Trigger Finger

Diagram showing a finger tendon gliding normally through a pulley
The pulley and tendon in a finger, gliding normally.
Diagram showing a thickened pulley preventing normal tendon gliding in trigger finger
In trigger finger, a thickened pulley can prevent the tendon from gliding smoothly.

Trigger finger is a very common and treatable problem that can occur in both fingers and thumbs.

The fingers and thumbs have flexor tendons that help them bend. These tendons have an outside lining called tenosynovium. The tendon and lining are covered by a series of thick, soft-tissue structures called pulleys. The tendon and its lining are designed to glide through the pulleys without friction, similar to how a line is held on a fishing rod.

Trigger finger, sometimes called trigger thumb or stenosing tenosynovitis, can occur when the tendon enlarges, the lining becomes thicker, or the pulley becomes thicker and the opening for the tendon gets smaller. If the tendon becomes tight within the pulley, the lining can be squeezed and react by thickening. The bigger lining produces more fluid, and the higher volume of fluid increases pressure. The undersurface of the pulley can also change and thicken, creating friction on the moving tendon and making it difficult for the tendon to move back and forth.

The good news is that trigger finger can usually be diagnosed by history, symptoms, and a physical exam. It is rare to require other diagnostic testing, and several successful treatments are available.

Causes

Trigger fingers are more common with certain medical conditions. Rheumatoid arthritis, gout, and diabetes are risk factors. Repeated and strong gripping may also lead to the condition. In most cases, the cause of trigger finger is not known.

Signs and Symptoms

Symptoms of trigger finger can include:

  • Pain: Trigger finger may start with discomfort at the base of the affected finger or thumb, where the finger joins the palm. This pain may occur with pressure over the A1 pulley area and may be more noticeable with gripping or other activity.
  • Swelling: Over time, a lump may develop at the A1 pulley. This can be due to nodular swelling within the tendon or a fluid-filled cyst called a flexor sheath ganglion.
  • Stiffness or loss of motion: Trigger finger may cause loss of the ability to bend or straighten the finger. Chronic untreated trigger fingers can make motion painful and limited.
  • Mechanical symptoms: A trigger finger can cause popping, catching, or locking while bending or straightening the finger. Early symptoms may be mildly painful, but pain can increase as the tendon and pulley interaction becomes tighter.

Treatment

The goal of treatment is to reduce or eliminate swelling and catching or locking, allowing full, painless movement of the finger or thumb. Restoring normal motion is easier when the problem is diagnosed and treated as soon as possible.

Common treatment options include:

  • Splinting at night: A night splint can keep the finger straight and prevent painful locking during sleep.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs): Oral or topical anti-inflammatory medication, such as ibuprofen or naproxen, may help relieve pain and improve movement.
  • Changing activity: Limiting or spacing out forceful, repetitive, or sustained gripping may help.
  • Steroid injection: Corticosteroid injections, also known as cortisone shots, can be given at any stage of symptoms, although they may work better when given early.
  • Hand therapy: Some patients benefit from supervised and home exercises, including motion exercises, tendon-gliding techniques, edema control, and other treatments.

If non-surgical treatments do not relieve symptoms, surgery may be recommended. The goal of surgery is to open the pulley at the base of the finger so the tendon can glide more freely. In most cases, the clicking or popping goes away after cutting the A1 pulley.

If mechanical symptoms remain after trigger finger release, additional procedures may be considered, such as flexor tenosynovectomy to remove thickened lining from the tendon surface, or removal of part of the superficial tendon to reduce the volume of tendon moving through the pulley system. Your orthopaedic hand surgeon will develop an individual treatment plan for you.

Recovery

Finger motion can return at different speeds depending on each patient, the timing of symptoms, when treatment begins, and how effective each treatment is. There can be ongoing stiffness after hand surgery even when locking is gone, and hand therapy can be beneficial after surgery. Some mild to moderate tenderness at the surgery area may last up to several months, but most patients resume their normal lifestyles within a few weeks.

This mobile-friendly version is adapted from patient education content originally provided by the American Society for Surgery of the Hand.