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Surgery for Trigger Finger Has Low Major Complication Rate
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Posted on: 11/30/1999
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Trigger finger is a condition that occurs when a finger or thumb is caught in a bent position. In severe cases, it may become locked in that position. If you can straighten the digit, it may straighten with a sharp snap. The bending occurs because the rings, or pulleys at the base of the finger, which surround the tendons, become thick and put pressure on the tendon, making it difficult for the tendon to slide back and forth, bending and extending the finger. The catching or snapping feeling comes as the tendon catches on the rings.
Trigger finger is fairly common and if surgery is needed, the surgeon releases the A1 pulley. The minor procedure is said to have a low complication rate but there has not been a lot of research done into the procedure or its complications. The few studies that have been done show complication rates of between 11 percent to 43 percent, with the majority of them being minor, such as scar pain and tenderness, a bit of difficulty extending the finger, redness (treated with antibiotics), and a recurrence of the condition. However, some major complications have also been reported and these include bowstringing of the flexor (bending) tendon, nerve damage, and infection that does not clear up with antibiotics. The authors of this article investigated the reported complications associated with this procedure.
Researchers reviewed the records of 43 patients (25 women) who had undergone surgery to release their trigger finger. Their ages ranged from 34 to 85 years, with the average being 61.5 years. Among the 43 patients, 78 open trigger release procedures were performed. The patients were followed, on average, for 16 months, although one was followed for as long as 126 months. All surgeries were performed by the same surgeon, the senior author of this article.
Upon review, the researchers found that there were 27 minor complications in 22 digits as a result of their first procedure (primary release). This comes in at 28 percent (22 procedures out of 78). Ten cases were decreased range of motion in the affected digit, four of scar tenderness, nine of swelling and pain, and four of redness and/or infection. None of the complications lasted any longer than six months.
There were two major complications reported after the primary procedure, giving a complication rate of only three percent (two out of 78). One, a fistula (tunnel) inside the joint, stopped the would from healing, despite antibiotics and dressing changes. Surgery was needed to correct the problem and healing then occurred. The second complication was arthrofibrosis, thickening of tissue in the joint. This was managed by applying a cast for three weeks, followed by three weeks of active range of motion exercises and medications. Although the wound had healed, the patient was left with a lower degree of correction, losing 30 degrees in extending the finger and only able to bend it to 85 degrees.
The authors concluded that although the minor complications, usually wound complications or difficulty with some range of motion, was a bit high, the major complication rate was low. Therefore, surgeons should advise their patients of the possibilities before performing the procedure.
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References:
Ryan Will, MD, and John Lubahn, MD. Complications of Open Trigger Finger Release. In Journal of Hand Surgery. April 2010. Vol. 35. No. 4. Pp.594-596.
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