finger.

Preparing for Surgery

trigger finger
Reproduced and adapted from Griffin LY (ed): Essentials of Musculoskeletal Care. 3rd Ed. Rosemont, IL. American Academy of Orthopaedic Surgeons, 2005.

Avoid taking any medicines that thin the blood (including anti-inflammatories, aspirin, Vitamin E or Coumadin) for at least five days before surgery. In most cases, you will be able to resume taking these medications after your procedure. If you are being sedated for the procedure, you will most likely be told to fast from food and beverages starting the night before (see anesthesia options below for more details).

Anesthesia Options

Trigger finger release surgery can be performed with or without sedation:

  • Wide awake straight local (no sedation): About 20-30 minutes prior to the procedure, local anesthesia will be injected into the affected hand. This provides adequate time for the surrounded area to absorb the anesthetic. More anesthesia can be injected directly before surgery if necessary. Because there is no sedation, patients can eat and drink prior to the procedure, and drive themselves to and from surgery if desired. Remember to avoid anti-inflammatory or blood-thinning medications for at least five days before the procedure.
  • Sedation: If your procedure is performed under general anesthesia, an IV will be started in the non-operative hand to deliver medicine. Because this approach involves an anesthetic, patients may not eat or drink anything after midnight the night before surgery (for diabetic patients, we will make every attempt to schedule your procedure as the first case of the day). The same medication restrictions apply – no anti-inflammatories or blood thinners for at least five days prior. You will be allowed to slowly resume eating right after surgery, but you will need to designate a friend or family member to be there after surgery to receive your discharge instructions and drive you home.

What to Expect After Surgery

If only local anesthetic is used (no sedation), you may leave right after surgery. If general anesthesia is used, you will need to remain in the hospital to be monitored for about one hour.

Dressing and sutures: You will have sutures and a dressing on your hand for approximately 7-10 days after surgery. During this time, it is important to keep the wound covered and the wrap dry, so it is best and keep it out of the direct spray when showering. Do not use ointment of any kind until three days after stiches have been removed. If the steri-strips fall off, cover with a water-proof adhesive bandage.

Recovery time: Activities are allowed directly after surgery as long as they are comfortable. Some restrictions may apply:

Driving: If your procedure does not involve sedation, you will have no driving restrictions – you may begin driving right after surgery. However, if general anesthesia is used, you should not drive until the day after surgery.

Work: You may return to work as soon as you feel comfortable doing so. Some patients may go back to work the day after surgery, but if your job involves heavy or strenuous use of your hands, you may want to wait until after suture removal (7-10 days) before going back.

Results: After surgery, the tendon will no longer rub on the sheath as the inflammation and swelling go down. The portion of the tendon sheath will remain open and will not heal together. In most instances, full finger motion returns following recovery and the risk of recurrence is very low.