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 treatment primarily targets the limitation of finger flexor tendon movement caused by narrowing of the tendon sheath, which prevents smooth 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 the best therapeutic outcome.

Types and Mechanisms of Treatment

Trigger Finger Release mainly divides into two categories:

Local Injection Therapy: Direct injection of corticosteroids into the tendon sheath to reduce inflammation and swelling.
Surgical Release Therapy: Making small incisions to cut open the tendon sheath, relieving mechanical obstruction to the tendon.

Surgical therapy is usually performed under local anesthesia, where the physician makes an incision at the palmar-phalangeal joint 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 caused by fibrosis or narrowing. Post-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, splinting).
Presence of catching, sudden jerking, or severe pain during finger movement.
Severe limitation of daily activities due to tendon sheath narrowing.

>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 prioritize surgical intervention. The decision should be made after assessment of the degree of tendon narrowing and overall health status 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 Betamethasone) into the tendon sheath.
The single dose is approximately 0.5-1cc, usually 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 takes about 15-30 minutes. Postoperative care includes dressing the wound and avoiding excessive use of the finger 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 incisions with short recovery time (usually 1-2 weeks to resume daily activities).
Immediate relief of tendon obstruction, with symptom improvement rates exceeding 90%.
Injection can serve as an initial treatment to avoid immediate surgery.

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

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

Risks and Side Effects

Potential risks and side effects include:

Local injection: temporary bruising, infection risk, or tendon atrophy (after multiple injections).
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 of symptoms.

A small number of patients may experience delayed wound healing due to allergic reactions to anesthesia 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 immunocompromised status should strengthen 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 necessary to consider adjusting the treatment plan.

Interactions with Other Treatments

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

If corticosteroids have been previously administered, 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 actively 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 5 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 solution, especially for severe fibrosis cases.

Alternatives

Non-surgical treatments include:

Splinting and rest: temporarily alleviating early 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.

Open surgery is the traditional approach, but it involves larger wounds and is less commonly used now. Trigger finger release surgery, due to 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 diseases such as diabetes, as medication adjustments may be necessary. Fasting for 4-6 hours prior to surgery is advised, and avoid wearing jewelry or tight clothing to facilitate exposure of the surgical site. The procedure is usually outpatient, requiring no hospitalization, but arrangements for transportation should be made.

How is postoperative pain managed? Are painkillers necessary?

Postoperative discomfort may include mild pain or swelling. The doctor will 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 3 days or worsens, immediate follow-up is recommended to evaluate for complications.

When can normal activities and work be resumed after surgery?

Light activities such as writing or eating can usually resume after 2-3 days, but avoid lifting heavy objects or repetitive finger movements for at least 2 weeks. Patients whose work does not involve repetitive gripping can typically return to work after 1 week; those with high physical demands should consult their physician for specific timelines.

What rehabilitation exercises are recommended post-surgery? How can recurrence be prevented?

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

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 6 weeks, it may be due to incomplete release of the fibrous capsule or premature loading. In such cases, follow-up assessment is necessary, and the physician may recommend adjusting the rehabilitation plan or performing a second surgery. The incidence of this situation is less than 5%.