Trigger finger release

Overview of Treatment

Trigger Finger Release (Trigger Finger Release) is a common surgical procedure used to treat "Trigger Finger" (Stenosing Tenosynovitis). This therapy primarily targets the limitation of finger flexor tendon movement caused by stenosis of the tendon sheath, resulting in difficulty in flexion and extension. The treatment options include local corticosteroid injections or surgical incision of the tendon sheath to restore tendon gliding function.

The goal of this therapy is to relieve pain, improve finger mobility, and prevent long-term inflammation from causing joint stiffness or functional impairment. Depending on the severity of the condition, physicians may recommend injections or surgery to achieve optimal results.

Types of Treatment and Mechanism

Trigger Finger Release is mainly divided into two categories:

Local injection therapy: Corticosteroid medication is directly injected into the tendon sheath to reduce inflammation and swelling.
Surgical release therapy: A small incision is made to cut open the tendon sheath, relieving mechanical obstruction to the tendon.

The surgical method is performed under local anesthesia, where the physician makes an incision at the palmar- digital crease to open the tendon sheath, allowing the tendon to glide normally.

The mechanism involves reducing friction between the tendon and the sheath, alleviating the catching phenomenon caused by fibrosis or stenosis. After surgery, the tendon can move freely, relieving the "stuck" sensation.

Indications

This treatment is suitable for the following conditions:

Failure of conservative treatments (such as rest or splinting).
Snapping, sudden jerking, or severe pain during finger movement.
Stenosis of the tendon sheath causing significant limitation in daily activities.

If symptoms persist for several weeks and conservative treatments are ineffective, surgery is usually recommended. Special cases such as diabetic patients or recurrent cases may require priority consideration of surgical treatment. The decision should be made after assessment of the degree of tendon stenosis and the patient’s overall health by a physician.

Usage and Dosage

The steps for local injection therapy are as follows:

Clean the affected area with disinfectant.
Under ultrasound guidance, inject corticosteroid medication (such as methylprednisolone) into the tendon sheath.
The single dose is approximately 0.5-1cc, typically limited to once every 3 months.

Surgical procedures require local anesthesia, with a 0.5-1 cm incision to cut open the tendon sheath.

The surgery lasts about 15-30 minutes. Postoperatively, the wound should be bandaged, and excessive use of the finger should be avoided for 2-3 days. Injection therapy does not require anesthesia but may have gradually diminishing effects.

Benefits and Advantages

The advantages of this therapy include:

Small surgical incision with a short recovery time (usually 1-2 weeks to resume daily activities).
Immediate relief of tendon obstruction, with symptom improvement rates exceeding 90%.
Initial treatment with injections can avoid immediate surgery.

Post-surgical recurrence rates are low, and it can also prevent the risk of tendon atrophy associated with long-term steroid use.

Compared to traditional open surgery, this minimally invasive technique involves smaller wounds and fewer complications, making it suitable for elderly or highly active patients. Injection therapy can serve as a preliminary trial before surgery.

Risks and Side Effects

Potential risks and side effects include:

For injections: temporary bruising, infection risk, or tendon atrophy (after multiple injections).
For surgery: wound infection, temporary nerve paralysis, or excessive tendon laxity leading to joint instability.

Serious complications such as deep tissue injury are rare but require close monitoring for changes in symptoms.

A small number of patients may experience delayed wound healing due to allergy to anesthetic drugs or inadequate postoperative care. The physician will evaluate the risk-benefit ratio based on the patient’s condition.

Precautions and Contraindications

Contraindications include:

Infection or skin ulceration at the injection site.
Allergy to steroids or anesthetic drugs.
Coagulopathy or patients on anticoagulants should discontinue medication beforehand.

Emphasis: Patients with diabetes or immunodeficiency should take enhanced infection prevention measures.

Postoperative care includes avoiding overuse of the affected finger and regular wound check-ups. If symptoms do not improve or worsen, immediate medical evaluation is recommended to consider further treatment adjustments.

Interactions with Other Treatments

This therapy has minimal interactions with other treatments, but attention should be paid to:

If previously treated with steroids, inform the physician to avoid overdose.
Physical therapy should only commence after wound healing.
Patients on immunosuppressants should adjust medication doses to reduce infection risk.

Patients should proactively inform their healthcare provider of all medications and supplements they are taking.

Effectiveness and Evidence

Clinical studies show that surgical treatment has a success rate of up to 95%, with symptom relief typically within 24 hours post-operation. Long-term follow-up indicates a recurrence rate of less than 5% within five years.

Injection therapy is effective in about 60-80% of mild cases, but recurrent cases may require surgery. Most studies support surgery as a definitive treatment, especially for severe fibrosis cases.

Alternatives

Non-surgical options include:

Splinting and rest: temporarily alleviates initial symptoms.
Physical therapy: stretching exercises and heat therapy to improve blood circulation.
Oral anti-inflammatory drugs: such as NSAIDs to reduce inflammation.

However, these methods may not cure the condition and are only suitable for mild symptoms. Traditional open surgery is less favored now due to larger incisions. Trigger finger release surgery, with its minimally invasive nature, has become the mainstream treatment.

Frequently Asked Questions

What preparations are needed before surgery? What activities should be avoided on the day of surgery?

Before trigger finger surgery, it is recommended to inform the doctor if you are taking anticoagulants or have chronic conditions such as diabetes, which may require medication adjustments. Fasting for 4 to 6 hours before surgery and avoiding jewelry or tight clothing are advised to facilitate exposure of the surgical site. The procedure is usually outpatient, requiring no hospitalization, but transportation arrangements are necessary.

How is postoperative pain managed? Are painkillers needed?

Postoperative discomfort may include mild pain or swelling. The doctor may prescribe pain medication or recommend ice packs to alleviate discomfort. It is generally advised to apply ice for 15 minutes every 2 hours for the first 24 hours. If pain persists beyond three days or worsens, a follow-up visit is necessary to evaluate for complications.

How soon can daily activities be resumed? When can work be restarted?

Light activities such as writing or eating can usually resume after 2-3 days, but lifting heavy objects or repetitive finger movements should be avoided for at least two weeks. For jobs that do not require gripping, most patients can gradually return after one week; high-demand workers should consult their physician for specific timelines.

What postoperative rehabilitation exercises are recommended? How can recurrence be prevented?

Physicians will prescribe passive exercises such as finger extension and fist clenching, performed 3-4 times daily, possibly combined with heat therapy to promote tendon gliding. Avoid lifting heavy objects or prolonged gripping activities within one month after surgery, and reduce repetitive flexion and extension of the fingers to lower recurrence risk.

What is the success rate of the treatment? When should a second surgery be considered?

The success rate of a single surgery is approximately 85-90%. If symptoms such as catching or pain persist after six weeks, it may be due to incomplete release of the fibrous capsule or early overloading. In such cases, follow-up assessment is necessary, and the physician may suggest adjusting the rehabilitation plan or performing a second surgery. The incidence of this situation is less than 5%.