If you have trigger finger, also known as stenosing tenosynovitis, you’re familiar with the pain from having a finger or thumb stuck in a curled position. It can hurt whether or not you’re using your hand. Plus, there’s the frustration of not being able to do the things you want to, from buttoning your clothes to texting to playing guitar, or maybe even playing a video game.
Surgery for trigger finger is done to increase the space for your flexor tendon to move. Your flexor tendon is a tendon in your fingers that is activated by your muscles to pull on the finger bones. That allows your finger to bend and flex. After surgery, the finger can bend and straighten without pain.
Good candidates for this surgery
Your doctor may recommend surgery if you’re healthy and have tried other treatments without success, or if your symptoms are severe.
Nonsurgical treatments include:
- resting the hand for three to four weeks by not doing activities that require repetitive motion
- wearing a splint at night for up to six weeks to keep the affected finger straight while you sleep
- taking over-the-counter nonsteroidal anti-inflammatory medicines, including ibuprofen (Advil, Motrin IB) or naproxen (Aleve), to ease pain (though they won’t likely decrease swelling)
- one or two steroid (glucocorticoid) injections near or into the tendon sheath to reduce inflammation
Steroid injections are the most common treatment. They’re effective for up to 90 percent of people who don’t have diabetes. This treatment is less effective in people with both diabetes and trigger finger.
Your doctor may recommend surgery sooner if you have diabetes or have severe symptoms, such as:
- restricted finger or hand movement that’s bothersome or disabling
- painful fingers, thumbs, hands, or forearms
- the inability to do daily tasks without them being awkward or painful, including work, hobbies, or activities you enjoy
- feeling embarrassed or nervous about having trigger finger
- worsening over time so that you drop things, have trouble picking them up, or can’t grasp anything
How to prepare for surgery
You won’t be able to eat the day you have surgery. Ask your doctor how long you’ll need to fast before surgery. Depending on what time your surgery is scheduled for, you may need to have dinner the night before earlier than you normally would. You should be able to continue drinking water as normal. Just avoid drinking other beverages, like soda, juice, or milk.
There are two types of trigger finger surgery: open and percutaneous release.
You may be able to have trigger finger surgery as an outpatient. That means you’ll be in an operating room, but you don’t have to stay overnight in the hospital. The surgery should take from a few minutes to half an hour. Then you can go home.
Your surgeon first gives you a mild sedative by intravenous line (IV) to help you relax. An IV consists of a bag of liquid medicine that flows into a tube and through a needle into your arm.
Your surgeon numbs the area by injecting a local anesthetic into your hand. Then they cut about a 1/2-inch incision in your palm, in line with the affected finger or thumb. Next, the surgeon cuts the tendon sheath. The sheath can impede movement if it becomes too thick. The doctor moves your finger around to check that the motion is smooth. Finally, you get some stitches to close the small cut.
This procedure is most commonly done for the middle and ring fingers. You may have this procedure done in your doctor’s office.
Your doctor numbs your palm, then inserts a sturdy needle into the skin around your affected tendon. The doctor moves the needle and your finger around to break apart the blocked area. Sometimes doctors use ultrasound so they can see for sure that the tip of the needle opens the tendon sheath.
There’s no cutting or incision.
You’ll probably be able to move the affected finger on the day of the surgery as soon as the numbness wears off. Most people can. You should have a full range of motion.
Depending on the kind of work you do, you may not need to take any time off after the day of surgery. You may be able to use a keyboard almost immediately. If your job involves strenuous labor, you may need to be off work for up to two weeks after surgery.
Here’s a general timeline of how long your recovery will last and what it will include:
- You’ll likely wear a bandage on the finger for four or five days and need to keep the wound dry.
- Your finger and palm will be sore for a few days. You can use ice packs to ease the pain.
To limit swelling, your doctor may suggest you keep your hand propped above your heart as much as possible.
- Your hand surgeon may recommend you see a hand therapist or do specific exercises at home.
- Most people feel able to drive within five days.
- Avoid sports for two or three weeks, until the wound is healed and you have grip strength.
It may take up to three to six months for the last bit of swelling and stiffness to disappear. Recovery may be shorter if you had a percutaneous release. Recovery may be longer if you had surgery on more than one finger.
The tendon sheath that’s cut during surgery grows back together more loosely so the tendon has more room to move.
Sometimes people need more than one surgery. But trigger finger only recurs in about 3 percent of people after either open surgery or percutaneous release. That percentage is likely higher for people who have diabetes. People with diabetes are more likely to have trigger finger in more than one finger too.
Trigger finger surgery is very safe. Complications that are common to most surgeries, such as infection, nerve injury, and bleeding, are very rare for this type of surgery.
Complications specific to trigger finger surgery are less likely if you work with a board-certified hand surgeon with experience in microsurgery and plastic surgery. They move and test your finger during surgery.
If complications occur, they may include:
- nerve damage
- bowstringing, when too much of the sheath is cut
- persistent triggering, when the sheath doesn’t release completely
- incomplete extension, when the sheath stays tight beyond the part that was released
Surgery will likely correct the problem with the tendon and sheath, and restore full movement of your finger or thumb.
People who have diabetes or rheumatoid arthritis have a higher chance of developing trigger finger. Trigger finger can occur in a different finger or tendon.
In severe cases, the surgeon may not be able to straighten the finger.