TREATMENT

You have
options

Is there a natural way
to treat my symptoms?

If your symptoms are mild, there are several conservative treatment options. We generally recommend rest, wearing a splint, scheduling a consultation with an occupational therapist, and possibly a cortisone shot. But if you’re still having symptoms or if your symptoms are worse after six weeks, you need to consult a specialist.

AVOID CERTAIN ACTIVITIES

Identify what activities are causing your symptoms and avoid doing them for several days. You should also avoid activities or actions with repetitive finger movements. We recommend alternating certain tasks to give the affected fingers a rest.

WEAR A SPLINT

Get a resting splint for the affected finger. It should only restrict finger movement at the joint (keeping it in a straightened position) while still allowing the rest of the finger to move. The splint should not limit movement of the wrist or other fingers in any way.

AVOID SQUEEZING

Try not to squeeze your hands or grip small tools or instruments for long periods. You should also avoid using tools that vibrate or put pressure on the fingers.

ICE YOUR FINGERS

If you find it alleviates your pain, apply ice or an ice pack to the affected fingers and palm. Ice can be applied for ten minutes at a time at two-hour intervals.

CONTRAST BATHS

Alternate placing your hand in ice water and warm water every 60 seconds for a total of 10 minutes in the morning and evening. This helps reduce the feeling of swelling you might have in your hand and fingers.

OCCUPATIONAL THERAPY

An occupational therapist can help you modify how you sit or your workstation setup and encourage you to take regular breaks. They will also be able to help you identify what movements to avoid.

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If left untreated, trigger finger can cause permanent damage.

Are cortisone
shots recommended?

Cortisone is a powerful anti-inflammatory that can temporarily ease symptoms. Relief can last anywhere from several weeks to several months. When performed by a specialist, preferably with the help of ultrasound, cortisone injections into the tendon sheath are effective and relatively painless.

However, receiving more than two to four cortisone injections is not recommended because they lose their effectiveness over time and can lead to localized complications like infections, a weakening of the tissues, and skin discolouration.

If patients don’t see any improvement, even temporary, they should look into other treatments.

Is surgery
always necessary?

If conservative treatments fail and your symptoms persist, it means that the compression is advanced enough to require a consultation with a hand surgeon. The way surgical treatment works is quite simple.

The flexor tendons in your fingers and thumb pass through a rigid canal called a tendon sheath. The bottom of this canal is made of your finger bones and the top is a thick ligament called the first annular, or A1, pulley. The goal of surgery is to reduce the amount of pressure in the sheath so that the tendon slides normally again, thereby eliminating the inflammation caused by mechanical stress. The procedure involves making an incision in the A1 pulley to open the passage and make the sheath wider. This instantly reduces the pressure and decompresses the tendon. The ligament heals in the new position and the sheath stays wider permanently.

Do not ignore trigger finger symptoms. If not treated quickly, the condition can cause the joints to stiffen irreversibly and permanently affect finger mobility.

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Say goodbye to pain
today

What does surgical
treatment entail?

WHICH TYPE OF PROCEDURE SHOULD I HAVE?

There are two ways to surgically treat trigger finger: the traditional “open” method, which is the procedure hospitals perform, or a minimally invasive endoscopic technique first performed in North America by Dr. Jean-Paul Brutus. While the results of both techniques are the same, the endoscopic procedure has significant advantages when it comes to discomfort, recovery, and getting back to normal.

OPEN SURGERY

Traditional surgery is performed under regional or general anaesthesia. It involves making a two-centimetre incision in the palm to reach the annular pulley and then cutting and widening the tendon sheath. This is an effective technique, but it has some drawbacks. Since it involves making an incision, it compromises the skin and underlying tissue above the ligament that needs to be cut. The healing period is relatively long, and the wound could reopen or become infected. Patients report a loss of strength for three to six months after surgery and each hand must be operated on separately.

The procedure has a high success rate, but full recovery is long and can take six to eight weeks. It is also common for there to be lingering scar sensitivity and hand swelling, which would require physiotherapy.

ENDOSCOPIC SURGERY

Endoscopic decompression is a more recent and considerably less invasive alternative. During the procedure, the surgeon makes two tiny holes where the finger meets the palm, then inserts a camera and uses miniaturized surgical instruments to make precise incisions into the annular pulley. With this technique, the surgeon targets just the annular pulley without cutting into the palm, so the skin, subcutaneous tissue, and muscles are left intact with minimal surgical trauma. The procedure is performed under local anaesthesia and doesn’t require stitches.

