Trigger Finger

Principles

The flexor tendons of the hand course through fibrous sheaths called pulleys that are located on the palmar surface of the fingers.  These pulleys serve to maintain the flexor tendons appropriately against the fingers to prevent bowstringing during flexion.  A trigger finger occurs when the flexor tendon is inhibited from gliding smoothly through the A1 pulley located at the base of the fingers and thumb.  This can cause pain and catching of the finger in motion.  In more severe cases, the finger can become locked in position due to the inability of the tendon to pass through the pulley.  The picture below on the left depicts normal anatomy.  The picture on the right depicts a thickened nodule getting caught in the A1 pulley.

Treatment options include rest, splinting and NSAIDs with a wide range of variability in successful outcomes (40-97%).  Injections are also consider with anywhere from 60-90% resolution of symptoms.  If conservative therapy fails, then a trigger release is recommended.

Surgical treatment of a trigger finger requires a small incision and surgical release of the A1 pulley. This is done as an outpatient procedure and a small soft dressing is applied. Minimal pain medications are usually required.  The goal of rehabilitation after trigger finger release is to allow for wound healing while still maintaining the function of the fingers. Heavy gripping is prohibited for 6 weeks to allow wound healing.  Below is Dr. Lee’s postoperative protocol for trigger finger releases.

Phase One – week 1-2:

You will have a soft dressing on that can be removed on postoperative day 2 and a replacement dressing can be placed
On the same day of surgery you can start moving the fingers fully. You should continue to flex and extend at least 5 times per day to prevent adhesions and wound complications
Start with the fingers full straight, then hook the fingers keeping the knuckles straight, then make a full fist. Repeat this 10 times per session.
It is okay to shower on POD 5 with no dressing on at that time
Pain is controlled with ice, ibuprofen, Tylenol (acetaminophen), and limited narcotics

Phase Two – week 3-6:

Sutures will be removed at your 2 week follow up visit
3 days after the sutures are removed, the scar needs to be massaged at a minimum of three times per day to prevent adhesions and to desensitize the region
Begin more full range of motion of the fingers
Still no heavy gripping with the operative hand but can initiate lifting
Strengthening of the fingers can being with squeezing a foam ball

Phase Three – past week 6:

No restriction to function
Begin full strengthening of the hand and wrist
Continue scar massage

As with all surgery please call the clinic at 307-578-1955 if there are any concerns including abnormal redness or drainage around the wound, fevers, chills, or increasing pain.