What is it?
A Trigger Finger/Thumb is due to an area of swelling in the tendon, which bends the finger/thumb into the palm of the hand. These tendons run in a tendon sheath (tunnel). The swelling in the tendon causes the tendon to catch in the tendon sheath. This causes the finger/thumb to stick during movement of the finger/thumb. This sticking is commonly called “triggering”. This is often painful and in more severe case can cause the finger/thumb to stay “locked” (stuck) in the palm.
Why has it occurred?
In most patients triggering occurs because of no apparent reason. Occasionally it can occur following a minor injury to the finger/thumb. It is also more common in diabetic patients, patients with kidney disease and patients with inflammatory types of arthritis such as rheumatoid arthritis, all of whom can get severe triggering.
What is the treatment for it?
If the triggering is mild and has not been occurring for very long, a short period of rest for about 7 to10 days with a splint and anti-inflammatory drugs may relieve the triggering. If the triggering has been occurring for a longer time treatment with an injection is recommended. In the most severe cases, surgery is recommended.
The injection
The finger or thumb which is triggering can be injected in the outpatient department when you are seen. The tendon sheath (tunnel) is injected with a mixture of local anaesthetic (pain killer) and steroid (anti-inflammatory drug). The local anaesthetic helps to reduce the pain in the short-term and the steroid helps to reduce the swelling and pain in the long-term.
Does the injection hurt?
Normally there is no more pain than a normal injection for a blood test or vaccination.
What happens after the injection?
You are advised to rest the tendon by avoiding heavy lifting for 4-6 weeks.
Are there any side effects from the injection?
Patients may experience a warm reddening of the skin for a short while after the injection. An increase in pain can occur after the injection. This varies considerably but may last up to 7 days. The local anaesthetic is given with the injection to help reduce this side effect. Very occasionally some of the steroid leaks into the skin. This can cause the skin over the injection site to become lightened in colour. This effect is often temporary, but occasionally it can be permanent. The amount of steroid injected into the tendon sheath (tunnel) is very small and the body quickly removes it. It does not have any of the general effects found with taking long -term steroids.
How long do the benefits of the injection last?
As everyone is an individual, some may have more benefit than others. Usually, the beneficial effects of the injection will be within weeks. In some people, these benefits may be permanent.
Can the injection be repeated?
Occasionally. Sometimes the triggering is improved but not completely cured. Sometimes the triggering is “cured” but comes back after several months or years. A further injection may help in these cases.
Can more than one finger/thumb be injected at the same time?
Yes.
How successful are the injections?
Treatment with injections helps in approximately 60-80% of patients but it depends on how severe the triggering is.
The surgery
Surgery is required for the most severe cases of triggering and when the triggering does not respond to injections. Surgery involves dividing part of the roof of the tendon sheath (tunnel) in which the tendon is triggering (getting stuck). This allows the tendon to move more freely in the tendon sheath (tunnel).
What type of anaesthetic will I have?
The surgery is normally performed under a local anaesthetic. Occasionally a general anaesthetic or regional anaesthetic (block) is required.
How long will I be in hospital?
The majority of patients can be admitted and discharged home the same day (Day Case Surgery). A small number of patients require an overnight admission.
What is the treatment after surgery?
You will be encouraged to start moving the finger/thumb straight away. You may have stitches to be removed but this will not prevent you from moving your finger/thumb.
What are the risks of surgery?
The risk of surgery is very small but includes bleeding, infection, stiffness, nerve injury and increased sensitivity of the skin. This is discussed with you before your surgery.
How successful is the surgery?
The success rate of surgery is excellent. However, triggering can reoccur again in the future.