FLEXOR TENDON SHEATH RELEASE
When a finger catches, clicks or locks when bent, the tendon sheath is compressing the tendon. A surgical release of the sheath treats the cause. The operation usually takes under thirty minutes, with return to light work within days and no splint required.
ABOUT THIS CONDITION
Trigger finger occurs when the flexor tendon (the tendon responsible for bending the finger) cannot move smoothly within the sheath that surrounds it. A small nodule or thickening on the tendon, or swelling of the sheath itself, creates a narrowing that the tendon cannot pass through freely. The result is a finger that clicks, catches, or locks in a bent position and cannot straighten without assistance or significant pain.
In line with British Society for Surgery of the Hand (BSSH) guidance, the first-line treatment is typically a steroid injection into the tendon sheath. This reduces inflammation and restores free tendon movement in many cases. If the injection is ineffective, or if the condition recurs, surgery is recommended. The surgical procedure widens the tendon sheath to give the tendon the room it needs to glide freely.
Two surgical techniques are available: percutaneous release, where a needle is passed through the skin to divide the sheath without an incision; and open release, where a small incision is made in the palm to directly visualise and divide the sheath under local anaesthesia. Both take under thirty minutes and are performed as day cases. The appropriate technique is chosen based on the individual case.
A STEPPED APPROACH TO TREATMENT
Treatment follows a logical progression. Most cases start with injection. Surgery is reserved for those where injection is insufficient or the trigger has recurred.
FIRST LINE: BSSH GUIDANCE
A corticosteroid is injected directly into the tendon sheath to reduce inflammation and restore free tendon gliding. Effective in 60 to 80 percent of cases. Recovery is immediate and no procedure is required. Recurrence is possible, typically within one year, at which point a second injection or surgery is considered.
SURGICAL OPTION 1
A needle is passed through the skin at the base of the finger to divide the constricting A1 pulley without a surgical incision. A minimally invasive option suitable for selected cases. Requires precision to avoid the digital nerves. No wound to heal, no sutures, rapid return to use.
SURGICAL OPTION 2: OPEN RELEASE
A small incision is made in the palm to directly visualise the A1 pulley, which is then divided under direct vision. The standard surgical approach. It allows precise division and protection of the surrounding nerves, and recurrence is uncommon. Preferred for severe triggers, large nodules, or cases requiring certainty.
PROCEDURE OVERVIEW
One of the most common hand procedures.
Surgery Time
Anaesthesia
Hospital Stay
Drains
Splint
The exact surgical approach is determined at consultation, after an examination and a discussion of the options.
RECOVERY TIMELINE
Day 1–2
Most patients go home the same day and can return to light or desk-based work within one to two days. Keep the wound clean and dry and avoid submerging the hand for the first week.
Week 1
A follow-up at one week reviews the wound and confirms that the finger is moving freely. Most patients notice an immediate improvement in clicking and locking from the day of surgery.
Weeks 1–2
A short two to four week physiotherapy programme begins to restore full range of motion and prevent any scar tissue forming around the released sheath. Exercises are gentle and easy to perform at home.
Weeks 2–4
Return to moderately physical work is typically possible within two to four weeks. There is no splint requirement and no prolonged rehabilitation. Recovery from trigger finger release is usually straightforward.
WHAT SURGERY DELIVERS
Most patients notice improvement from the day of the procedure.
WHY CHOOSE SURGICAL RELEASE
Trigger finger release is one of the shortest and most efficient procedures in hand surgery. You arrive, the tendon sheath is divided under local anaesthetic, and you go home the same day.
Unlike many hand procedures, trigger finger release requires no post-operative splinting. The finger can move immediately after surgery, which both aids recovery and minimises the disruption to daily life.
Percutaneous or open release is selected based on your specific presentation. Both achieve the same result; the decision is guided by the grade of trigger, the anatomy of the nodule, and patient factors.
Surgical release of the A1 pulley provides a definitive anatomical correction. Recurrence after surgery is uncommon, and rarer than after steroid injection alone, which is why surgery is recommended when injection has failed.
THE SIMPLEST OPERATIONS CHANGE LIVES TOO
Dividing the A1 pulley gives the flexor tendon the clearance it needs to glide freely through the sheath. The moment the pulley is released, the mechanical block that was causing the catching and locking no longer exists. For most patients, the finger moves smoothly from the day of surgery.
The activities that become possible or comfortable again after trigger finger release are often the everyday ones that had quietly become difficult. Patients regularly tell us they had forgotten what a normally functioning finger felt like.
IS IT TIME FOR SURGERY?
Steroid injection is the recommended first-line treatment and works well in many cases. Surgery is indicated when injection has not provided lasting relief, or when the severity of the trigger makes conservative management unlikely to succeed:
WHEN TO MOVE TO SURGERY
Steroid injection is a good first-line treatment, but it does not work for everyone, and even when it does, recurrence is common within twelve months. Surgery provides a permanent anatomical correction that injection cannot match. If any of the following apply, surgical release is worth discussing at a consultation.
ALSO TREATED BY PROF. HINDOCHA
Related conditions managed at the same clinic.
HAND SURGERY
Thickened tissue in the palm that contracts the fingers toward it, limiting grip and extension.
HAND SURGERY
Tendon cuts, ruptures or avulsions affecting grip and finger movement, needing prompt surgical repair.
HAND SURGERY
Benign fluid-filled lumps near the tendons and joints of the hand and wrist that can cause pain or restrict movement.
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Patient stories describe individual experiences. Results vary from person to person, and the risks, limitations and likely outcome of any procedure are discussed with you at consultation.
TAKE THE FIRST STEP
A quick assessment. A fast, effective solution.
If a clicking, catching or locking finger is affecting your work or daily life, whether or not you have had a steroid injection before, a consultation with Professor Hindocha will confirm the diagnosis and outline the treatment options. For most patients, trigger finger is one of the most straightforwardly resolved conditions we treat.
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