What is Trigger finger/thumb?
This is a condition caused by inflammation in the tunnels of the hand, under which the tendons pass, into the fingers. It causes pain and lumpiness in the palm of the hand, as well as the clicking, triggering and locking of the fingers into the palm of the hand. When the fingers get stuck in a certain position, the other hand is often required to move them back to their normal position.
What are the non-surgical and surgical options available?
First line therapy includes a steroid injection into the synovial fluid that lubricates the tunnels and surrounds the tendons. This reduces inflammation and resolves symptoms in the majority of cases. If the condition fails to improve after two injections, a small operation is necessary under local anaesthetic. This involves a cut in the palm crease of the hand to enable the top of the tunnel to be divided to create space and allow the tendon to glide more easily. Surgery is more likely in diabetics or for patients with multiple triggering fingers.
How long do the results last for?
The results of a steroid injection are usually very good. If the symptoms and signs completely resolve on a permanent basis, then no other treatment is necessary and the need for a surgical intervention is prevented. The chance of recurrence is small although the injections do not work as well for patients with diabetes. If the steroid injection fails, or an immediate solution is required, surgical alternatives will be explored if appropriate. The results of surgery are usually permanent.
What are the risks?
Steroid injections are usually painful for 1-2 days and then take approximately six weeks to take effect. With surgery, like all other surgery, infection and bleeding is a theoretical risk. Tender scar tissue occasionally takes a few months to settle down with massage. The condition rarely recurs. More commonly, the condition affects multiple fingers and depending on the severity, what has previously worked and restrictions on use, the injections can be repeated.
What are the success rates?
The results of steroid injection are usually extremely good and at the very least temporarily improve the situation, especially in painful triggering. When the effect is temporary (lasting 6-9 months) or some of the symptoms still remain, the steroid injection can be repeated. They do not work as well for patients with diabetes. The results of surgery are very good once fully recovered.
How much does the surgery cost?
The indicative prices below include the surgical fee, any anaesthetic used and the associated fees from the consultant administering this, in addition to the hospital fee and all tests and follow up. An accurate breakdown and a detailed quote will be given following the initial consultation.
From £250 for steroid injection
From £2,000 for trigger release under local anaesthetic
What general advice is there?
Following any injections or surgery on the hand, swelling and discomfort is inevitable. Elevation of the affected arm and non-steroidal anti-inflammatory medication helps. Early immobilisation for 48 hours helps recovery but must be followed by appropriately gauged rehabilitation. Simple pain relief (paracetamol and/or ibuprofen) taken one hour before hand therapy rehabilitation allows more exercises to be undertaken. Desensitisation with moisturiser and massage helps scars to soften and become less painful.
Facts for Trigger finger/thumb
- Surgery duration: 30 minutes
- Type of anaesthesia: Local anaesthetic
- Time in hospital: Day case
- Time off work: 1 week
- Recovery time: 2 weeks
- First follow up appointment: 1 week
- Total number of follow up appointments: 3
- Pain management: Simple pain relief (paracetamol and/or ibuprofen)
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