Trigger finger, ganglion and other hand problems: when do they need surgery?

Trigger finger

The tendon that bends the finger catches in its tunnel at the base of the finger, so the finger clicks, sticks bent, then snaps straight. It is commonest in the thumb, ring and middle fingers, and more common in people with diabetes. Mild cases may settle with rest or a splint. A steroid injection into the base of the finger helps many people. If the finger keeps locking, or is stuck bent, a short operation under local anaesthetic releases the tunnel, usually through a small cut in the palm.

Ganglion cyst

A smooth, jelly-filled lump, usually on the back or front of the wrist or at the base of a finger. It is not cancer. Many disappear without treatment. Do not try to burst it by hitting it: that can injure the wrist and it usually comes back. If it is painful, limits movement or worries you, it can be drained with a needle or removed surgically, though ganglions can return even after removal.

Dupuytren's contracture

Thick cords form under the skin of the palm and slowly pull one or more fingers, usually the ring and little fingers, into the palm. It is painless. Treatment is considered when you can no longer lay your hand flat on a table, or when the bent finger gets in the way of washing, dressing or work. Options include releasing the cord with a needle or removing it with surgery. It can come back over the years.

Other common problems

• De Quervain's: pain on the thumb side of the wrist, often in new mothers lifting a baby; usually treated with a splint or injection
• Thumb base arthritis: aching at the base of the thumb when gripping or turning a key; splints and exercises first, surgery for severe cases
• Lumps that grow quickly, are hard or fixed, or are painful without a reason: get them examined

When a hand problem is urgent

Go the same day, to an emergency department if needed, for:

• A cut on the hand after which a finger will not bend or straighten, or is numb
• A red, hot, swollen, very painful finger or palm, especially with fever or after a bite or puncture
• A crush injury or a finger that looks deformed
• Swelling after an injury that is getting worse under a bandage or ring

What minor hand surgery is like

Most of these operations are done as a day case under local anaesthetic, so you are awake but feel no pain in the hand. You go home with a dressing, keep the hand raised for a few days and move the fingers gently. Stitches usually come out after about two weeks. Your surgeon will tell you when to return to work, driving and heavy gripping.

Common questions