Trigger finger is a condition in which one of your fingers gets stuck in a bent position. Your finger may bend or straighten with a snap — like a trigger being pulled and released. Trigger finger is also known as stenosing tenosynovitis.

Some Trigger Fingers will resolve spontaneously. Splinting of the affected digit for a brief period may help resolve the symptoms. Over the counter anti-inflammatories may also help to relieve pain and inflammation. If the symptoms do not spontaneously resolve within six weeks, a more aggressive form of treatment may be required.

The first line of treatment for most patients is a cortisone injection into the A-1 Pulley of the affected digit. This corticosteroid injection usually shrinks the swelling around the A-1 Pulley causing the finger to move freely, without pain or locking. The overwhelming majority of patients will have complete resolution of their symptoms within six to eight weeks following a cortisone injection. Over 95% of patients who have a Trigger Finger of less than six months duration will realize significant improvement in their symptoms, following the cortisone injection.

Unfortunately, only 2/3 of the patients will have permanent resolution of their symptoms following a cortisone injection. Depending on the severity and chronicity of the problem, a second cortisone injection may be considered. Patients with diabetes, or those with more advanced and chronic symptoms, likely will have a higher rate of failure with cortisone alone.

If Trigger Finger fails to improve with non-surgical treatment, then a surgical procedure, called a Trigger Finger Release, may be required. The goal of the procedure is to release the A-1 Pulley that is blocking tendon movement. The procedure is usually done under local anaesthetic alone. A 1 centimetre incision is made over the A-1 Pulley and the pulley is cut to allow free gliding of the flexor tendon. This usually results in immediate resolution of the problem but patients will have to contend with a small wound on the hand.

The wound is usually dressed for 48 to 72 hours after surgery, at which point the wound may be washed with soap and water. Patients are asked to avoid soaking or a dirty environment for 10 to 14 days. The surgical site usually becomes harder over six weeks and a course of deep massage, after two weeks, is usually encouraged to soften the scar and ease the tenderness. This palmar scar reaction to surgery can often become more significant over the first six weeks after intervention.

The surgical site scar tenderness usually resolves within three to six months and the finger function usually returns to normal. Patients with more advanced cases, prior to surgery, may be left with a small bend in the proximal interphalangeal joint but this rarely causes any functional problems. Often seeing a local family physician or a physiotherapist in conjunction with a registered dietitian and athletic therapist is a great option to take control of this condition. Smart Food Now and exercise is also optominal for overall health.    

Wound infections can occur after surgery and occasionally may require a course of oral antibiotics. Persistent numbness in the finger after surgery is usually caused by an injury to the digital nerve. This will, more likely than not, resolve with time.

Presenter: Dr. Bertrand Perey, Orthopaedic Surgeon, New Westminster, BC

Local Practitioners: Orthopaedic Surgeon

Surgery for trigger finger involves an incision in the palm, and any time that an incision is carried out in the palm, you get a scar reaction because of the type of the skin in the palm, which is similar to the sin in the foot, called glabrous skin.

And that scar reaction can be quite significant in many patients. In fact, it can get worse for three to six weeks after surgery, so most patients - although their symptoms of tendon catching and locking and triggering that they had prior to surgery are immediately gone, they often experience tenderness over the incisional site for many weeks.

It completely resolves over a period of many months, to a point that you can barely even see the incision where the surgery was done. But sometimes patients have an abnormal reaction, abnormal scarring and they should seek attention from a therapist, to see if they can provide them with scar massage, scar improving tool through pressure devices, that can help that go away faster.

The general results from surgery are outstanding, with the majority of patients never having a recurrence. The problem is we do have 10 digits and trigger finger can happen in multiple fingers.

Most patients in a lifetime will not get more than two trigger fingers; some patients have multiple digits that occur sequentially, until ultimately they’re all surgically fixed. The recurrence rate after surgery is extremely low.

If your doctor believes that you may have trigger finger and that you’re referred to a surgeon who specializes in this, it will likely be your hand surgeon, who may have even orthopedic or plastic surgery. But most of these sub-specialists only do hand surgery for a living, so ask your doctor for further information about that.

Presenter: Dr. Bertrand Perey, Orthopaedic Surgeon, New Westminster, BC

Now Health Network Local Practitioners: Orthopaedic Surgeon