Stenosing tenosynovitis, commonly known as trigger finger, is a condition affecting the hand’s ability to move a finger or thumb smoothly. The issue arises from inflammation and narrowing of the tendon sheath, which is the protective tunnel surrounding the flexor tendon. Specifically, the restriction occurs at the A1 pulley, a band of tissue at the base of the finger in the palm. When the tendon attempts to glide through this thickened pulley, it catches, producing a locking or clicking sensation. When non-surgical treatments like splinting or steroid injections fail to provide lasting relief, a surgical release becomes the definitive method to free the tendon and restore smooth, comfortable motion.
Preparing for the Procedure
Trigger finger surgery is typically performed as an outpatient procedure in a surgery center or doctor’s office, allowing the patient to be discharged the same day. Anesthesia is administered to ensure comfort, most frequently a local anesthetic that numbs only the hand or finger, though sometimes a regional block is used.
The hand and arm are cleansed and draped with sterile covers to minimize infection risk. A tourniquet is placed around the upper arm or forearm; inflating this device temporarily stops blood flow, creating a bloodless surgical field that gives the surgeon a clear view of the anatomy.
The Surgical Release Techniques
The core of the procedure is the release of the A1 pulley, and surgeons generally employ one of two primary methods to accomplish this goal. The classical approach is the open release, which has long been considered the standard technique because it allows for direct visualization of the anatomical structures.
The open release begins with a small incision, typically less than one centimeter, made in the palm skin crease at the base of the affected finger. The surgeon carefully dissects through the subcutaneous tissue to expose the underlying flexor tendon sheath and the thickened A1 pulley. Care is taken to protect nearby nerves and blood vessels, especially the digital radial nerve.
Once the A1 pulley is clearly visible, it is precisely divided longitudinally along its entire length using a small surgical knife or scissors. The surgeon then typically flexes and extends the finger to confirm that the tendon now glides freely without any catching or clicking. After ensuring the release is complete, the surgical site is irrigated, the tourniquet is deflated to restore blood flow, and the small incision is closed, usually with a few sutures or sterile adhesive strips.
A less invasive alternative is the percutaneous release, which uses specialized instruments inserted through the skin without a formal open incision. This technique uses a small needle or a purpose-designed blade to divide the tight A1 pulley. The procedure is often guided by ultrasound imaging, allowing the surgeon to visualize the pulley and the tendon in real-time.
The percutaneous approach is generally quicker than the open method and leaves only a tiny puncture wound, leading to a faster initial recovery. The instrument is inserted near the A1 pulley, and under ultrasound guidance, the pulley is transected to widen the tunnel. While effective, the percutaneous method requires specialized guidance to ensure the pulley is fully released and to avoid damaging surrounding structures, such as the digital nerves.
Immediate Post-Surgical Expectations
Immediately following the procedure, the hand is covered with a sterile dressing to protect the surgical site. Patients can expect mild soreness, tenderness, and swelling in the finger and palm. Pain is typically managed effectively with over-the-counter pain relievers after the local anesthetic wears off, though prescription medication may be provided for the first day or two.
Gentle, active movement of the operated finger is encouraged immediately post-operatively. Patients should begin carefully bending and straightening the finger to prevent stiffness and reduce the risk of internal scarring. The hand should also be kept elevated as much as possible, especially in the first 24 to 48 hours, to minimize swelling.
Wound care involves keeping the initial dressing clean and dry for 2 to 5 days, depending on the surgeon’s preference. Once removed, the incision site should be covered with a simple bandage and may be gently washed with soap and water. Activity restrictions involve avoiding heavy gripping, pushing, or lifting anything heavier than a small household object for the first week or two.