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  • Q&A with Australian Health Practitioners

    Is there a way to resolve trigger fingers?

    Related Topic
    Sports Injuries & Prevention
    In my left hand, I have two fingers which “lock” (3rd and 4th). I've had cortisone injections, and they worked for a period, but then it all went back to locking. Initially it was only the 4th finger in two points and now the 3rd too, in the upper part of the finger. I've had some therapy in the hand and the forearm, but I don't seem to be able to resolve this problem. I am a rower (master, 42yo) and the onset of this trouble was about 3 years ago when I first started sweep rowing (I'm bow side so the left hand/arm do a lot of wrist twisting).
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    Helen Potter

    Physiotherapist

    As a Specialist Musculoskeletal Physiotherapist, with extensive experience and highly advanced qualifications, as well as excellent communication skills, I can help you to: Become informed … View Profile

    Hi
    Unfortunately trigger fingers occur because of a swelling/lump in the tendon (usually in the hand). Cortisone injection can give several weeks or months relief but usually surgery by a plastic surgeon is the next option.
    Helen Potter
    In Touch Physiotherapy Subiaco


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    Dr Ryan Hislop

    Chiropractor

    Ryan Hislop is the Clinical Director at the Orange Chiropractic Health and Wellness Centre. As an experienced and evidence-based diagnostician, Ryan works largely by medical … View Profile

    Surgical management of this condition is indicated with recurrence after or failure of conservative management (splinting, activity modification, cortisone injections etc) or initially in cases of  greater than 6 months duration and is highly effective with low complication and recurrence rates.

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    annacico

    HealthShare Member

    I understand surgical management means cutting the sheath open. Wouldn't that weaken the overall grip and does the sheath heal itself or is this a permanent outcome?
    Thanks.


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    Dr Ryan Hislop

    Chiropractor

    Ryan Hislop is the Clinical Director at the Orange Chiropractic Health and Wellness Centre. As an experienced and evidence-based diagnostician, Ryan works largely by medical … View Profile

    Normal use of the hand can usually be resumed once comfort permits. Some patients may feel tenderness, discomfort, and swelling about the area of their surgery longer than others. Occasionally, hand therapy is required after surgery to regain better use.

    Surgery is a same-day procedure that can be done under local anesthetic or regional nerve block. A small (<2cm) incision is made in the skin, and the tight part of the sheath is released allowing the tendon to glide smoothly again.Following the trigger-finger release, activity of the finger is encouraged, to help prevent scar tissue.  Full recovery is expected.Trigger finger surgery is very safe, but there are possible complications. The most common problem is that the trigger finger can come back if the tendon sheath is not adequately released. Other possible problems include infection, stiffness and damage to the nerves of the finger. This surgery has a very high success rate.

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    Dr Jillian Tomlinson

    Hand Surgeon, Plastic Surgeon

    Dr Jill Tomlinson is a fully qualified plastic, reconstructive and hand surgeon. After graduating dux in her year at University High School, Jill completed medical … View Profile

    Yes, there are most definitely ways to resolve trigger fingers!

    The most common initial approach, which you have already tried, is a series of up to 3 corticosteroid injections to the affected area in the palm. As your problem has persisted for 3 years and has not resolved with the corticosteroid injections you may (after discussion with a hand surgeon) wish to proceed with surgical treatment.

    Depending on your preferences the surgery can be done under local anaesthetic or twilight sedation or general anaesthetic (the latter is uncommon). A small incision is made on the palm and the tight part of the tendon sheath that is causing the restriction is released. In technical terms, “the A1 pulley is divided” - your surgeon will be able to explain to you in more detail if you wish!

    The surgery is extremely effective at resolving trigger finger and the effects are immediate. It is possible that you may develop trigger finger affecting other fingers in your hand, but recurrence in the treated finger is extremely uncommon. Complications are rare.

    Officeworkers generally find that their work activities are not limited during the post operative recovery period. It is recommended that you keep your hand elevated for 2 days after the surgery to minimise swelling. If you regularly do a large amount of gripping and heavy use with your affected hand (eg rowing) you should plan your recovery activities understanding that it may take 6 weeks before you feel completely comfortable having heavy pressure directly on the incision site. Massage and scar therapy will assist in resolving this as quickly as possible.

    For more information about this and other conditions of the hand and wrist please visit the Melbourne Hand Surgery website.

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