If the fingers become locked in a flexed position it may be because of a "trigger finger". This is a common condition, may affect multiple fingers and often grumbles along for years. Most people complain of a single finger getting stuck in a bent position after they make a tight fist. They then need to use the opposite hand to pry open the curled finger which releases with a click. It may be painful and there is often a sensitive lump palpable in the palm of the hand.
Trigger finger is due to a nodule forming on the flexor tendon running to the finger. This nodule becomes trapped under the pulley in the palm. The pulleys are slings of fascia that hold the tendons down against the bone. As the tendon nodule becomes trapped it causes irritation and swelling which makes the nodule grow even bigger. This vicious cycle can lead to a situation where the finger locks continuously and release is more painful.
Treatment of this condition is initially with a steroid injection into the palm of the hand for mild symptoms. For more severe symptoms or for those who don't improve with injections, the definitive treatment is with surgical release of the pulley. The surgery is performed as a day case operation under local anaesthetic +/- sedation. An incision is hidden in one of the skin creases in the palm and the pulley is divided under direct vision. The locking disappears immediately but it usually takes a few weeks for the stitches to dissolve and the incision to heal so normal activities can be resumed.
Side effects and complications
It is normal to have some swelling and bruising around the surgical site. Occasionally there may be excessive bleeding that results in a haematoma that should be washed out in the operating theatre.
Wound infection may occur following any surgery. If the skin around the wound becomes swollen, painful and red you should contact the office before your next appointment. This will usually settle with a short course of antibiotics.
As the stitches dissolve they can sometimes cause a sterile pustule on the edge of the wound. This is called a stitch abscess and is not truly a wound infection. These usually completely resolve once the suture has gone.
The nerves that supply sensation to the fingers may become bruised or very rarely cut during the surgery. This will give numbness in the finger tip.
Sometimes the symptoms of triggering may return despite adequate release of the pulley. This is usually due to scar tissue forming over the tendon. A further release may be necessary.
