Trigger Finger Release: Percutaneous and Open Surgery

When a condition called trigger finger causes a finger or thumb to become temporarily “stuck” in a bent position, a physician may recommend a procedure to physically release the constricted tendon sheath causing the problem. Freeing this soft tissue will allow the finger or thumb to move freely again.

A release is done using anesthesia and can be performed by piercing the skin with a needle (percutaneous release) or by making a surgical incision. Both procedures are considered relatively low risk and are described in detail below.

Percutaneous Release for Trigger Finger

“Percutaneous” means through the skin, and this in-office procedure uses a needle to treat the affected tendon sheath tissue. Research suggests it has similar results to open surgery.¹Amirfeyz R, Mcninch R, Watts A, et al. Evidence-based management of adult trigger digits. J Hand Surg Eur Vol. 2017;42(5):473-480.^,2Fiorini HJ, Tamaoki MJ, Lenza M, Gomes dos santos JB, Faloppa F, Belloti JC. Surgery for trigger finger. Cochrane Database Syst Rev. 2018;2:CD009860.

Here is a step-by-step description of percutaneous release for trigger finger:

• The surgeon administers a local anesthetic, typically lidocaine.
• The physician uses ultrasound imaging to carefully guide the needle to the affected tendon sheath and avoid damage to the tendon or nearby nerves. Most physicians will use a 16- or 18-gauge needle—about the size of needles used for blood donation.
• The needle is used to break up constricting tissue around the tendon sheath.
• Because no incision is made, no stitches are needed after the procedure.

Not all physicians choose to use or are trained to use ultrasound imaging during this procedure.

Traditionally, percutaneous release has been less popular than open surgery (described below), because open surgery gives the surgeon a clear view of the affected tissues. Most physicians have been concerned that percutaneous release increases the risk of damaging unseen tendon tissue as well as nearby nerves, which may be 2mm or 3mm away from the affected tendon.³Marij Z, Aurangzeb Q, Rizwan HR, Haroon R, Pervaiz MH. Outpatient Percutaneous Release of Trigger Finger: A Cost Effective and Safe Procedure. Malays Orthop J. 2017;11(1):52-56. A physician trained to use ultrasound imaging to guide a needle during this procedure may reduce the likelihood of damaging nerves and tendons.

Recovery from percutaneous release is typically shorter than for open surgery, allowing patients to return to work sooner.¹Amirfeyz R, Mcninch R, Watts A, et al. Evidence-based management of adult trigger digits. J Hand Surg Eur Vol. 2017;42(5):473-480.

Surgical Release for Trigger Finger

An alternative to percutaneous release is an open surgery, which requires a small incision. The surgery, known as trigger finger release, is done as an outpatient procedure and takes about half an hour. It can take longer if more than one finger is being released.

Here is a step-by-step description of trigger finger surgery:

• The surgeon administers a local anesthetic and, once it takes effect, makes a small incision in the palm of the hand. For trigger thumb, the incision is in the pad of the thumb.
• The surgeon then locates the tendon sheath and carefully cuts through it to make more space for the tendon.
• Before concluding the procedure and closing the wound, the surgeon may flex and extend the affected finger to make sure the tendon can move freely.

Once the anesthesia wears off, the finger should be able to move normally right away.

The risk for complications or revisions after surgery is minimal. Approximately 97% of patients have complete resolution of symptoms after the procedure.⁴Calandruccio J. Carpal tunnel syndrome, ulnar tunnel syndrome, and stenosing tenosynovitis. In: Canale S, Beaty J. Campbell’s Operative Orthopaedics, Twelfth Edition. Philadelphia PA: Elsevier Mosby; 2013, 3637-3660.

Recovery After Open Surgery for Trigger Finger

After open surgery, patients will have a compression dressing on the surgical site that needs to be kept clean and dry. The dressing can be removed after a day or two, and then the sutures may be removed after 10 to 14 days or they may dissolve on their own.

The affected hand may be painful and swollen for a few days after surgery. Individuals can relieve pain and inflammation by:

• Using ice therapy for 5 to 10 minutes several times a day
• Keeping the hand propped up and elevated above heart
• Taking anti-inflammatory pain medications such as ibuprofen as directed

Watch: Video: How to Make a Gel Ice Pack

Most people can return to work after a few days if they work in an office environment, however, positions that involve manual labor may require 2 weeks before returning to work.

Most pain and symptoms from the surgery will be resolved in a few weeks, although it may take 6 months for stiffness and swelling to completely subside. Recovery can take longer if multiple fingers were treated.

Some patients may benefit from physical therapy after surgery to recondition and rebuild strength in the hand. Patients should work with their physicians to ensure their recovery plan is appropriate for their unique situation.