DEAR DR. GOTT: I have a trigger finger. Three times the doctor has injected it to resolve the problem. He tells me there will be no more injections and that I must have surgery. Is there another solution? If not, can you detail the surgery for me? Thank you.
DEAR READER: When a finger or thumb catches in a bent position and will straighten only with a popping or snapping similar to the trigger on a gun being pulled and released, the condition is referred to as trigger finger, medically referred to as stenosing tenosynovitis. The condition commonly occurs in the dominant hand, although both hands might be involved. When the condition becomes severe, the finger may remain locked in the bent position.
The cause results from a narrowing of the sheath that surrounds the tendon in the affected finger. A tendon is a fibrous cord that attaches muscle to bone. Each tendon is encased by a protective covering lined with a lubricating fluid to help the tendon glide smoothly as the finger is bent and straightened. Because of inflammatory conditions such as rheumatoid arthritis, the space within the tendon covering can narrow. The tendon becomes irritated, causing the digit to catch.
The condition is common in individuals whose work patterns or hobbies require repetitive gripping actions and is more prominent in individuals with a history of rheumatoid arthritis, hypothyroidism, diabetes and certain infections.
Treatment for mild cases might begin with rest of the affected digit for about a month; however, on the flip side, mild finger exercises may help maintain mobility. Since symptoms are more prominent in the morning, when the digit has been dormant for a period of time, soaking it in warm water might lessen symptoms. A splint might prevent curling at the joint. While massage will not modify the inflammation, it will certainly make it feel better.
Medication often begins with NSAIDs, non-steroidal, anti-inflammatory drugs, typically those found over-the-counter. From there, prescription NSAIDs or steroids will given to reduce inflammation. Steroids will not be as effective in those with diabetes or rheumatoid arthritis.
Then there’s percutaneous trigger finger release performed under local anesthesia and most effective for the index, middle and ring fingers. During the procedure, a physician will insert a needle and inject steroids to release the locked position of the finger.
Finally, surgical release is generally considered to be safe and may be the best solution for cases that don’t respond to other forms of therapy. This procedure is performed in an operating room. The hand is cleaned and draped, and the surgeon releases the band that restricts the tendon. Two or three sutures will be used to close the incision and a sterile dressing will be applied. The incision should be kept clean and covered for up to two weeks.
Motion of the digit during this period is actually encouraged. However, pulling, heavy gripping and pushing are discouraged. You can expect to receive immediate instruction on what specific activity is allowed or discouraged. A hand therapist may become involved. This will be followed with massage of the area of the incision. The incision may remain tender for up to two months, but symptoms will lessen with time.
I suggest you be guided by your surgeon’s recommendations. If you have any questions, request a second surgical opinion.
