When to
operate on
trigger
finger?

Trigger Finger : when to operate?

The trigger finger, also known as stenosing tenosynovitis, is one of the most commonly diagnosed hand problems. Its symptoms are typically easy to identify and the principles of treatment are simple.

Non-surgical treatment may be recommended in early stages. Rest, avoiding certain activities, wearing an orthosis at night, taking anti-inflammatory medication and applying cold to the affected area can be helpful to relieve symptoms. A cortisone injection can sometimes provide relief, however, the effectiveness of these measures depends on the severity of the disease and associated conditions. Trigger finger is often more severe in diabetic patients or in those who have more manually intensive labour jobs.

If conservative management fails

Surgery becomes necessary as the discomfort worsens or when the deformity adversely affects the patient's quality of life. You know it's time the right time to consult a hand surgeon when you begin to have the following symptoms:

  • Restricted mobility of the finger or hand
  • Difficulty performing certain daily or professional tasks
  • Persistent pain in the palm or at the base of the finger
  • Recurrence after cortisone injection
  • Multiple fingers are affected
  • Worsening of symptoms and decreased dexterity

Surgical treatment

Two surgical methods are used to release the trigger finger: open surgery or endoscopic trigger finger release (ETFR). Open surgery uses a 2 centimeter incision in the palm of the hand to expose and release the pulley that is restricting the flexor tendon. This method is effective, but injures the palmar skin and subcutaneous tissue (which contains a lot of small nerve endings). Stitches (sutures) are used to close the wound and need to be removed after two weeks. Each layer of tissue that was cut open requires weeks to heal and is a source of potential complications (wound breakdown, infection, delayed healing, stiffness and painful scars). It can take up to three or four months for swelling, stiffness and pain to settle. Endoscopic decompression is a much less invasive and more modern approach that allows the release of the tendon (pulley) while leaving the skin and subcutaneous tissue intact. It is known as "keyhole surgery" and is performed via two small 2 mm access portals, a small camera and miniaturized instruments (endoscope). No stitches are required as the two little holes are closed with glue and heal within two or three days. Immediate careful use of the hand is encouraged. The Endoscopic trigger finger release (ETFR) significantly reduces surgical trauma by sparing the skin and subcutaneous tissue of the hand and shortens recovery to a few days or weeks rather than a few months. It has a very high rate of efficiency and satisfaction.

It is important not to ignore your symptoms and not to postpone the consultation with a hand specialist. Trigger finger can cause permanent deformity if left untreated or if treatment is delayed.

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