What is the role of surgery in the treatment of trigger finger (TF)?

Updated: Apr 26, 2021
  • Author: Satishchandra Kale, MD, MBBS, MBA, MCh(Orth), FRCS(Edin), FRCS(Tr&Orth); Chief Editor: Harris Gellman, MD  more...
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Answer

The chief indications for surgical management of TF are as follows:

  • Failure of splinting and/or injection treatment
  • Irreducibly locked TF
  • Trigger thumb in infants - Without surgical release, these infants are likely to develop a fixed flexion deformity of the interphalangeal (IP) joint

Although the results of percutaneous release are well established, the open technique is absolutely essential for the thumb or little finger or in the presence of proximal interphalangeal (PIP) contractures. Percutaneous release should be reserved for the index, middle, and ring fingers. [6, 7, 8, 9]

In a study from Oxford comparing percutaneous and open surgical methods, the two approaches displayed similar effectiveness, and both proved superior to conservative corticosteroid-injection treatment with regard to trigger cure and relapse rates. [45]

In children, triggering has varying causes. Release of the A1 pulley alone does not always correct the problem. Additional treatment (eg, resection of one or both limbs of the flexor digitorum superficialis [FDS] tendon, A3 pulley release) may be required and is recommended in RA tenosynovitis. [9, 46, 47, 48]

In infants, the nodule on the flexor pollicis longus (FPL) tendon can be resected with good results. Corticosteroid injections are generally not helpful in these cases of trigger thumb.


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