Trigger Finger Surgery in Ankara, Turkey

Trigger finger surgery is performed to eliminate locking and pain caused by the finger tendons not being able to pass comfortably through the tunnel called the A1 pulley. Surgery provides a permanent solution in cases with catching and restricted motion.

Before surgery, trigger finger presents with inability to bend and straighten the fingers, a catching sound, and pain. Although the first-line treatment is steroid injection and splint use, surgical indication arises in cases resistant to these methods.

Trigger finger surgery is usually performed under local anesthesia. Through a small incision, the ligament called the A1 pulley is released, allowing the tendon to glide freely. The procedure is short, and most patients are discharged the same day.

In the postoperative period, gentle hand exercises are recommended, and returning to normal activities is usually possible within a few days. Rarely, infection or wound-healing problems may develop. The success rate is very high, and the risk of recurrence is low.

What Is Trigger Finger Surgery?

Trigger Finger Surgery is the surgical release of the narrowed tendon sheath that restricts tendon movement and causes catching. It is usually performed under local anesthesia, and the connective tissue causing compression is released through a small incision. This allows the finger to move smoothly and without pain. It is an effective and safe treatment option in advanced cases to prevent permanent locking.

By what mechanism does trigger finger occur?

To understand the movement mechanism of our fingers, you can imagine a fishing rod setup. The fishing line passes through rings along the rod. In our hand, there are cords called “flexor tendons” (the line) extending to the fingertips, and a “pulley” (ring) system that allows these cords to glide without lifting away from the bone. In a healthy hand, these tendons glide through the tunnels smoothly, almost like oil.

The problem usually begins at the first tunnel entrance, located at the point where the palm meets the finger, which we call the “A1 pulley.” Due to constantly repetitive movements, strains, or certain diseases, the entrance of this tunnel narrows or the tendon itself swells with edema. This localized swelling or nodule on the tendon has difficulty passing through the narrowed tunnel.

When you try to bend your finger, you push this swelling into the tunnel with your muscle strength. As the swelling forcibly passes through the narrow mouth of the tunnel, it creates a “click” sound or a snapping sensation. However, when you want to open your finger again, the extensor muscles, which are not as strong as the flexor muscles, are not sufficient to pull this swelling back out of the tunnel. As a result, the nodule gets trapped behind the tunnel and the finger remains locked in a bent position. This can be likened to a button not being able to come back out after passing through a buttonhole.

What are the biggest risk factors for developing trigger finger?

Why this condition develops is one of the most frequently asked questions by our patients. Most of the time there is no single culprit; a combination of genetic predisposition, systemic health status, and lifestyle is involved. However, clinical experience and scientific data show that certain conditions significantly increase the risk.

Especially the impact of systemic diseases on hand tissues is undeniable. Diseases that disrupt the body’s connective tissue structure or increase the tendency for edema can initiate the process by causing thickening in tendon sheaths.

The risk factors most closely associated with the development of trigger finger are:

• Diabetes
• Rheumatoid Arthritis
• Gout
• Hypothyroidism
• Amyloidosis
• Kidney failure

In this list, diabetes deserves particular emphasis. In patients with diabetes, high blood sugar causes the collagen structure in tissues to become stiffer. In these patients, trigger finger is not only more common, but it also tends to be more resistant to treatment. In a diabetic patient, usually not just one finger but multiple fingers may be affected sequentially or at the same time.

In addition, the incidence in women over the age of 45 is higher than in men. Although the reason is not fully known, it is thought to be related to the effect of hormonal changes in the postmenopausal period on connective tissue elasticity and fluid retention.

Occupational factors should also not be ignored. In people who use tools that apply continuous pressure to the palm (for example pruning shears, pliers), those who use a keyboard for long periods, or musicians who use their hands intensively and repetitively, mechanical stress on the tendon can trigger the disease.

What are the symptoms of trigger finger and how is diagnosis made?

For the diagnosis of trigger finger, we usually do not need expensive and cumbersome imaging methods such as MRI or ultrasound. The patient’s story and a simple physical examination are more than sufficient to make the diagnosis. The disease may start insidiously and worsen over time.

In the early stages, our patients usually complain of a vague pain and tenderness in the palm, at the base of the finger. The pain increases when this area is touched. In later stages, a pronounced feeling of stiffness and tightness in the fingers begins upon waking in the morning. As the finger is moved during the day, this stiffness “loosens,” but it recurs the next morning.

