Trigger finger (stenosing tenosynovitis) occurs when the flexor tendon sheath in the palm thickens, impeding the smooth gliding of the tendon. The A1 pulley, a fibrous band at the base of the finger, narrows the space, causing the tendon to catch or lock the finger in a bent position. Trigger finger release surgery cuts this constricted A1 pulley, allowing the tendon to move freely and eliminating the catching. Although the procedure resolves the locking mechanism, many patients immediately notice that the finger remains bent or feels stiff. This residual bend is a common and expected part of the healing process, resulting from the body’s natural response to trauma and the hand’s pre-existing state, not surgical failure.
Anatomical Reasons for Residual Bending
The stiffness and residual bend immediately following surgery are largely mechanical, beginning with the body’s inflammatory response to the incision. Localized swelling (edema) occurs as fluid accumulates around the surgical site in the palm. This post-surgical fluid physically occupies space, restricting the movement of the flexor tendon and the surrounding joint capsule, which mechanically prevents the finger from achieving full extension.
The body’s repair process involves laying down new tissue, leading to the formation of scar tissue around the released A1 pulley. This scar tissue consists of collagen fibers that, as they mature, can temporarily tether the flexor tendon to surrounding structures, creating adhesions. When the tendon sticks to the sheath or adjacent soft tissue, its ability to glide smoothly is impaired, resulting in persistent stiffness and a lack of full straightening.
The duration of the condition before surgery also contributes to the initial bend. If the trigger finger was present for an extended period, the joints and soft tissues may have adapted to the bent position. This long-standing posture can lead to a flexion contracture, where the joint capsule and ligaments shorten and tighten. Although surgery removes the obstruction, it does not instantly lengthen these contracted structures, requiring dedicated effort to stretch them back to their original length.
Regaining Full Extension Through Hand Therapy
Overcoming the residual bend and stiffness requires active participation in a structured rehabilitation program, as surgery is only the first step in recovery. A Certified Hand Therapist (CHT) is often utilized to maximize the range of motion and safely manage the healing tissues. This specialized professional creates a treatment plan tailored to the unique way the patient’s hand is healing.
The primary focus of therapy is restoring the tendon’s gliding ability through specific exercises. Tendon gliding exercises, such as progressing from a straight hand to a hook fist, a full fist, and back to straight, are crucial for preventing adhesions and mobilizing the tendon. Blocking exercises isolate movement to a single joint, such as bending only the tip (DIP joint) or the middle joint (PIP joint), ensuring each part of the finger regains its full range of motion.
Managing scar tissue is important to prevent the skin and underlying tissues from restricting movement. Therapists teach techniques like deep tissue massage or friction to soften the scar and prevent it from adhering to the moving tendon beneath. This mobilization helps the collagen fibers align properly, reducing sensitivity and improving the skin’s flexibility over the surgical site.
In cases involving a significant pre-existing contracture, the therapist may employ splinting as a supplemental treatment. Custom-made static or dynamic splints are worn for periods, often at night, to hold the finger in a gentle, sustained position of extension. This prolonged stretch slowly lengthens the shortened joint capsule and ligaments, gradually correcting the established bent posture.
What to Expect During the Recovery Period
The recovery timeline follows a predictable pattern, with initial stiffness giving way to gradual improvement over several months. The immediate post-operative period, typically the first two weeks, is when swelling, discomfort, and stiffness are most pronounced. Patients are encouraged to begin gentle, active range of motion exercises to prevent further stiffening, while focusing on wound care and keeping the hand elevated to minimize swelling.
The intermediate phase, spanning approximately three to six weeks, marks a significant turning point in rehabilitation. As initial swelling subsides, stiffness decreases, and the hand therapist accelerates the program with more intensive stretching and mobilization techniques. Since scar tissue is most active during this period, consistent exercise and scar massage are vital for a successful outcome.
Achieving complete resolution of stiffness and regaining near-full function can take a longer time, often extending into the long-term phase of two to four months or more. Full strength and comfort may take up to six months, with improvements being slow but steady over this duration. Consistent daily therapy must be maintained during this time to ensure the gains are permanent.
While most stiffness is normal, specific signs warrant contacting the surgeon, as they may indicate a complication or inadequate progress. These include worsening pain, increased redness or warmth around the incision, or a fever, which may signal an infection. If the finger remains locked or if the range of motion plateaus despite consistent hand therapy, it may suggest the initial release of the pulley was incomplete or that an underlying issue requires further assessment.