Trigger Fingers or Thumb
In adults trigger fingers or thumb are a "wear and tear " phenomenon. They can occur in anyone but often we see them in people who do repetitive tasks like knitting or needlecraft.
People with trigger fingers complain of painful clicking and/or locking of one or more of their fingers.
Often it is worse in the morning and sometimes people wake up with their finger "locked " down in a flexed position and they have to use their other hand to manipulate the figure to straighten it out. Usually, this is painful.
Trigger finger is a mechanical problem. The exact reason why it occurs is not usually known but for whatever reason you develop a lump on your flexor tendon. Within your finger, the flexor tendon runs in a closed tunnel which has a smooth surface and there is no edges for this lump to catch on.
If however, you flex your finger down into your palm far enough the lump on the tendon pops out of the mouth of the tunnel and catches on the edge. This is when you get the painful clicking as the lump flicks in and out of the mouth of the tunnel and catches as it moves backwards and forwards.
If the lump is big enough it can get totally caught on the edge and "lock".
This process is a "vicious cycle" the more it happens the more irritation and swelling you get at the mouth of the tunnel. This causes the mouth of the tunnel to become thickened and narrower. Of course, this narrowing makes it more likely the lump on the tendon will get caught the next time it flicks outside the tunnel.
We have a range of treatments available to help with this condition:
1. Non-surgical Splints and steroid injections (alone or in combination)
Steroid Injections: Often the first treatment we recommend for trigger finger is a steroid injection to the area at the mouth of the tunnel. (The mouth of the tunnel is at the level of the skin crease in your palm).
Steroids are anti inflammatory drugs they reduce swelling and inflammation.
The logic of this is that if we decrease the amount of swelling and narrowing at the mouth of the tunnel the lump will n longer get caught and the clicking or locking will resolve.
This technique works about 80% of the time. Sometimes the condition resolves for good. Sometimes the clicking returns after the steroids wear off in about 6 weeks.
Splints: You can have a splint made that holds your finger straight ( so it cannot bend). We rarely use them because they are pretty impractical to wear during the day.
When we do use them people tend to wear them overnight to keep their finger straight so they do not wake up in the morning with their finger in a "locked ' position.
Usually, when we use them they are used as a temporary aid while we are waiting for the steroid injection to work or if someone is planning to have surgery but for whatever reason this cannot happen immediately.
2. Surgery
Trigger finger surgery is usually a very straightforward Day Procedure at the hospital.
You normally do not require a general anaesthetic. The surgery is normally performed under local anaesthetic with sedation so you will not remember it. You will have a small incision in your palm. You will have stitches in your palm for around 10 14 days. You will have a bandage on your hand for 1 week.
Your fingers will be free to move directly after surgery. Because trigger finger is a true mechanical problem you will notice the problem has resolved within the first few hours after surgery. You may have some soreness in your hand related to the surgery but the clicking and locking will be gone immediately after surgery.
All surgery (even relatively minor surgery like this ) has risks.
We attempt to minimise the anaesthetic risk by avoiding general anaesthetics if at all possible.
The risks of the trigger finger release itself will be explained to you at the time of our consultation but essentially they relate to a very rare risk of a structure adjacent to the tendons in your hand being damaged during the surgery ( a nerve or blood vessel) .This is extremely rare.
For any had surgery operation there is a risk of a rare pain syndrome occurring afterwards. This is known as compound regional pain syndrome (CPRS). We can discuss this at your consultation in more detail.
There is a small risk of a bad scar (raised ,lumpy or tender). Fortunately bad scars in the hand after surgery are rare. If they do occur there is normally a range of things we can do to overcome the issue.
