Trigger finger: what is it and how is it treated?

Trigger finger, also known as stenosing tenosynovitis, occurs when the tendon that runs along your palm and into your finger becomes trapped. This causes your finger to become stuck in a bent position. Trigger finger usually affects the ring finger or thumb but can affect any finger. 

Around three in every 100 people in the UK will experience trigger finger at some point in their life. 

What happens in trigger finger?

Tendons connect your muscles to your bones; in your fingers, your tendons are held closely to the finger bones to which they attach with structures called pulleys. These pulleys ensure the smooth movement of your tendons as your fingers move. 

In trigger finger, the A1 pulley becomes inflamed and narrows the passage through which the tendon can glide. Consequently, when you try to bend your finger, your tendon gets mechanically stuck and your finger either clicks or gets stuck in a bent position. 

In extreme cases of trigger finger, you may need to use your other hand to straighten your finger. 

Symptoms of trigger finger

In the early stages of trigger finger, you may feel pain at the base of the affected finger or thumb with intermittent (two to three times a day) clicking when you move your finger or thumb. 

When you try to straighten all of your fingers, your affected finger will still straighten in the early stages of trigger finger. However, as trigger finger progresses, this will become more difficult, until finally, you will need to use your other hand to straighten your affected finger. 

In very rare cases, you will not be able to straighten your affected finger even when using your other hand. If this occurs, you should seek medical attention as soon as possible (ie within a few days) as the longer your finger is in a locked position, the harder it is to treat it. 

Risk factors for trigger finger

Trigger finger is most common in those aged between 40 and 60, and is more common in women than in men.  

Your risk of developing trigger finger is also higher if you have diabetes or any form of inflammatory arthritis such as rheumatoid arthritis, and if you regularly perform activities that require repetitive hand movements. 

Carpal tunnel syndrome is also associated with a higher risk of developing trigger finger. 

If you have trigger finger in one hand, you have a high risk of developing it in your other hand. 

Getting a diagnosis

Trigger finger is diagnosed by asking you about your symptoms and medical history, and through a physical examination of your hand. In rare cases, you may need an ultrasound scan to confirm your diagnosis. 

Treating trigger finger

Treatment for trigger finger depends on how far your condition has progressed. 

In the early stages where your finger is clicking one to two times a day with some pain, your doctor may prescribe a short course of anti-inflammatory medication. They may also suggest wearing a night-time splint to keep your finger straight when you sleep — this will help ease your symptoms first thing in the morning, which is when symptoms are often at their worst. 

Steroid injections

If your finger is clicking more frequently, your pain levels have increased and these symptoms are bothering you, your doctor may recommend a steroid injection. This usually eases symptoms in seven to 10 days and lasts for nine to 12 months. 

In some cases, steroid injections can trigger a steroid flare. This is where you experience increased pain in the area where the steroid was applied for around three days. This gets better on its own and you can manage your increased pain with over-the-counter pain medications such as paracetamol and ibuprofen. 

It is not recommended to have more than one or two steroid injections. This is because the steroid injection works by thinning out the A1 pulley but the steroid also comes into contact with the tendon. If the tendon thins out too much, it can rupture — repeated steroid injections increase the risk of this happening. 

If you are of African or Asian descent and have darker skin, a steroid injection into your palm can cause a small but long-lasting white patch of skin. 

Surgery

As trigger finger progresses, anti-inflammatory medication and steroid injections become less effective. 

If your symptoms start to interfere with your ability to perform daily activities (eg your finger locks up when you try to pick something up) and consequently significantly affect your quality of life, your doctor may recommend surgery. 

Trigger finger release surgery is usually performed as a day case under a local anaesthetic, so you can return home on the same day as your procedure. It takes 15–20 minutes to complete.

A local anaesthetic alongside adrenaline will be injected into the affected area of your hand. Once this area is numbed, a small cut will be made into your palm along the A1 pulley, which will create more room for your tendon to glide and consequently, will stop it from getting stuck when you move your finger. 

If there is a lot of inflammation in the area around your trigger finger, your surgeon may also remove some of the inflamed tissue wrapped around the tendons, also known as synovectomy. 

Finally, your wound site will be washed with saline, the wound will be stitched together and a dressing will be placed on top.

Recovering from trigger finger surgery

You can return home on the same day as your surgery. You should start moving your fingers that evening to prevent any stiffness from setting in. 

You can use your hand for simple activities the next day. You should, however, avoid carrying anything heavy or going to the gym for around six weeks. 

You will need to wear your dressing for 10 days and you should keep your wound site dry. After 10 days, you can remove the dressing yourself. Your stitches will be removed either at an outpatient hospital appointment or by a nurse at your GP surgery.

In most cases, hand physiotherapy isn’t needed, with the exception being if you are already prone to stiffness in your hands. 

It takes four to six weeks before your hand will be fully recovered. Your scar site will be the most sensitive area. Gently massaging your scar from around 10 days after your surgery can help smooth your scar and ease discomfort. 

The success rate for trigger finger release surgery is around 98%. In a minority of cases, scar tissue can form along the A1 pulley, which can cause a recurrence of trigger finger. In these cases, you may need a steroid injection or further surgery. 

Preventing trigger finger

To reduce your risk of trigger finger, if you routinely have to perform repetitive tasks with your hands, try using devices to assist you and take the strain off your hands. If you smoke, quitting can reduce your risk too. 

If you have diabetes, which is a risk factor for trigger finger, keep your blood sugar levels under control. Similarly, if you have inflammatory arthritis, follow the advice of your rheumatologist to keep your condition under control. 

If you’re concerned that you have the early signs of trigger finger, see your GP for treatment ie night-time splints and a short course of anti-inflammatory medication.