Trigger thumb is a common hand condition, and it occurs possibly more frequently with the use of smart phones and tablets. Symptoms occur when there is catching between the flexor tendon of the thumb and the sheath which surrounds the tendon. Instead of gliding smoothly through the sheath, the flexor pollicis longus (FPL) tendon can meet resistance within the tight sheath, which can be painful and cause the thumb to be very stiff, click, and lock up. This can make the hand difficult to use. Some patients may feel a tender nodule or “bump” in the palm at the base of the thumb. In worse cases, the thumb can become stuck or “locked” in flexion, requiring the person the straighten the thumb with the other hand. This “unlocking” can be very painful. These symptoms are often worse in the morning. Trigger thumb is 3 times more common in females than males. It typically occurs in people between 40 and 60 years of age. Diabetics and patients with RA have a higher risk. Children may also have a trigger thumb, however, this is much less common. “Congenital trigger thumb” is occasionally diagnosed in infants who cannot fully straighten the end of the thumb.
How is trigger thumb diagnosed?
Trigger thumb can be diagnosed by careful evaluation by a physician. Laboratory tests, x-rays, ultrasound, and MRI are usually not necessary.
What are the treatment options?
Non-operative treatment is tried first. Using a splint at night can reduce swelling and decrease triggering. Resting the hand may also help. Oral anti-inflammatory medications such as Ibuprofen, Naproxen, and Tylenol can help reduce pain and inflammation. A steroid injection (cortisone shot) can fix the problem in many patients.
If this does not help, surgery may be recommended to help take care of the problem. During the trigger thumb release procedure, the tight sheath (the A1 pulley) is opened through a small incision in the base of the thumb and this allows the thumb flexor tendon to glide smoothly. Local anesthesia is typically used, and most patients do not need to be put to sleep for the procedure.
What is the recovery from surgery?
The surgery is performed in a surgery center with local anesthesia. A Valium pill can be used to help with relaxation. Patients may use their hands for light activities. I encourage gentle thumb range of motion to reduce stiffness. Most people can return to light duty work in a few of days. Normal use of the hand is resumed as comfort permits. The soft surgical bandage can be removed after about 5 days. Afterwards the wound should be covered with a light dressing, such as a band-aid. The skin sutures are removed in clinic in 10-14 days. I typically recommend avoiding heavy use with the hand for approximately 3-4 weeks after surgery.
What are the results from surgery?
Free gliding of the tendon is noticed soon after surgery. Most patients are very satisfied with their outcome from surgery. However, some patients report mild soreness in the incision, scar tissue thickening, and stiffness of the thumb, which often improve over a few weeks or months. People with hand arthritis are more prone to hand stiffness. Complications such as infection, nerve injury, and wound healing problems are not common. Occasionally hand therapy is recommended to improve range of motion and decrease pain. Recurrence of the thumb triggering after surgery is very uncommon.