Endoscopy is a safe technique that significantly shortens recovery. It causes less pain and stiffness and minimizes scar sensitivity. Patients rarely require physiotherapy and return to normal much more quickly.

TWO SURGICAL METHODS, MANY DIFFERENCES

Classic technique Endoscopic technique
Method Two-centimetre incision into the palm Endoscopic decompression (two tiny holes)
Duration 15 to 30 minutes A few minutes
Pain Moderate Little to none
Stitches Yes No
Scar Yes No
Resumption of daily activities Several weeks Immediately after surgery
Resumption of light work 2–3 weeks 48 hours
Resumption of heavy work 3–4 months 4–6 weeks
Physiotherapy Yes Only in rare cases
Success rate High High
Risk of complications Medium Low

*Information for reference only. The amount of time it takes to recover and resume personal and professional activities can vary from patient to patient.

What are the advantages
of endoscopic decompression?

Endoscopy is a major leap forward in the treatment of hand conditions. It is less invasive than traditional surgery and therefore provides numerous advantages for patients, especially when it comes to healing and recovery:

  • Very safe and much less invasive technique where the only thing the surgeon cuts is the pulley.
  • Performed under local anaesthesia, so patients remain awake.
  • Minimal surgical trauma because muscles are left intact.
  • Video camera provides clear view of anatomical structures.
  • Fast, proven, and highly successful procedure lasting about ten minutes.
  • Can be performed on several fingers at a time and both hands if needed.
  • No stitches, incisions, or scars.
  • Surgeon can immediately see whether the procedure was successful by checking how the tendon slides and whether the pressure is gone.
  • Immediate relief of pain and symptoms.
  • Much faster recovery with less pain and stiffness, and patients can use the affected hand a few hours after the procedure.

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A first step towards recovery

How long will it take to get back
to my day-to-day activities?

Recovery periods can vary from a few days to a few months, depending on the surgical technique used and how many fingers are operated on. Patients can usually resume light work after 48 hours. They can resume activities that require greater physical effort between two and three weeks after their procedure. For traditional surgery, the recovery period is much longer—often two to three months.

After open surgery, patients must keep their hands elevated for several days and do regular finger mobilization exercises. They must usually plan on not using the hand that was operated on for two to three weeks after surgery. The wound has to be protected to keep it from reopening or getting infected. Patients that have had endoscopic decompression are allowed to drive, dress themselves, drink, and eat immediately after surgery, essentially as soon as the anaesthesia wears off. How long patients have to wait before resuming physical activity depends on how demanding the activity is. Patients can start biking and golfing again about two weeks after an endoscopic procedure, whereas they’d need to wait six to eight weeks after traditional surgery.

For activities or jobs that require even greater physical effort (strength training, construction or manufacturing jobs, etc.), patients must wait four to six weeks after an endoscopic procedure but three to four months after traditional surgery.

How long is
post-operative recovery?

Stiffness is usually a result of soft tissue scarring, a normal part of the healing process. The degree of stiffness can vary depending on the type of procedure and the patient’s genetic predisposition.

Patients experience much less stiffness after endoscopic decompression because they can mobilize their hands immediately after the procedure without waiting for an incision to heal. Since decompression is much less aggressive than the classic procedure, it results in less scar tissue, which in turn results in less joint stiffness.

Unlike traditional surgery, which requires several weeks of physiotherapy, endoscopic procedures rarely require rehabilitation.

You can start
smiling again, too!

_________________

Do I have to have surgery?

If the condition is relatively new, you can try a conservative treatment plan. If after several weeks, your symptoms are the same or have gotten worse, we recommend making an appointment with a hand surgeon.

Which surgical technique is best?

Both the open and endoscopic techniques have very high success rates. However, endoscopic decompression offers several advantages from a comfort and recovery standpoint.

How long should I expect recovery to last?

The amount of time you will need to recover and get back to your personal and professional activities will vary depending on the surgical technique and type of activity. In general, patients who undergo an endoscopic procedure return to work more quickly.

How can I find a surgeon?

Your regular doctor can refer you to a surgeon. However, in the public system, the wait is often several months or more.

Will I get trigger finger again?

It is possible that you will redevelop trigger finger, but this is rare. It is worth mentioning that people who have had trigger finger are likelier to develop other hand conditions like carpal tunnel syndrome and Dupuytren’s contracture.

Practical and
comprehensive medical guide

Everything you need to know to identify and treat trigger finger. Written in clear and simple language by hand surgeon Dr. Jean-Paul Brutus, this e-guide identifies the causes, symptoms, and different ways to treat trigger finger and offers recommendations on how to ease your symptoms at home.

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