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Trigger Finger and Thumb

What is trigger finger?

A trigger finger/thumb is caused by the tendon (sinew) catching as it passes through a tunnel at the base of the finger/thumb.

What are the usual symptoms?

The commonest symptom is clicking or locking of the finger/thumb when it bends associated with pain. The finger/thumb may be difficult or impossible to fully straighten and require forcefully pulling straight. It may feel like the joint is dislocating. There is commonly a painful area at the base of the finger/thumb and you may notice a nodule and clicking sensation if you feel the tender area.

What causes it?

The cause is usually unknown although it occurs more frequently in diabetics and patients with rheumatoid arthritis. In the vast majority of cases there is no arthritis and the joints are not affected or damaged by this condition.

What are the treatment options?

1. Some trigger finger/thumbs settle on their own, but persistent symptoms and pain may require treatment.

2. The simplest treatment is to inject a small amount of cortisone around the tendon. This can be done in the out-patients and although slightly uncomfortable at the time, can get rid of the problem in about 70-80% of cases. You can use the hand normally after the injection but it can take a few weeks to respond to the injection.

3. Repeat injections can be undertaken but are less likely to be successful.

4. Surgery may be required if the injections are not successful.

What does the operation involve?

The operation usually uses local anaesthetic to "freeze" the skin at the bottom of the finger/thumb. All jewellery, nail varnish and false nails must be removed from the hand, which is to be operated upon. During the operation the area where the tendon is catching is released. You should only feel a small amount of pushing and touching but no pain. The skin takes 10-14 days to heal.

Will I be able to use my hand after surgery?

You will have a bandage on your hand, which will be reduced in size in 2-3 days, but you should not wet your bandage.

You will be encouraged to use your hand gently within the limits of your bandage avoiding pressure over the palm.

The district nurse will check the wound and arrange for the stitches to be removed between 10-14 days.

The scar is over a sensitive area of the front of the hand and you should try to avoid pressure over this area and strenuous manual activities, such as gardening and DIY for about 2 weeks.

The tenderness and swelling may persist for several weeks in a small number of patients.

You will be able to drive a car after 3-5 days.

Can the operation do me any harm?

Surgery carries a small risk of damage to the other tissues around the operation site, particularly the nerves to the finger although this is very rare (<1%).

The scar may be sore for a few weeks, but use of the hand will not damage or delay the healing.

Infection in the wound can occur but it is usually simple to treat with antibiotics.

Recurrence of symptoms after surgery is very rare.

The Manchester Orthopaedic Group has three hand and wrist surgeons. Steve Royle , Jochen Fischer and Mohammed Waseem are established consultants. They are able to offer a range of treatments for various conditions from carpal tunnel syndrome to wrist arthritis.

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