Trigger finger release is the surgical treatment for trigger finger or trigger thumb. Surgery is often useful for patients whose symptoms have not responded to non-surgical treatment, or where the finger or thumb is persistently clicking, catching or locking.
It is a relatively minor operation which is usually performed under local anaesthetic as a day case procedure.
Mr Robert Farnell is an experienced specialist Consultant Orthopaedic Hand and Wrist Surgeon who has been working in Leeds for over 25 years. He exclusively treats conditions affecting the adult hand and wrist, including carpal tunnel syndrome, trigger finger and thumb, thumb arthritis and Dupuytren’s disease.
What is trigger finger release?
Trigger finger release is an operation to release the tight pulley at the base of the affected finger or thumb. This pulley is called the A1 pulley.
Releasing the A1 pulley allows the flexor tendon to glide more freely and prevents the painful catching or locking which occurs with trigger finger or trigger thumb.
Read more about trigger finger and thumb.
Before your surgery
You will receive a letter with details of the date and time of your operation. This will provide information about what to do and what to expect during your treatment.
Some hospitals routinely arrange pre-operative assessment clinics, where you will see a nurse and any relevant medical issues can be reviewed.
You will also be given advice about post-operative pain relief. Trigger finger release is not normally a very painful operation and simple painkillers such as paracetamol are often sufficient.
Because the operation is usually performed under local anaesthetic, there are normally no restrictions on eating or drinking before surgery. However, you should always follow the specific advice provided by your hospital and surgeon.
On the day of your surgery
You should arrive at your allotted time. Your pre-operative letter will tell you whether you need to bring anything specific, although patients are commonly asked to bring a dressing gown and slippers.
The nursing team will complete some paperwork, check your medication and make sure you are ready for surgery.
Your surgeon will also see you before the operation, confirm that you understand what is going to happen and answer any questions you may have.
You will be asked to sign a consent form. An arrow will also be marked on your arm using a felt-tip pen. This is routine practice and is used to identify the correct side for surgery.
Local anaesthetic
Before surgery, local anaesthetic is injected to numb the skin and tissues around the operation site.
This is usually done in the operating theatre, although some surgeons may inject the local anaesthetic on the ward before you go into theatre.
Many patients worry that the injection will be painful. Generally, if it is administered carefully, the injection is not usually painful.
What happens during the operation?
Once the anaesthetic has worked, the surgery can take place. The skin is cleaned with antiseptic fluid and sterile towels are used to cover the area.
Some surgeons use a tourniquet to temporarily prevent blood from entering the arm. If this is used, you will be aware of a tight bandage on your upper arm, similar to the cuff used when your blood pressure is taken.
A small incision is made in the palm at the base of the affected finger or thumb. The A1 pulley is released so the tendon can move freely.
On average, the operation takes less than ten minutes and is not usually painful. You may be aware of tugging or pulling sensations, but this should not hurt.
If you have a personal music player, you may be able to listen to music during the operation.
Figure 1: The A1 pulley is released during trigger finger release surgery.
The wound is then closed, usually with absorbable stitches.
Figure 2: The wound has been closed with absorbable sutures.
After the operation, a bandage is applied and you will return to the ward, where you can have a drink and something to eat.
After your surgery
Once the nurses are happy, you will be able to go home.
It is generally expected that someone accompanies you home, as it is not advisable to drive yourself or to be left alone immediately after surgery.
You will usually be given a sling so that you can keep your arm elevated for a day or two. You will also be given an appointment for your next outpatient clinic review.
Trigger finger release is not normally a painful operation. If you experience discomfort, you should take your recommended pain relief medication.
You will need to keep your bandage dry. The bandage usually remains in place for up to two weeks.
At your follow-up appointment, the wound will be checked. Some stitches need removing, although Mr Farnell uses dissolvable stitches which do not usually need to be removed.
It is unusual to require physiotherapy after trigger finger release.
Read more about post-operative care.
Recovery after trigger finger release
The painful locking should resolve soon after the operation. Gentle finger movement is encouraged to reduce stiffness and help restore normal function.
The scar may remain tender for several weeks and discomfort from deep pressure may continue for several months.
Most people return to normal light activities within two to three weeks, although heavier activities may need to be restricted for four to six weeks.
Possible complications
Complications are uncommon and usually minor.
- Scar tenderness: this is the most commonly experienced problem. It can be a nuisance but usually resolves completely. Massaging the scar with moisturiser can help.
- Wound infection: this is seen in up to 1% of cases.
- Finger stiffness: this is uncommon and is best avoided by keeping the fingers moving.
- Nerve injury: this has been described but is uncommon.
Prognosis after surgery
The painful locking usually resolves soon after the operation.
The surgical scar usually heals well. Once the redness and lumpiness have settled, it fades and often looks like a natural skin crease.
Considering trigger finger surgery?
If you have a painful clicking, catching or locking finger or thumb, Mr Robert Farnell can assess your symptoms and advise whether trigger finger release may be appropriate.
Trigger finger release FAQs
What is trigger finger release?
Trigger finger release is an operation to release the A1 pulley at the base of the affected finger or thumb, allowing the tendon to glide freely.
Is trigger finger release performed under local anaesthetic?
Yes. Trigger finger release is usually performed under local anaesthetic as a day case procedure.
How long does trigger finger surgery take?
The operation usually takes less than ten minutes.
Is trigger finger release painful?
The operation is not usually painful. You may feel tugging or pulling sensations, but this should not hurt.
When does the locking improve?
The painful locking usually resolves soon after the operation.
How long does the bandage stay on?
The bandage usually remains in place for up to two weeks and should be kept dry.
Will the stitches need removing?
Some stitches need removing, although Mr Farnell uses dissolvable stitches which do not usually need to be removed.
Will I need physiotherapy?
It is unusual to require physiotherapy after trigger finger release.
What are the risks of trigger finger release?
Risks include scar tenderness, wound infection, finger stiffness and uncommon nerve injury.