Trigger Finger (Stenosing Tenosynovitis)
Trigger finger occurs when the tendon that bends the finger catches within its sheath. As the finger is bent or straightened it catches at one point and then releases suddenly with a click. It takes its name from this trigger-like movement.
Why Does It Happen?
The tendons that bend the fingers run within a sheath from the palm to the fingertip and are held close to the bone at intervals by pulley-like bands. When the tendon thickens at the first pulley (A1) in the palm, or the sheath narrows, the tendon has to force its way through this narrow point.
The result is catching, sudden release and pain as the finger bends and straightens. Symptoms are generally more marked in the morning and may ease somewhat with movement during the day.
Risk Factors
- Diabetes — the most strongly associated condition; more than one finger may be affected
- Rheumatological conditions
- Repetitive hand use requiring gripping
- Female sex and age over 40
- A history of carpal tunnel syndrome or De Quervain’s tenosynovitis
Symptoms
- The finger catching as it bends and straightens, then releasing with a sudden click
- Tenderness and a palpable nodule in the palm at the base of the finger
- Morning stiffness; waking with the finger bent
- In advanced cases the finger locking in a bent position and needing the other hand to straighten it
- In some patients the pain being felt in the palm rather than at the fingertip
Diagnosis
The diagnosis is made from the history and examination. Tenderness and a nodule in the palm at the base of the finger can be felt, and the catching movement is demonstrated on examination. Imaging is generally not required; ultrasound may be requested if another problem is suspected or the picture is atypical.
In the differential diagnosis, osteoarthritis of the finger joints, Dupuytren’s contracture and rheumatological conditions are considered. If more than one finger triggers at the same time, assessment for diabetes is recommended.
Treatment
Non-surgical treatment
- Reducing the gripping movements that trigger symptoms and adjusting hand use
- A night splint — holding the finger straight may reduce morning stiffness
- Gentle stretching and tendon gliding exercises
- Pain management
- Injection into the sheath — can markedly reduce symptoms in many patients; repeated injections are assessed with care
In people with diabetes less benefit may be expected from injection and a temporary rise in blood glucose can occur; the decision is therefore made individually.
Surgical treatment
In surgery the narrow band where the tendon catches is released. Surgery is considered where non-surgical treatment has not worked, where symptoms recur, or where the finger has locked. If the finger has been held bent for a long time, joint stiffness can develop, so assessment should not be delayed.
Starting finger movement early after the procedure is important in preventing adhesions and stiffness. Outcomes vary from person to person.
When Should You Seek Assessment?
- If your finger catches as it bends or straightens
- If you wake with the finger bent and straighten it with your other hand
- If you feel a painful lump in the palm at the base of the finger
- If more than one finger has the same symptom
- If your finger has locked and cannot be straightened
When to Seek Medical Help Without Delay
- Redness, warmth, widespread swelling and fever in the finger (suspected infection)
- Inability to bend or straighten the finger after a cut (this may be a tendon injury)
- Coldness, colour change or loss of sensation in the finger
These findings require urgent assessment. Outside office hours, go to the nearest emergency department.
Frequently Asked Questions
Does trigger finger settle on its own?
In mild cases symptoms can improve with adjusted hand use and a splint. Where catching has become marked and locking has begun, spontaneous improvement is less expected and treatment is recommended.
How many injections can be given?
Injection is effective in many patients; however, repeated applications are assessed carefully with regard to the tendon tissue. How many are given is decided by your physician according to the clinical response.
Why did it happen in more than one finger?
Triggering in more than one finger may be associated particularly with diabetes and rheumatological conditions. In this situation assessment for accompanying conditions is recommended.
My finger has locked — should I wait?
A finger held bent for a long time can develop joint stiffness, making it harder to regain movement later. If locking is present, assessment should not be postponed.
When can I use my hand after surgery?
Finger movement is generally started early, which is important in preventing adhesions and stiffness. Return to work requiring heavy gripping is planned gradually and the timeframe varies from person to person.
My child’s thumb stays bent — is it the same thing?
Stiffness of the thumb seen in children is a different condition and its course differs from that in adults. Assessment by paediatric orthopaedics is recommended.
Academic Work
Assoc. Prof. Bertan Cengiz, MD has scientific work published in national and international peer-reviewed journals in the field of hand and wrist surgery and related areas. The publication list and verifiable academic sources are available on the Publications page.
Related Pages
- Hand and Wrist Surgery
- Carpal Tunnel Syndrome
- Tennis Elbow and Golfer’s Elbow (Epicondylitis)
- Wrist Arthroscopy
- Paediatric Orthopaedics
The information on this page is for general guidance and does not replace an in-person medical examination. Diagnosis and treatment require a physician’s clinical assessment. Outcomes of any treatment or surgical intervention may vary from person to person; no guarantee of a specific result or timeframe is given on this page.