Trigger finger (stenosing tenosynovitis), surgical treatment

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Trigger finger (stenosing tenosynovitis), surgical treatment is a surgical procedure intended to treat stenosing tenosynovitis, a condition in which the flexor tendon of the finger has difficulty gliding through its tendon sheath. The procedure aims to release the tendon and restore its normal gliding, improve finger mobility, and reduce pain and the sensation of locking.

Indications

• trigger finger with locking or restricted finger movement;
• pain at the base of the finger, particularly during movement;
• a clicking or snapping sensation when bending and straightening the finger;
• difficulty extending the finger;
• persistent symptoms despite conservative treatment;
• recurrence of symptoms after conservative treatment;
• forms of the condition in which restricted finger function affects daily activities;
• indications established by an orthopedic trauma surgeon or a surgeon specializing in hand surgery.

Procedure

1. Preoperative assessment – the physician assesses finger mobility, the location of pain and the characteristics of the symptoms. The diagnosis is established based on clinical examination, and additional investigations may be recommended when necessary.
2. Determination of the indication and surgical technique – the physician determines the area requiring tendon release and the appropriate surgical method according to the specifics of the case.
3. Anesthesia – the procedure is performed under local anesthesia or another method recommended by the physician, depending on the clinical situation.
4. Access to the affected area – the surgeon makes a small incision in the corresponding area and identifies the flexor tendon sheath.
5. Tendon release – the stenotic portion of the tendon sheath is released to allow the tendon to glide freely.
6. Assessment of mobility – the surgeon checks tendon gliding and finger mobility to ensure that the mechanism causing the locking has been eliminated.
7. Wound closure – the incision is closed with sutures and a dressing is applied.
8. Postoperative period and recovery – the patient follows recommendations regarding wound care and gradual mobilization of the finger. Return to usual activities is gradual, according to the physician’s recommendations.

Limitations

• temporary pain, tenderness or swelling may persist in the surgical area after the procedure;
• finger mobility is restored gradually;
• the recovery period may vary depending on the duration and severity of the condition and individual characteristics;
• temporary restriction of certain manual activities may be required;
• in some cases, stiffness, scar tenderness or other local symptoms may persist;
• as with any surgical procedure, the individual outcome may vary.

Contraindications

• active infection in the surgical area;
• skin lesions or local inflammation that do not allow the procedure to be performed safely;
• acute or decompensated conditions that increase surgical or anesthetic risk;
• severe uncorrected coagulation disorders;
• other clinical situations in which the procedure needs to be temporarily postponed.

The decision to perform the procedure is made by the physician after an individual assessment of the patient’s condition and the balance between benefits and risks.

Advantages

• release of the tendon and restoration of its gliding;
• reduction of the sensation of locking and clicking during finger movement;
• improved finger mobility;
• reduction of pain associated with stenosing tenosynovitis;
• a localized surgical procedure with a relatively short recovery period in most cases;
• gradual return to usual activities after healing.

Sources:

https://pmc.ncbi.nlm.nih.gov/articles/PMC10144458/
https://www.assh.org/handcare/condition/trigger-finger   
https://www.nhs.uk/conditions/trigger-finger/treatment/
https://www.researchgate.net/publication/356278649_Stenosing_flexor_tenosynovitis_of_the_hand_trigger_finger
https://www.theplasticsfella.com/trigger-finger/