Trigger Finger and Trigger Thumb fundamentals
Trigger finger and trigger thumb are painful conditions that cause the fingers or thumb to catch or "lock" most often in a bent position. The problems often stem from inflammation of tendons located within a protective covering called the tendon sheath. Thickenings of the sheath called pulleys function like the rings on a fishing rod, which hold the line against the rod. These pulleys hold the tendons against the bone. The affected tendons are tough bands of tissue that connect the muscles of the forearm to the finger and thumb bones. Together, the tendons and muscles allow you to bend your fingers and thumb, for example, when making a fist. A tendon usually glides quite easily through its sheath and pulleys, thanks to lubricating synovial fluid. Occasionally, a tendon may become inflamed and swollen or nodular. When this happens, bending the finger or thumb causes the swollen tendon to catch on one of the pulleys as it glides through the sheath.
One of the first symptoms may be soreness at the base of the finger or thumb. The most common symptom is a painful clicking or snapping when attempting to flex or extend the affected digit. In some cases, the finger or thumb that is affected locks in a flexed position, or in an extended position as the condition becomes more serious, and must be gently manipulated with the other hand in order to eliminate the locking. Joint contractures may eventually occur if left untreated. Usually the most severe symptoms occur upon awakening in the morning. The symptoms tend to improve during the day.
What are the causes of Trigger Finger and Trigger Thumb?
Trigger finger and thumb may be caused by repetitive or forceful use of these digits. For example, repeatedly wringing a washcloth is known to cause the problem. Medical conditions that cause changes in tissues – such as rheumatoid arthritis and diabetes – may also result in symptoms. Prolonged, forceful grasping – of power tools, for instance – also aggravates the condition. Farmers, industrial workers and musicians who rely on their fingers and thumbs for multiple repetitive movements are among those most frequently affected. In some cases, no specific cause can be found.
What are the benefits of treatment?
The majority of trigger finger and trigger thumb problems respond to conservative medical treatment. Restricting activities that aggravate the condition is usually the first step. Occasionally, your doctor will splint the affected digit to restrict joint motion and avoid the painful clicking and locking. Because many patients sleep with their hands tightly flexed, splinting at night to avoid tight bending of the fingers can be especially helpful. If symptoms continue, anti-inflammatory medications may be given orally or may be injected into the tendon sheath to reduce inflammation and subsequent pain, clicking and locking. If the condition doesn’t respond to conservative measures or recurs, surgery may be recommended to release the pulley and restore full movement.
Surgery is performed on an outpatient basis usually under local anesthesia with or without accompanying sedation. Through a 1 cm incision at the base of the digit, the tendon sheath and pulley are exposed to view. The pulley is incised, relieving the constriction and allowing the tendon to move freely. The wound is usually closed with two to three stitches, which are removed 10 days to two weeks later.
What are the risks of treatment?
Complications related to the surgical treatment of trigger finger or trigger thumb are quite rare. The greatest risks include infection, residual clicking, nerve injury and stiffness. In general it is considered an extremely safe procedure.
How do I prepare for surgery?
Always ask your surgeon for complete pre-operative preparation instructions. Typically, these may include:
- Complete any pre-operative tests or lab work prescribed by your doctor.
- Arrange to have someone drive you home from the hospital.
- Refrain from taking aspirin and non-steroidal anti-inflammatory medications (NSAIDs) one week prior to surgery.
- Call the appropriate surgery center to verify your appointment time. If your surgery is being done at Cleveland Clinic, call:
- Main Campus: 216.444.0281
- Beachwood: 216.839.3500
- Refrain from eating or drinking anything after midnight the night before surgery.
Are there exercises I can start now prior to surgery?
Generally if conservative measures have failed and surgery is recommended, there are no specific exercises that will help relieve the problem. It is advantageous to maintain as much motion as possible in a digit, and you may perform range-of-motion exercises within your comfort zone.
What do I do the day of surgery?
- If you currently take any medications, take them the day of your surgery with just a sip of water.
- Refrain from taking diabetic pills or insulin.
- Do not wear any jewelry, body piercing, makeup, nail polish, artificial nails, hairpins or contacts.
- Leave valuables and money at home.
- Wear loose-fitting, comfortable clothing.
What happens during surgery?
The procedure is performed in an operating room with the patient lying comfortably on their back, with their hand out to the side. The hand is cleaned and draped sterilely, which prevents the patient from being able to see it. Typically, the surgeon releases the band, or pulley, that is restricting the tendon. You may be asked to move the tendon during the surgery to make sure it has been completely released and that the clicking and locking has been eliminated.
What happens after surgery?
Two to three small sutures are used to close the incision and a sterile dressing is applied. Depending on the exact situation, the dressing will be removed by the patient five to seven days later and a sterile bandage will be applied and changed daily by the patient. The incision should be kept clean, dry and covered until the sutures are removed 10 to 14 days following the operation. During this period, motion of the digit is encouraged, from full flexion into full extension. However, heavy gripping, pulling and pushing are discouraged. Everyday activities are allowed during this time period.
How long is the recovery period after surgery?
In general, use of the digits is restricted from heavier activities for a period of three weeks. The incision will be tender for six to eight weeks but will improve steadily over that time. Length of recovery is dependent upon joint contractures that may have developed prior to surgery. Sometimes fairly prolonged therapy (one to two months) is required to overcome these contractures.
What is the rehab after surgery?
The day of the first post-operative visit, patients are instructed on a specific range-of-motion program. Depending on their condition, they may see a hand therapist. Five to seven days later, they are started on a scar massage program which may incorporate use of a “scar conformer” at night. The scar conformer may be made of silicone and places direct, mild pressure over the incision to help minimize scarring and maximize remodeling and healing of the tissues. If a joint contracture was present prior to surgery the patient may be given a splint to help supplement their exercise program and eliminate these contractures.
How can I manage at home during recovery from the procedure?
Immediately following surgery, daily activities are allowed. Heavier or repetitive activities are discouraged. The wound should be kept clean, dry and covered. You do not have to wear a splint, you will be able to change your own dressing, and your doctor will advise you regarding showering.
How frequently should I schedule follow up appointments with my doctor following surgery?
The first post-operative visit will take place 10-14 days following surgery, and often the surgeon will see the patient one more time in another two to three weeks.
