Surgical Treatments for Trigger Finger

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Trigger finger is a common tendon problem that occurs when the tendons of a finger become caught as the finger bends and straightens, causing the digit to snap open or get stuck in a bent position in the palm of the hand. It usually affects the ring finger and thumb.

While many people find relief with non-surgical treatments for trigger finger, some need surgery to remedy the condition.

This article explains the mechanics of trigger finger, the signs, and the treatment options, including two types of surgery: open surgical release and percutaneous release.

Close up of doctors holding instruments during surgery
Caiaimage / Sam Edwards / Getty Images

Causes

Tendons pull your fingers into a fist when your forearm muscles contract. The tendon is held against the bones of the fingers by multiple pulleys. Trigger finger is caused when the tendon becomes stuck as it passes through a pulley in the palm of the hand. 

These pulleys keep the tendons against the bone, but one pulley in particular—called the A1 pulley—can thicken and cause the tendon to become stuck. In the worst case, a person must use their other hand to straighten out this finger.

Medically known as stenosing flexor tenosynovitis, trigger finger is common, affecting 2% to 3% of the population. The condition appears to be more prevalent among people with certain medical conditions, such as carpal tunnel syndrome, diabetes, gout, and rheumatoid arthritis. Repeated and/or strong gripping may lead to trigger finger, but the exact cause is still not clear.

Trigger finger can strike people of all ages. But it's most common among children under age 8 and adults between 40 and 60.

Symptoms

The symptoms of trigger finger are more straightforward than the causes. They are:

  • Pain, which often begins where the affected finger meets the palm. Pressure may be felt around the A1 pulley area. Movement (like gripping) may provoke the pain; at rest, there may be no pain at all.
  • Swelling, with a lump at the A1 pulley.
  • Stiffness and loss of movement, or an inability to bend or fully straighten the finger. After several weeks, a ligament known as the volar plate can tighten up and impair natural motion.
  • Abnormal sensations, including catching, locking, and popping. Pain with these sensations tends to increase the longer the condition goes on.

Inactivity Intensifies Pain

You're not imagining things if you think your trigger finger is at its worst first thing in the morning. Long periods of inactivity (like overnight) seem to make stiffness and locking worse.

Treatment Options

Treatments for trigger finger range from conservative to invasive. Non-surgical treatments are almost always attempted first and can include:

  • Massage, heat, and/or ice
  • Rest, or at least avoiding activities that typically strain the hand
  • Splinting, to keep the affected finger (or thumb) in a straight position overnight
  • Exercises to improve range of motion
  • Medications, especially acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs), to address pain and inflammation
  • Steroid injections at the base of the trigger finger

Extracorporeal shock wave therapy (ESWT) may be another treatment option for people who want to avoid injections or surgery. It is used for other soft-tissue conditions, like tennis elbow. But there is very little research on how it works on trigger finger.

If trigger finger fails to respond to non-surgical treatments, surgery is an option. There are two surgical procedures: Open surgical release and percutaneous release.

Open Surgical Release

During an open surgical release, the surgeon makes a small (1 centimeter) incision over the palm of the hand where the tendon is getting stuck. Specifically, they cut the tendon sheath (the layer of tissue surrounding the tendon), which gives the tendon more room to move.

Most surgeons prefer to use local anesthetic for this outpatient procedure. One advantage of using a local anesthetic is the patient can bend their finger once the release has been performed to ensure the problem is resolved.

After an open surgical release, a suture (stitch) or two—or sometimes skin glue—is used to close the incision. Many patients have some discomfort around the incision and at the second knuckle joint. Some patients feel stiffness in the finger that can take weeks or longer to fully go away.

Percutaneous Release

A percutaneous release is a less invasive surgical procedure. In it, a surgeon uses a needle, guided by an ultrasound, to break up the tissue around the tendon sheath that is blocking movement.

This procedure has some advantages: It can be conducted in the office of a healthcare provider. You won't need any stitches, and the recovery time is shorter.

One study concluded that percutaneous release is "a safe, effective, and minimally invasive surgical alternative."

Is One Option Better?

Both options seem to be effective treatment options for trigger finger. The gold standard is still the traditional open surgery, which has been practiced longer. But surgeons continue to learn techniques to make both procedures less invasive.

Even with open surgery, recovery is typically fast; the incision should heal within a few weeks. However, it could take up to six months for all the swelling and stiffness to completely resolve.

For now, researchers haven't found grounds to say that one technique is superior to the other. As some researchers note, surgeons may prefer open surgery because it affords better visibility as they work; patients may prefer percutaneous release because it's less invasive.

One study concluded that "there is no consensus about the best surgical treatment approach." And another study comparing the two methods found "no difference" in treatment failure or complications between the two.

Perhaps the most important factors are your surgeon's experiences as well as their preference. Be sure to inquire about their track record, too.

Complications

Complications are possible with any type of surgery. To prepare you, your surgeon should discuss them with you beforehand. The more common complications of trigger finger surgery include:

  • Difficulty or inability to straighten the affected finger
  • Stiffness at the surgery site
  • Swelling at the site

Less common complications include:

  • “Bowstringing,” meaning that the tendon may arch away from the bone, causing a reduced range of motion
  • Nerve injury, which can lead to numbness or tingling
  • Infection, which is rare
  • Persistent locking or clicking

Most patients who undergo surgery enjoy relief from pain and better finger mobility. But even surgery is not a cure-all. If you struggled with loss of motion before surgery, you may not regain full range of motion after it.

Summary

Trigger finger is a result of a tendon in the finger becoming stuck as it passes through a pulley in the palm of the hand. It can cause pain, swelling, and stiffness.

The condition often responds well to non-surgical treatments, from medications to splinting. But when it doesn't, two types of surgery are an option: Open surgical release and percutaneous release. The former method has been in use longer, but the latter is less invasive. Both seem to work well.

A Word From Verywell

If you symptoms of trigger finger, consult with a healthcare provider to get a diagnosis and suggestions for treatment. You may be able find relief with conservative treatments such as rest, heat, and over-the-counter medications. But if not, there are two good options for surgical treatment.

8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. American Academy of Orthopaedic Surgeons. Trigger finger.

  2. American Society for Surgery of the Hand. Trigger finger.

  3. Journal of the American Academy of Physician Assistants. Trigger finger: An overview of the treatment options.

  4. Nebraska Hand & Shoulder Institute. Percutaneous vs. open A-1 pulley release surgery for trigger digit.

  5. Michigan Surgery Specialists. Trigger finger surgery.

  6. Sato ES, dos Santos JB, Belloti JC, Albertoni WM, Faloppa F. Percutaneous release of trigger fingers. Hand Clin. 2014;30(1):39-45. doi:10.1016/j.hcl.2013.08.017

  7. Wang J, Zhao JG, Liang CC. Percutaneous release, open surgery, or corticosteroid injection, which is the best treatment method for trigger digits?. Clin Orthop Relat Res. 2013;471(6):1879-86. doi:10.1007/s11999-012-2716-6

  8. Fiorini HJ, Tamaoki MJ, Lenza M, dos Santos JBG, Faloppa F, Belloti JC. Surgery for trigger finger. Cochrane Database Syst Rev. 2018;2(2):CD009860. doi:10.1002/14651858.CD009860.pub2

Additional Reading

By Jonathan Cluett, MD
Jonathan Cluett, MD, is board-certified in orthopedic surgery. He served as assistant team physician to Chivas USA (Major League Soccer) and the United States men's and women's national soccer teams.