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Trigger Finger & Trigger Thumb

Why does it occur?
The finger tendons travel through pulleys in the hand. In trigger finger / thumb a nodule forms on the tendon which gets stuck in the pulleys which causes clicking and sometimes the finger may be stuck in the palm.

Symptoms / Examination
Clicking / Locking of the finger / thumb. The fingers fully bend but on attempting to straighten they lock with a bend. This can be painful. A nodule may be felt at the base of the thumb or in the palm. In some cases the finger or thumb may be stuck in the palm.

A steroid injection into the sheath may lubricate and also damp down the inflammation. Steroid injections can be repeated. Further attempts may damage the tendon and surgery would be advised after one or two failed injections.

Operative treatment

Percutaneous Needle Technique

The advantage about the percutaneous technique is that no incisions are made and the recovery is rapid compared to open surgery. Local anaesthetic is infiltrated to the skin and then using a needle the pulley is divided. The surgeon will perform a test to check if there has been complete release of the pulley. A cold compress is required for 24 hours afterwards and you will be encouraged to move fingers ASAP. Not all type of trigger finger is suitable for this technique.

Open Surgery
The surgery is a day case procedure usually under local anaesthetic. A tourniquet is used; it is like a blood pressure cuff around the upper arm that prevents blood from obscuring the surgeons view. Local anaesthetic is infiltrated under the skin. Extreme care is taken not to injure nerves and blood vessels to the digit. The pulley is divided carefully and the surgeon will usually ask the patient if the clicking has stopped.

Post-operative rehabilitation
Patients can go home usually within 1 hour. The hand should be elevated as much as possible for the first 5 days to prevent the hand and fingers swelling.

Mobilisation of fingers is encouraged to prevent stiffness.

Return to activities of daily living

Keep the wound clean and dry until the stitches are removed – approximately 7 days.ComplicationsOverall, greater than 95% are happy with the result. However complications can occur. There Are complications specOific to Trigger Finger release and also general complications associated with hand surgery.

General complications

Infection - Less than 1%
Neuroma - Less than 1%, a coiled painful nerve bundle
Numbness, scar tenderness - Reflex Sympathetic Dystrophy - RSD (2% bad reaction to surgery with painful stiff hands. This can occur with any hand surgery from a minor procedure to a complex reconstruction.)

Specific complications
Failure to completely resolve the symptoms, this may be due to incomplete release of the pulley.Injury to the nerves - to the finger (less than 1%). This may leave one side of the finger numb. If this occurs, the wound should be explored and if injured, the nerve repaired.  

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