Trigger Finger

What it is

The tendons that bend your fingers glide through a series of pulleys, much like a fishing line through the guides on a rod. In trigger finger (stenosing tenosynovitis), the tendon, its lining, or the first pulley at the base of the finger (the A1 pulley) thickens, so the tendon no longer glides smoothly. The finger or thumb catches, clicks, or locks.

What causes it

In most cases the cause is not known. Trigger finger is more common in people with diabetes, rheumatoid arthritis, or gout, and repeated strong gripping may contribute.

Symptoms

• Pain where the finger meets the palm, often only with gripping at first
• A tender lump at the base of the finger
• Popping, catching, or locking when bending or straightening the finger
• Symptoms that are often worse at night or in the morning
• Over time, difficulty fully bending or straightening the finger

Diagnosis

Trigger finger is diagnosed from your history and an examination. Other tests are rarely needed.

Treatment

Without surgery: a night splint to prevent painful locking during sleep, oral or topical anti-inflammatory medication, spacing out forceful or repetitive gripping, hand therapy, and a corticosteroid injection, which can be given at any stage but may work best early.

Surgery: if symptoms continue, a trigger finger release opens the A1 pulley so the tendon can glide freely, which ends the catching in most cases. If catching remains, the thickened tendon lining can also be removed, ideally during the same procedure. Being awake at the end of surgery lets you bend and straighten the finger so your surgeon can confirm the catching is gone.

Recovery

Finger motion returns at different speeds for different people. Some stiffness can remain even after the locking is gone, so hand therapy after surgery can help. Mild to moderate tenderness at the incision can last several months, but most people return to their normal routines within a few weeks. Treating trigger finger early makes a full recovery more likely.