The most typical symptoms of the condition are:

• Morning stiffness
• A tender nodule in the palm
• A snapping sensation during movement
• Finger locking
• Painful release

In our clinical assessment, we use a staging system called the “Quinnell Classification.” This system guides us on how to plan treatment. In stages 1 and 2, even if the finger catches, the patient can correct it with their own strength. However, when it reaches stages 3 and 4, the situation becomes serious. When the patient bends the finger, it locks and cannot be opened with their own strength; they have to use the other hand to release the locked finger. This releasing maneuver is usually painful. In the final stage, the finger is fixed and cannot be opened even with passive assistance.

Is non-surgical treatment of trigger finger possible?

As with every mechanical problem, surgery is not always the first option for trigger finger. Especially in the initial stages of the disease and in cases where catching is not very severe, conservative methods can be tried. The main purpose of these methods is to allow the tendon to pass through the tunnel comfortably by reducing inflammation and edema in the area.

In the first step of treatment, rest and anti-inflammatory medications are used to reduce swelling. In addition, special splints used at night prevent the finger from bending during sleep, allowing the tendon to rest. These simple measures may relieve mild catching in very early stages.

Among non-surgical methods, the most effective are local corticosteroid injections. In this procedure, popularly known as a “cortisone shot,” a potent anti-edema medication is injected into the problematic tendon sheath. This medication can rapidly reduce swelling at the tunnel entrance and resolve the mechanical impingement.

However, there are some limits that must be considered when applying injection therapy:

• Maximum of two doses
• Low success in diabetic patients
• Possibility of a temporary solution
• Risk of skin discoloration
• Risk of tendon weakening

In particular, more than two injections into the same area are not recommended. Repeated steroid applications can weaken the tendon structure and cause rupture. In addition, since tissue healing and blood circulation differ in diabetic patients, the response rate to injection therapy is significantly lower than in patients without diabetes. If complaints recur within 3–6 months despite one or two doses of injection, or if the finger remains locked, the surgical option becomes inevitable.

What is the plastic surgery perspective in trigger finger surgery?

Although trigger finger surgery is technically referred to as a “simple release,” the anatomy of the palm is extremely complex and delicate. For a Plastic, Reconstructive and Aesthetic Surgery specialist, this operation is not limited to cutting a compressed tunnel. Our priority is to restore function while showing maximum respect for tissue and preserving aesthetic integrity.

In hand surgery, working with “microsurgical principles” is vital. Right next to the tunnel we call the A1 pulley, the digital nerves that provide finger sensation and the vessels that supply it pass by. These structures are millimetric, and there is a risk of injury when working with the naked eye. Especially in the thumb, the digital nerves run much closer to the skin and may show anatomical variations.

Therefore, as plastic surgeons, we routinely perform these surgeries under special magnifying loupes. Working under magnification allows us to clearly see the nerve branches and protect them while releasing only the pulley we target.

In addition, in line with the principle of “respect for tissue,” we use delicate microsurgical instruments, fine-tipped scissors, and skin hooks that do not crush tissues, rather than coarse tools during surgery. The less trauma the tissue undergoes, the less postoperative swelling and pain occur. The healing process accelerates accordingly.

Is trigger finger surgery comfortable with the WALANT technique?

In traditional hand surgery methods, a tight cuff resembling a blood pressure cuff, called a “tourniquet,” used to be applied to the arm to stop bleeding and allow the surgeon to work comfortably. This tourniquet could be quite painful and uncomfortable for patients. It also required the patient to undergo general anesthesia or complete numbing of the arm.

However, today, this process has completely changed with the “WALANT” (Wide Awake Local Anesthesia No Tourniquet) technique. This method is a revolution performed while the patient is awake, without using a tourniquet, and with only local anesthesia.

The advantages provided by the WALANT technique are:

• No tourniquet pain
• No risk of general anesthesia
• No need for fasting before surgery
• Complete bleeding control
• Ability to communicate

In this technique, a special solution containing a local anesthetic (lidocaine) and a bleeding-control agent (adrenaline) is injected into the area to be operated on. Adrenaline temporarily constricts the vessels in that area, providing us with a bloodless, clean surgical field. Thus, there is no need for a tourniquet.

The greatest and perhaps most critical advantage of the WALANT technique is that it allows an “active movement test.” Since the patient is attentive, immediately after we release the compressed tunnel, while the patient is still on the operating table, we can say, “Open and close your finger.” When the patient moves the finger, both we and the patient can see and feel that the catching has completely resolved. If there is still even the slightest friction or catching, we can intervene immediately to ensure complete release. This test is not possible in surgeries performed while the patient is asleep. In this way, the patient leaves the operating room 100% confident that the problem has been resolved.