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Hand & Wrist ConditionsTrigger Finger (stenosing tenosynovitis)

Trigger finger is a condition of the tendons in the finger, most commonly your ring finger or thumb (known then as trigger thumb). People affected by trigger finger find that stiffness and pain prevent free movement of the finger, with it often being locked in a bent position. Trigger finger surgery can help to release the finger, though most cases can be well-managed with non-surgical treatments.

Trigger Finger (stenosing tenosynovitis)

What is trigger finger?

Each finger contains a flexor tendon responsible for pulling your fingers into a curled position or fist. These tendons run from your forearm muscles to your finger bones, passing through a system of sheaths known as pulleys, designed to hold the tendon in place. In trigger finger, the tendon is unable to glide freely through the pulley, catching or getting stuck as you try to bend and straighten the affected finger. 

Irritation of the flexor tendon may cause it to become thickened and inflamed, increasing the friction as it tries to slide through the pulley and resulting in trigger finger. In other situations, a bump known as a nodule may develop on the tendon, and get caught on the pulley sheath as you bend and stretch your finger. 

Trigger finger is found in about 2% of the population. Although the exact cause of trigger finger is not fully understood, it is most common among:

  • Women aged over 40 years
  • Individuals who engage in repetitive finger movements, such as typing or holding tools
  • Those with co-existing medical conditions, such as diabetes or rheumatoid arthritis

Symptoms of trigger finger

The characteristic symptom of trigger finger is a ring finger or thumb stuck in a bent or straight position. Any finger may be affected, though the ring (fourth) finger and thumb are the most commonly involved.

Other common trigger finger symptoms include:

  • Pain on trying to bend or straighten your finger, which may radiate up the length of your finger or down into your palm
  • Stiffness in the affected finger
  • Swelling and tenderness at the base of the finger where it meets your palm
  • The sensation of catching, clicking, or popping when moving your finger

You may notice the stiffness and pain in your finger is worse in the mornings upon waking, and gradually improves over the course of the day as you reintroduce movement into your hand. 

How is trigger finger treated?

For some people, a finger or thumb locked in a bent position can be gently uncurled by using the other hand. For more severe cases, intervention by an orthopaedic surgeon or other healthcare professional may be necessary.

Non-surgical trigger finger treatment

Conservative treatment for trigger finger may be appropriate if your case is mild to moderate. Non-surgical trigger finger treatment can include:

  • Resting: adjusting how you use your hand and avoiding repetitive movements that exacerbate the pain and stiffness may help the inflammation to improve
  • Splints: wearing a splint during sleep to support your finger or thumb in a straight position 
  • Anti-inflammatory medications: such as ibuprofen may alleviate pain and inflammation in your finger/thumb
  • Stretching exercises: gentle exercises can improve stiffness and range of movement
  • Corticosteroid injections: may be sufficient to provide complete relief of symptoms but tend to be less effective for those living with diabetes, long-term symptoms, or trigger thumbs

Trigger finger surgery

Surgery for trigger finger is often recommended only after first-line, non-surgical approaches have been ineffective at fully resolving symptoms. 

A trigger finger release is a day procedure usually performed with local anaesthesia, though you may also have light sedation to help with comfort and anxiety. The affected pulley in your palm is divided via an incision or with a needle, which reduces the friction on the tendon, allowing it to glide more smoothly as you bend and straighten the finger. 

It may be necessary in some cases to shave down part of the tendon if a conventional trigger finger release does not fully resolve your symptoms.

Frequently Asked Questions

It is important to keep up light movement in your fingers and hand after your operation, as this aids in faster recovery. Though the incision is likely to heal within a few weeks, it can take up to six months for swelling and soreness in your palm to resolve completely. If you are still experiencing discomfort or reduced mobility in your finger/thumb after six months, hand therapy can be effective at improving your symptoms further post-surgery.

Trigger thumb is caused by inflammation and swelling of the tendon responsible for straightening and bending the thumb. The swelling of this tendon increases the friction as it slides within the tendon sheath during thumb movement, and in some cases, results in the tendon getting stuck. The underlying reasons for inflammation and swelling are not always well understood. Contributing factors may include having specific hand anatomy that is prone to developing trigger thumb, driven by repetitive and strenuous activities such as gripping or squeezing.

Yes, there are non-surgical treatment options for trigger finger that can be highly effective in certain cases. These include corticosteroid injections or more conservative approaches such as splinting, exercises, or simply allowing your hand to rest and recover by avoiding activities that exacerbate pain and stiffness. For cases of trigger finger that do not resolve with non-surgical treatments, trigger finger surgery may be the next step. 

Need a trigger finger surgeon in Central Queensland?

If you have a hand or wrist condition that’s causing pain or interfering with your function or quality of life, request your appointment with Dr Fleming now. Providing comprehensive assessment, diagnosis, and both surgical and non-surgical treatments, with Dr Simon Fleming, you’re in good hands.

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