What are the benefits of surgery for 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 benefits of operative treatment of trigger finger and trigger thumb were outlined in three studies of surgical pulley release.

Between 1994 and 2004, Li et al treated seven children (nine thumbs; three right, two left, two bilateral) for trigger thumb with hyperextensible MCP anomaly (>60°) by surgical release of the first anular pulley (A1 pulley) and proximal advancement of the MCP volar plate. The patients (four girls, three boys), who had a mean age of 46 months at surgery (range, 26-82 months), were observed over a mean follow-up period of 64 months (range, 1-8 years).

All patients in the study at last follow-up had returned to full activity without limitation or pain, and none of the patients had a recurrence of triggering or MCP hyperextension deformity, demonstrating, according to the authors, that trigger thumb with concomitant MCP hyperextension deformity can be treated in children by A1 pulley release and advancement of the volar plate. [13]

In a study of 93 trigger thumbs in 83 patients, Chao et al compared the results of miniscalpel-needle percutaneous release with those of steroid injection. At 12 months, 44 of the 46 trigger thumbs treated with the miniscalpel-needle release had satisfactory results (measured by visual analogue pain scale and patient satisfaction), but only 12 of 47 thumbs treated with steroid injection had satisfactory results. No nerve injuries occurred in either group. [70]

Trigger thumb in children almost always calls for surgical management. Trigger thumb in an adult not responding to corticosteroid tendon sheath injection needs surgery. The technique of release itself is irrelevant. Open and not percutaneous surgery is the norm for trigger thumb in children and adults alike, since the neurovascular bundles in the thumb are closer to the midline than in other digits. A single series as quoted above comparing the efficacy of percutaneous surgery vis-a-vis a corticosteroid injection still proves surgery is more effective than injection treatment, but this technique of surgical release itself is not ad rigeur.

Lange-Rieb et al presented long-term results of open operative treatment of TF and trigger thumb in adults. Of the operations performed, 210 (76%) were for a single-digit release and 76 (24%) for multiple digits. All operations were performed under tourniquet control with local anaesthesia as outpatient procedures using a transverse incision just distal to the distal palmar crease or on the flexor crease of the thumb at the MCP joint. At latest follow-up (average, 14.3 y), 234 patients were evaluated, with no complaints, and there were no serious complications, such as nerve transection or bowstringing, or recurrence. [71]


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