Trigger finger surgery explained by a specialist

Has one of your fingers or thumbs started to become stiff? Perhaps the digit is in the later stages and you have a permanently flexed finger. In some cases, surgery is recommended to resolve the issue. Learn from Dr Stephen Lipscombe about when surgery is necessary and how it’s performed.

What does trigger finger/thumb feel like?

A trigger digit typically begins with stiffness and then intermittent locking and clicking of the finger. As a consequence, this interrupts the rhythm of the hand and can be painful. In the latter stages, the digit can become persistently locked into the palm with a permanently flexed finger posture.

When is surgery necessary for trigger finger/thumb?

Non-surgical treatments (such as night-splints and hand therapy) can be useful in the initial stages. Failing that, a steroid injection, which is provided in a clinic, is one of the most successful injections I perform – it can cure trigger finger or trigger thumb in around 75 per cent of cases.

If steroid injections fail, or the finger has become persistently locked, surgery would then be recommended. This is also a very successful treatment for trigger digits.

How are patients prepared for surgery?

Surgery is completed under a local anaesthetic (meaning the patient is awake) and in an ambulatory day surgical suite.

1. The patient lies on the operating table with the hand extended flat onto the side table.
2. Local anaesthetic is carefully injected initially into the back of the hand for comfort and then into the palm at the site of surgery.
3. The entire area that will be operated on is sterilised and surgical drapes are used throughout the procedure.

How is the surgery performed?

1. Once the site of surgery in the palm is numb, a short incision is made overlying the tendon sheath.
2. With blunt dissection scissors, the tendon sheath is identified while the neighbouring nerves and vessels are protected.
3. The thickening on the tendon sheath (that causes the trigger digit) is divided using a blade.
4. The tendon is inspected, the wound washed.
5. The wound is closed with sutures (stitches) and a light bandage is placed over it.

Are there risks of complications?

Complications are uncommon. The scar can be tender for some weeks and the neighbouring joint can also feel uncomfortable as normal finger movement is restored.

Nerve injury is very rare. Stiffness and complex regional pain syndrome can occur following any hand procedure. Unfortunately, this can take months to recover from but again, this is thankfully is very rare.

What is the success rate for trigger finger/trigger thumb surgery?

Nearly all patients experience immediate relief and recovery.

When can I return to activity after trigger finger surgery?

After two days, the bandage is removed and light daily activity can be started. Light activity can increase to normal activity once the sutures are removed two weeks post-op.

Will I need hand therapy after trigger finger surgery?

Hand therapy is not typical following surgery.

Dr Stephen Lipscombe is an expert in numerous hand and wrist conditions. Don’t hesitate to discover how he can help you.