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Trigger Finger: Causes, Symptoms & Treatment

Trigger finger is a condition affecting the flexor tendon of a finger, causing it to snap, catch, or lock when bending or straightening.

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Trigger finger is a condition affecting the flexor tendon of a finger, causing it to snap, catch, or lock when bending or straightening.

What is Trigger Finger?

Trigger finger (medically known as stenosing tenosynovitis or digitus saltans) is a common hand condition in which the flexor tendon of a finger can no longer glide smoothly through a narrowed section of its tendon sheath. When bending or straightening the affected finger, a characteristic snapping, catching, or locking sensation occurs. In severe cases, the finger may become completely locked in a bent position and can only be straightened with assistance from the other hand.

Causes

The condition is caused by a thickening of the first annular pulley (the A1 pulley) at the base of the finger, through which the flexor tendon must pass. Several factors can trigger this thickening:

Repetitive strain: Repeated gripping or pressing movements, for example in manual work or crafts
Metabolic conditions: Diabetes mellitus, rheumatoid arthritis, and thyroid disorders significantly increase the risk
Idiopathic onset: In many cases, the condition arises without a clear identifiable cause
Age and gender: Women in middle to older age are more frequently affected

Symptoms

Symptoms typically develop gradually and worsen without treatment:

Pain at the base of the finger, particularly over the knuckle joint
Audible or palpable snapping or clicking when bending or extending the finger
Increased stiffness and pain in the morning
A palpable nodule or thickening at the base of the finger
In advanced stages: complete locking of the finger in a flexed position

Diagnosis

Trigger finger is usually diagnosed clinically, meaning through physical examination. A physician palpates the metacarpophalangeal joints and observes finger movement. Ultrasound imaging can visualize the thickened pulley and rule out other causes. Advanced imaging such as MRI or X-ray is rarely required.

Treatment

Conservative Treatment

In mild to moderate cases, non-surgical treatment options are available:

Splinting: Immobilizing the affected finger to reduce strain on the tendon
Physiotherapy: Stretching and strengthening exercises to improve range of motion
Corticosteroid injection: An injection of a corticosteroid into the tendon sheath can reduce inflammation and swelling of the pulley. This is a commonly used and effective method.
Anti-inflammatory medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) can help relieve pain

Surgical Treatment

If conservative measures are insufficient or the finger remains permanently locked, a minor surgical procedure is recommended:

Open pulley release: Under local anesthesia, the constricting A1 pulley is divided through a small incision at the base of the finger, allowing the tendon to glide freely again.
Percutaneous needle release: In this minimally invasive technique, the pulley is divided using a fine needle without a skin incision.

Both methods have very high success rates and generally lead to complete resolution of symptoms.

References

Huisstede, B. M. et al. - Trigger Finger: A Systematic Review of Treatments. Archives of Physical Medicine and Rehabilitation, 2018.
Makkouk, A. H. et al. - Trigger Finger: Etiology, Evaluation, and Treatment. Current Reviews in Musculoskeletal Medicine, 2008.
Ryzewicz, M. & Wolf, J. M. - Trigger Digits: Principles, Management, and Complications. Journal of Hand Surgery, 2006.

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