Trigger finger (stenosing tenosynovitis) is a condition restricting the smooth movement of a finger or thumb tendon. This restriction occurs at the base of the digit where the flexor tendon passes through the A1 pulley, a fibrous tunnel. Inflammation of the tendon or its surrounding sheath prevents free gliding, causing a characteristic catching, clicking, or locking sensation. Trigger finger release surgery resolves this mechanical obstruction by cutting the A1 pulley, which opens the tunnel and allows the tendon to move without friction.
How Successful is Trigger Finger Surgery?
Trigger finger surgery provides long-term relief for the vast majority of patients. Success rates for open surgical release are reported between 90% and 100%, demonstrating its reliability in resolving the mechanical obstruction. The core of the procedure involves permanently dividing the A1 pulley, which immediately eliminates the narrow point causing the catching. This permanent structural change means the operated finger is highly unlikely to experience the original problem again. The rate of true recurrence in the same digit is extremely low, occurring in less than 3% of cases.
Understanding True Recurrence Versus New Onset
When symptoms return after surgery, it is important to distinguish between a true recurrence and a new onset of the condition. A true recurrence means the locking or catching symptom returns specifically in the exact same finger that underwent the A1 pulley release. This is a rare event, suggesting a potential mechanical or biological failure related to the original procedure. The recurrence rate in the operated finger is reported to be as low as 2.39% in some studies.
In contrast, a new onset is far more common and involves the development of trigger finger in a different finger or thumb that was not previously operated on. This new occurrence is not a failure of the initial surgery. Underlying systemic factors that predisposed the patient to the condition, such as diabetes or inflammatory arthritis, continue to affect the entire hand. These conditions can cause inflammation and thickening in the tendons and pulleys of other digits over time.
Why Symptoms Return in the Same Finger
True recurrence in the operated finger is usually attributed to specific technical or biological factors. The most common mechanical reason is an incomplete release of the A1 pulley during the initial operation. If a small band of the pulley remains intact, it can still constrict the tendon and cause symptoms to persist or return shortly after surgery.
Another potential cause is the formation of excessive scar tissue (fibrosis) around the flexor tendon post-operatively. This dense scar tissue can create a new point of friction, mimicking the original catching sensation. Underlying patient health conditions also contribute significantly to the risk. Individuals with poorly controlled diabetes or inflammatory diseases like rheumatoid arthritis have a higher predisposition to chronic tendon sheath inflammation, causing the sheath to re-thicken even after a successful pulley release. Additionally, a history of receiving more than three corticosteroid injections before surgery, and occupations involving heavy manual labor, are predictors for a higher risk of recurrence.
Treatment Options for Recurring Trigger Finger
If locking symptoms reappear, the first step is a thorough re-evaluation by a hand specialist to confirm the nature and location of the problem. If the recurrence is mild and thought to be due to scar tissue or residual inflammation, non-surgical options may be attempted first. A corticosteroid injection may be used to reduce localized swelling, though it is often less effective than the initial injection. Physical therapy focusing on tendon-gliding exercises and scar massage can also help improve tendon mobility.
For persistent symptoms, especially if an incomplete release was suspected, a revision surgery may be necessary. This second procedure involves re-exploring the area to ensure the entire A1 pulley is fully divided and to remove any restrictive scar tissue. While revision surgery has a slightly lower success rate than the first operation, it is generally effective in achieving a definitive resolution. Post-operative care for a revision procedure emphasizes hand therapy to prevent new scar adhesion and maximize long-term function.