Trigger Finger (or Thumb)

A common but easily treated problem. Non-surgical treatment usually works, but if surgery is needed, it's a 5-minute procedure, local anesthesia, and works great!

What is it?
A trigger digit is a condition where the main tendon which normally bends the finger or thumb catches in the palm, and causes popping, clicking, catching and locking of the middle joint of the finger or thumb. The first symptom of this is usually pain in the palm at the base of the finger or thumb, which is worse with grasping.

What causes it?
It is caused by inflammation (often from long-term overuse) of the lining around the tendon, and even of the tendon itself. This inflammation results in an enlarged tendon and tendon lining, and this makes it hard or impossible for the tendon to glide normally as the finger bends. It can be so bad that the enlarged tendon won't glide at all, and it will catch, leaving the middle joint of the finger or thumb painfully locked in place, usually in the bent position.

Will it get worse?
It is possible for it to just go away, but if there is catching, clicking, popping or locking of the joint, it is not likely to heal on its own. It will often progress and impair function of the whole hand because of pain and unpredictable joint locking. Other times it will just continue hurting.

What is the treatment?
Bracing and therapy are not very effective for this condition. Medicines like aspirin, Tylenol, Motrin and other anti-inflammatories may help with the symptoms. An injection given in the tendon lining by your doctor can cure this problem in up to 60% of patients. Sometimes 2 or even 3 injections might be necessary. Surgery is very effective for this condition.

Do I need surgery?
Less than half of patients need surgery for this, as up to 60% respond well to medicines and injections.

Tell me about the surgery
If injections and medicines don't work, surgery may be recommended. It is an outpatient surgery, meaning you go home the same day as surgery. It is done with local anesthesia, meaning you don't have to go to sleep. Patients don't feel anything and are very comfortable due to the sedative drugs given. It takes about 10 minutes, and is done through a very short incision which is often invisible after it is healed. After the surgeon incises the skin, the ligament that causes the catching is divided, leaving more room for the tendon to glide smoothly. Division of that ligament has no appreciable adverse effect on the use of the finger or thumb. More than 95% of patients have resolution of the problem after surgery, making this one of the most effective procedures in all of hand surgery.

Is surgery safe?
Your surgeon will discuss the risks with you, but it is a very safe and effective procedure.

How long would I be out of my job after surgery?
You will be sent home with a bandage on your hand. You should move your finger or thumb the day of surgery, as this helps prevent and reduce swelling and stiffness. The stitches are removed in the office in less than 1 week. Jobs with clerical or light-type of work can be resumed within 1-2 weeks, heavier duty-type jobs such as manual labor can be done after 2-4 weeks in most cases. Many people have returned to their jobs the day after surgery - it really depends on the job type more than anything.