Trigger finger /
Stenosing tenosynovitis
Overview of the treatment
The most important facts
OP duration: approx. 10 minutes
Anesthesia: local anesthesia
Dressing: dressing change on the following day, then special plaster
Suitable if...
painful snapping, catching when bending, or morning stiffness are constantly bothersome.
rest and infiltration are no longer sufficient and the symptoms persist permanently.
you want to use your finger again immediately – without a plaster cast and without long downtime.
Methods & Variants
Open A1 pulley release (standard)
Through a very small incision in the palm of the hand, the first annular ligament (A1 pulley) is released. This allows the flexor tendon to glide freely again. A plaster cast or prolonged immobilization is generally not necessary – the finger should be moved early after the operation.
Open instead of percutaneous – by choice
With the percutaneous technique, the pulley is severed with a needle without direct visualization. We prefer the open approach, as the tendon and neurovascular bundle can be directly visualized and the pulley can be released in a controlled and complete manner.
Conservative options
A cortisone injection can reduce symptoms, especially in the early stages, and in some cases even eliminate them in the longer term. If triggering recurs or is pronounced, surgical release of the pulley may be advisable.
Special considerations for thumbs and fingers
Surgical treatment of a trigger thumb is generally particularly straightforward. The procedure can also be performed successfully in patients with diabetes.
Due to its greater mobility, there is a slightly higher risk of a suture tract infection in the thumb. First signs should therefore be checked early. If an incipient suture tract infection is detected, early removal of the sutures – if necessary within 24 hours of the first signs appearing – can prevent it from spreading. At the same time, scar symptoms are less common on the thumb.
In the case of a trigger finger affecting the long fingers, additional pain may occur in the proximal interphalangeal (PIP) joints. These symptoms can therefore also be related to stenosing tenosynovitis.
Patients taking anticoagulant medication and patients with diabetes can usually be treated well on an outpatient basis. Whether and how existing medication needs to be adjusted will be discussed individually before the procedure.
Process – Step by Step
Diagnosis & Consultation
Trigger finger is a clinical diagnosis: The snapping is reproducible, there is clear tenderness over the first annular ligament (A1 pulley), and a nodule is often palpable on the flexor tendon. Imaging is generally not required.
Preparation
No unnecessary aspirin or ASA ten days before the operation – if there is an important medical reason, please continue taking it. You can fill out the forms for the consultation with the doctor in advance and bring them with you.
The Procedure
The operation is performed as an outpatient procedure under local anesthesia and takes about ten minutes; the total time spent in the clinic is usually half an hour. The first annular ligament is split via a small incision, and the free gliding of the tendon is checked directly. Billing is via statutory or private health insurance – without co-payment.
Aftercare
The first and only dressing change takes place on the following day: The dressing is removed and the wound is covered with a special plaster – which also allows the hand to be washed. The sutures are removed after about ten days; physiotherapy is not necessary in a normal healing process.
Healing process
After one day and a dressing change, the finger is already partially usable again.
After ten days, the stitches are removed; office work is basically possible again after just one to two days.
After six weeks, even heavy manual labor is possible again.
After a few weeks, the pressure sensitivity of the scar in the palm of the hand subsides.
Risks & Safety
In the first few days, swelling, bruising, and a feeling of tension are possible; a pressure-sensitive scar in the palm of the hand may occur. Rarely, wound healing disorders or inflammations occur – especially in patients who have to put heavy strain on the hand immediately. Likewise, a temporary restriction of movement or irritation of the adjacent neurovascular bundle is possible.
We minimize risks through open access with a direct view of the tendon and nerves, working under local anesthesia without any risk of general anesthesia, dispensing with plaster casts and immobilization, standardized hygiene processes, and follow-up monitoring on the day after the operation. Move your finger from the very beginning – whatever you like is allowed. If there is increasing swelling, severe redness, or fever, please contact us immediately.
Diagnostics & Alternatives
Clinical examination, palpation of the first annular ligament to confirm the diagnosis
Infiltration as a conservative option in the early stage
Watchful waiting for only occasional snapping – A1 pulley release for persistent symptoms
Individual consideration in diabetics, for the thumb, and for pediatric trigger thumb
