Hand > Trigger Finger > Treatments

   Flexor Tendon Release

Surgery to release the inflamed flexor tendon may be recommended of you fail to respond to conservative care. The decisions you make and the actions you take before surgery can be every bit as important as the procedure itself in ensuring a healthy recovery.

   Make sure you have received any equipment you will need when you get home from the hospital. This may include ice packs or heating pads. You should receive prescriptions for any of these from your doctor when your surgery is scheduled.

   Learn the potential risks and benefits of the surgery by asking your surgeon any questions that will help you better understand the procedure. It can also help to talk to someone else who has undergone the same surgery.

   Any physical problems, such as a fever or infection, should be reported to your surgeon, and you should notify your surgeon of any medication you are taking.

   Discontinue use of any anti-inflammatory medicine, especially aspirin, a week prior to surgery, to prevent excessive bleeding during the surgical procedure.

   Getting a second opinion from a surgeon who is as qualified as the surgeon who gave the initial diagnosis is advisable in any case.

   Make sure the orthopedist performing the surgery is board-certified, which can be determined by calling the American Board of Orthopaedic Surgery at 919-929-7103.

At most medical centers, you will go to "patient admissions" to check in for your flexor tendon release. After you have checked in to the hospital or clinic, you will go to a holding area where the final preparations are made. The paperwork is completed. You will wear a hospital gown and remove all of your jewelry. You will meet the anesthesiologist or anesthetist (a nurse who has done graduate training to provide anesthesia under the supervision of an anesthesiologist). Then, you will walk or ride on a stretcher to the operating room. Most patients are not sedated until they go into the operating room. Here are some important things to remember for the day of your surgery:

   You will probably be told not to eat or drink anything after midnight on the night before your surgery. This will reduce the risk of vomiting while you are under anesthesia.

   Because the anesthetic and pain medications may make you drowsy you will be unable to drive, arrange for someone to help take you out of the hospital and drive you home when you are released.

   Take it easy. Keeping a good frame of mind can help ease any nerves or anxiety about undergoing surgery. Distractions such as reading, watching television, chatting with visitors, or talking on the telephone can also help.

Before you undergo open surgical repair to release your trigger finger, you will be administered a local anesthetic to numb your wrist and hand. This may be injected either into your wrist or hand, or farther up your arm. The procedure can be performed while your awake. Some people choose to receive sedation which is medicine that allows you to relax during the operation. Enough medicine can be given so that you can fall asleep while the doctor is working. The procedure generally takes about 10-20 minutes.

TENDON RELEASE

Most surgeons prefer to perform this procedure under regional anesthesia. This means that they inject medicine around the local nerves in the hand or wrist so that you do not feel the hand. You can be awake or given medicines that relax you or even give you abnesia for the procedure so you don’t remember the actual procedure.

   The prodecure takes between five and 15 minutes to perform once the hand is asleep and everything is ready. It is an open procedure performed through a one inch incision in the palm. The thickened tissue surrounding the inflamed tendon is opened with a scalpel. The area which causes the tendon to catch is incised. This opens the size of the tunnel and allows free gliding of the tendon.

   After the stitches are placed a bulky dressing and even a splint may be applied from the forearm to midway on your fingers. The last two joints on the fingers are left free and light use of the hand and digital motion is encouraged immediately post-op. Most surgeons will leave this dressing until the stitches are ready to be removed 8-14 days after surgery.

PERCUTANEOUS RELEASE

Percutaneous release can be performed in an office setting using a small needle to cut the area where the nodule in the tendon is getting stuck. Since this is done without an incision there is a higher chance that local structures such as nerves and tendons can be injured by percutaneous release. Due to the high complication rate, this has not gained wide acceptance in the medical community.

When you awaken in the recovery room following flexor tendon surgery, your hand usually is wrapped in a dressing. You may feel a moderate amount of pain. You usually stay in the recovery room for at least one hour while the anesthetic wears off. You will be given adequate pain medicine, either orally or through an IV (intravenous) line, as well as instructions for what to do over the next couple of days. In addition, you will be given an appointment to return in eight to fourteen days and a prescription for pain medicine. Digital motion is generally encouraged. By moving the digits you pump swelling and bleeding away from the surgical site and this decreases the pressure of the tissue in the hand. This pressure is responsible for the annoying throbbing frequently experienced post-operatively. Elevation of the hand above the heart also reduces swelling and thereby reducing pressure and pain in the hand. Your temperature, blood pressure, and heartbeat will be monitored by a nurse, who, with the assistance of the doctor, will determine when you are ready to leave the hospital or, if necessary, be admitted for an overnight stay. The majority of patients leave the hospital after two or three hours. As soon as you are fully awakened, you usually are allowed to go home. You will probably be unable to drive a car, so be sure to have arranged a ride home.

After flexor tendon release for trigger finger, you will need to take steps to reduce the pain and inflammation in your hand and fingers. Rest and anti-inflammatory painkillers such as ibuprofen or aspirin can ease pain and swelling. Here is what you can expect while recovering from surgery at home:

   You should keep the dressing that your hand was wrapped in after surgery dry for at least 48 hours. Some bleeding and fluid drainage is normal for the first two days. Call your physician if bleeding continues.

   You may be instructed to return to your physician’s office after about two days to have a smaller dressing applied.

   Rehabilitation begins when the stitches are removed. The scar generally is sensitive and firm and the fingers are stiff. Most surgeons recommend a home program that involves massaging the scar with aloe or vitamin E to reduce the hardness and sensitivity of the scar. This is done two to three times daily for 10 minutes with firm pressure. If the fingers are stiff, exercises to improve motion by actively and passively bending the joints is recommend.

   It can take six to 12 weeks to soften the scars and restore digital motion. If significant digital stiffness is present the physician may refer you to an occupational therapist for supervised stretching and exercises.

After you rest your finger in the splint for seven to 10 days, your physician may refer you to a physical therapist to begin stretching and range of motion exercises for your fingers. Strengthening exercises usually follow a 10 percent rule, which means you increase the weight and repetitions by no more than 10 percent per week. This helps you avoid straining tendons before they have a chance to heal.

The best way to avoid a recurrence of trigger finger is to avoid direct pressure from tools or sports equipment that have hard, sharp, or small diameter handles. It is important that the tools and sports equipment you use are properly padded and large enough in diameter to fit the natural grip of your palm. Physicians also advise limiting repetitive, forceful hand movements. Your physician may refer you to an athletic trainer who can tape your fingers if you return to activities such as heavy weight lifting or rock climbing.