Trigger finger - Treating trigger finger

The treatment for trigger finger depends on the severity of your symptoms and how long you have had them.

Some cases of trigger finger get better without treatment, so your GP may recommend that you avoid activities that cause the pain to see whether this helps relieve your symptoms. 

Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may also be helpful in relieving any pain.

Splinting

Strapping your affected finger or thumb to a plastic splint can ease your symptoms by stopping your finger from moving. If your finger is particularly stiff in the morning, it may help to use a splint overnight. Your GP can advise you how long you need to wear the splint for.

While using a splint can be helpful for some people, it is generally less effective than the other treatments described below, particularly in the long-term.

Corticosteroid injections

Corticosteroids are medicines that can be used to reduce swelling. In cases of trigger finger, liquid corticosteroids are injected into the tendon sheath (the tunnel that the tendon slides through), at the base of your affected finger or thumb.

Corticosteroids are thought to work because they reduce swelling of the tendon, allowing the tendon to move freely again. This can sometimes happen within a few days of having the injection, but it usually takes a few weeks.

Corticosteroid injections are estimated to be an effective treatment for 50–80% of people with trigger finger. However, they are generally less effective in people with certain underlying health conditions, such as diabetes and rheumatoid arthritis.

A corticosteroid injection can permanently improve trigger finger, but the problem recurs after treatment in some cases. You can have a second injection if the effect wears off, but this is generally less effective than the first injection.

The risks of corticosteroid injections for trigger finger are small, but it very occasionally causes some thinning or colour change in the skin at the site of injection. There is also an extremely small risk of infection.

Surgery

If the above treatments do not work or are unsuitable, surgery may be recommended. This involves cutting through the affected section of the tendon sheath that attaches the tendon to the bone in your finger, so that your tendon can move freely again.

Whether surgery is recommended will depend on how much pain you are in, whether it is associated with other medical problems, such as rheumatoid arthritis, and how much it is affecting your life.

In most cases, trigger finger is a nuisance rather than a serious condition. However, if it is not treated, the affected finger or thumb may become permanently stuck in a bent position or, less commonly, in a straightened position. This can make it difficult to carry out everyday tasks.

Surgery is very effective and it is rare for the problem to recur in the treated finger or thumb, although you will need to take some time off work and there is a risk of complications (see below).

The operation takes around 20 minutes, and you will not need to stay in hospital overnight. The procedure is usually performed under local anaesthetic, so you will be awake but unable to feel any pain in your hand.

There are two types of surgery:

• open trigger finger release surgery
• percutaneous trigger finger release surgery

If you have rheumatoid arthritis, these types of surgery may not be recommended because they can cause your finger to drift sideways. Instead, a special procedure, called a tenosynovectomy, may be necessary. This involves removing part of the tendon sheath to allow the tendon to move again.

Open trigger finger release surgery

If you have open trigger finger release surgery, the surgeon will give you an injection of local anaesthetic into the palm of your hand. 

A small incision (cut) is made in the palm of your hand along one of the natural creases, which may mean the scar will be less noticeable. The surgeon carefully cuts through the tendon sheath to make it wider. The wound will then be closed with stitches and covered with a light bandage.

Percutaneous trigger finger release surgery

Percutaneous means 'through the skin'. As with the open method of surgery, the surgeon will inject your hand with a local anaesthetic. However, instead of making an incision in your palm, a needle is inserted into the base of the affected finger. The needle will be used to slice through the ligament.

As percutaneous surgery does not involve an incision, you will not have a wound or scar. However, the procedure is slightly more dangerous than open surgery and may be less effective at resolving the problem. Important nerves and arteries are very close to the tendon sheath and these can easily be damaged. For this reason, open surgery is usually the preferred method.

Recovering from surgery

After the procedure, you should be able to move your finger straightaway. The dressings can usually be removed after a few days to make movement easier, and full movement should return within a week or two.

If you have had open surgery, your palm may feel sore immediately after the procedure, but any discomfort should pass within two weeks.

• You can start driving again as soon as you feel it is safe for you to drive, which is usually after three to five days.
• You may be able to write and use a computer immediately.
• You can play sports after around two or three weeks, once your wound has healed and you can grip again.
• When you can return to work will depend on your job. If you have a desk job or a job that involves light manual duties, you may not need any time off work. If your job involves manual labour, you may need up to four weeks off.

If you have had surgery on more than one finger, your recovery period may be longer.

If you have had percutaneous surgery rather than open trigger finger release surgery, your recovery period may be shorter, as you will not have a wound on your palm.

Caring for your wound

If you have had open surgery, your surgeon should tell you how to care for the wound in your palm. Washing it with mild soap and warm water is all that is usually required.

If you have stitches, you will be told if you need to return to hospital to have them removed. Some stitches are dissolvable and will disappear on their own in around three weeks.

You may be left with a small scar running along your palm, where the incision was made.

Hand therapy

If your finger was quite stiff before surgery, you may need specialised hand therapy after your operation to loosen it. Discuss this with your surgeon before the operation. The type of therapy may include:

• Physiotherapy – manipulation, massage and exercise can help improve your range of movement.
• Occupational therapy – if you are struggling with everyday tasks and activities, either at work or at home, an occupational therapist will give you practical support to make those tasks easier.

Complications from surgery

Trigger finger release surgery is a safe procedure. However, as with any type of surgery, there are some risks. Complications are rare, but could include:

• infection
• stiffness or pain in the finger
• a tender scar
• nerve damage (if a nerve is damaged during surgery, you may never recover the full sensation in the affected area)
• tendon bowstringing, where the tendon is in the wrong position
• complex regional pain syndrome (CRPS), which causes pain and swelling in your hand after surgery – this usually resolves itself after a few months, but there can be permanent problems

Before your operation, ask your surgeon about the possible complications and risks.