Trigger Finger Surgery

Introduction

Trigger finger is a condition when one of the fingers or thumb is caught in a bent position. Other symptoms include:

  • Bent finger suddenly pops out and straightens.
  • Finger movement causes “clicking” sound or sensation.
  • Finger sticks in bent position.
  • Fingers feel stiff and sore

These symptoms commonly are worse in the morning. 

Each finger has two tendons which make it bend and the thumb has one tendon. The tenosynovium enables the tendon to move smoothly within its sheath when the finger is bent and straightened. Trigger finger is caused by inflammation of the tenosynovium. This inflammation prevents the tendon to glide smoothly within its sheath causing catching of the finger in the bent position and then suddenly releasing the finger straight.

Indications for surgery

Dr Lane can diagnose trigger finger on clinical history and physical diagnosis. Special tests are not required. Treatment options available are:

  • Splinting.
  • Steroid injection.
  • Trigger finger release.

If splinting and steroid injection fail and the condition is impacting daily activities, the sheath can be surgically released to allow the tendon to glide freely again. 

Pre-operative Instructions

Once surgery is recommended, Dr Lane will discuss the procedure with you. Information leaflets covering the procedure, surgical risks and after care will be supplied.

Anti-inflammatory drugs such as Feldene, Naprosyn, Brufen, Ibuprofen, Indocid, Voltaren, Mobic and Celebrex should be stopped 5 days before surgery. These drugs increase the risk of bleeding. Aspirin or other blood thinning drug use prior to theatre should be discussed with Dr Lane as this would depend on the patients underlying medical condition. The hand to be operated on should be free of cuts, scratches and sores as this would increase the risk of infection. If there is damaged skin in the area that has to be operated on, then it is highly likely that the operation will be postponed.

Trigger finger surgery is a day procedure. The reception staff will give clear instructions when to attend the hospital depending on your surgery time. Please take your Medicare, DVA or Private health cards to Day Hospital Admissions Unit. Do not eat or drink 6 hours before surgery.

Prior to surgery:

  • You will be admitted by the duty nurse and baseline observations taken.
  • Theatre gown given to wear.
  • The hand will be inspected, washed with anti-septic and covered with a sterile drape by nursing staff.
  • You will be given TED stockings to wear in Theatre to reduce the risk of thrombosis after surgery.

The nursing staff will take you into the theatre complex and then into anaesthetic bay, next to operating room. There you will meet your anaesthetist and Dr Lane. Trigger finger surgery can be performed under a local anaesthetic with twilight sedation or general anaesthetic.

Procedure

Once in the operating room, a tourniquet is applied to the upper arm to provide a bloodless field in which to operate. The hand and arm below the tourniquet are washed with an anti-septic solution and then the patient covered with sterile drapes with a window for the hand. A small incision, about 1 cm, is made in the palm at the base of the affected finger. The tight portion of the flexor tendon sheath is released. The skin is then closed with a couple of sutures. Dr Lane injects local anaesthetic around the wound to help with post-operative pain relief. The wound is then covered with primapore and dressings and bandage applied. The operation takes about 10 minutes.

After surgery, you will be taken to the recovery room. When you are adequately awake, observations stable and able to eat and drink you will be ready for discharge home. It is important that you have someone to take you home.

Post-operative Instructions

After surgery, Dr Lane will give you guidelines to follow:

  • Keep dressings clean and dry. Cover with plastic bag while showering.
  • The outer dressing can be removed in 3 days.
  • Once outer bandage is removed, full movement of the finger is encouraged.
  • Keep primapore over wound until reviewed in Dr Lane’s rooms 10 to 14 days after surgery. At this post-operative visit, your sutures will be removed.

Risks

General risks associated with Anaesthetic (v. rare)

  • Death.
  • Myocardial infarction (heart attack).
  • Stroke.
  • Thrombosis.

Local risks (uncommon)

  • Infection.
  • Bleeding.
  • Nerve injury- causing weakness, paralysis or loss of feeling in the hand area.
  • Trigger finger returns if sheath not adequately released.

Patients who are smokers, diabetic or have multiple pre-existing medical conditions are more at risk of adverse complication.