While many people find relief with non-surgical treatments for trigger finger, some need surgery to remedy the condition.
This article explains the mechanics of trigger finger, the signs, and the treatment options, including two types of surgery: open surgical release and percutaneous release.
Causes
Tendons pull your fingers into a fist when your forearm muscles contract. The tendon is held against the bones of the fingers by multiple pulleys. Trigger finger is caused when the tendon becomes stuck as it passes through a pulley in the palm of the hand.
These pulleys keep the tendons against the bone, but one pulley in particular—called the A1 pulley—can thicken and cause the tendon to become stuck. In the worst case, a person must use their other hand to straighten out this finger.
Medically known as stenosing flexor tenosynovitis, trigger finger is common, affecting 2% to 3% of the population. The condition appears to be more prevalent among people with certain medical conditions, such as carpal tunnel syndrome, diabetes, gout, and rheumatoid arthritis. Repeated and/or strong gripping may lead to trigger finger, but the exact cause is still not clear.
Symptoms
The symptoms of trigger finger are more straightforward than the causes. They are:
Pain, which often begins where the affected finger meets the palm. Pressure may be felt around the A1 pulley area. Movement (like gripping) may provoke the pain; at rest, there may be no pain at all. Swelling, with a lump at the A1 pulley. Stiffness and loss of movement, or an inability to bend or fully straighten the finger. After several weeks, a ligament known as the volar plate can tighten up and impair natural motion. Abnormal sensations, including catching, locking, and popping. Pain with these sensations tends to increase the longer the condition goes on.
Treatment Options
Treatments for trigger finger range from conservative to invasive. Non-surgical treatments are almost always attempted first and can include:
Massage, heat, and/or iceRest, or at least avoiding activities that typically strain the handSplinting, to keep the affected finger (or thumb) in a straight position overnightExercises to improve range of motionMedications, especially acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs), to address pain and inflammationSteroid injections at the base of the trigger finger
If trigger finger fails to respond to non-surgical treatments, surgery is an option. There are two surgical procedures: Open surgical release and percutaneous release.
Open Surgical Release
During an open surgical release, the surgeon makes a small (1 centimeter) incision over the palm of the hand where the tendon is getting stuck. Specifically, they cut the tendon sheath (the layer of tissue surrounding the tendon), which gives the tendon more room to move.
Most surgeons prefer to use local anesthetic for this outpatient procedure. One advantage of using a local anesthetic is the patient can bend their finger once the release has been performed to ensure the problem is resolved.
After an open surgical release, a suture (stitch) or two—or sometimes skin glue—is used to close the incision. Many patients have some discomfort around the incision and at the second knuckle joint. Some patients feel stiffness in the finger that can take weeks or longer to fully go away.
Percutaneous Release
A percutaneous release is a less invasive surgical procedure. In it, a surgeon uses a needle, guided by an ultrasound, to break up the tissue around the tendon sheath that is blocking movement.
This procedure has some advantages: It can be conducted in the office of a healthcare provider. You won’t need any stitches, and the recovery time is shorter.
One study concluded that percutaneous release is “a safe, effective, and minimally invasive surgical alternative.”
Is One Option Better?
Both options seem to be effective treatment options for trigger finger. The gold standard is still the traditional open surgery, which has been practiced longer. But surgeons continue to learn techniques to make both procedures less invasive.
Even with open surgery, recovery is typically fast; the incision should heal within a few weeks. However, it could take up to six months for all the swelling and stiffness to completely resolve.
For now, researchers haven’t found grounds to say that one technique is superior to the other. As some researchers note, surgeons may prefer open surgery because it affords better visibility as they work; patients may prefer percutaneous release because it’s less invasive.
One study concluded that “there is no consensus about the best surgical treatment approach.” And another study comparing the two methods found “no difference” in treatment failure or complications between the two.
Perhaps the most important factors are your surgeon’s experiences as well as their preference. Be sure to inquire about their track record, too.
Complications
Complications are possible with any type of surgery. To prepare you, your surgeon should discuss them with you beforehand. The more common complications of trigger finger surgery include:
Difficulty or inability to straighten the affected fingerStiffness at the surgery siteSwelling at the site
Less common complications include:
“Bowstringing,” meaning that the tendon may arch away from the bone, causing a reduced range of motionNerve injury, which can lead to numbness or tinglingInfection, which is rarePersistent locking or clicking
Most patients who undergo surgery enjoy relief from pain and better finger mobility. But even surgery is not a cure-all. If you struggled with loss of motion before surgery, you may not regain full range of motion after it.
Summary
Trigger finger is a result of a tendon in the finger becoming stuck as it passes through a pulley in the palm of the hand. It can cause pain, swelling, and stiffness.
The condition often responds well to non-surgical treatments, from medications to splinting. But when it doesn’t, two types of surgery are an option: Open surgical release and percutaneous release. The former method has been in use longer, but the latter is less invasive. Both seem to work well.
A Word From Verywell
If you symptoms of trigger finger, consult with a healthcare provider to get a diagnosis and suggestions for treatment. You may be able find relief with conservative treatments such as rest, heat, and over-the-counter medications. But if not, there are two good options for surgical treatment.
