Trigger finger: symptoms, causes, treatments

Trigger finger, or stenosing tenosynovitis, is a painful condition that affects the tendons of the hand, causing your finger to lock or catch when you bend it. Trigger finger can affect any of your fingers, though it is most common in the ring finger. It can also affect the thumb, a condition known as trigger thumb. Trigger finger can affect more than one finger and you can have it in one or both hands.

As the condition progresses, your finger can get stuck in a flexed position towards your palm, making it difficult, or impossible, to straighten it.

What are the symptoms of trigger finger?

Symptoms of trigger finger may include:

• A snapping or popping sensation when you move your finger. It may ‘catch’ or get stuck as it moves. This is often worse when you haven’t moved your finger for a long time, such as in the morning
• Pain and stiffness when flexing your fingers or thumb towards your palm
• Soreness and a bump at the base of your affected finger or thumb. This is known as a nodule
• Difficulty or inability to straighten your finger
• Stiffness in your finger, especially in the morning

Symptoms of trigger finger often get worse over time. Your symptoms may also be worse:

• In the morning
• When you try to straighten your finger
• During activities that involve moving your finger
• When you grasp something firmly

What causes trigger finger?

Trigger finger occurs when the tendons in your finger become inflamed and can’t move properly.

Tendons are tough bands of connective tissue that attach muscles to bones. They are surrounded by a tunnel of tissue (we call it a synovial sheath) that produces a small amount of fluid to lubricate the tendon to help it move easily. When the tendons or sheaths become inflamed and swollen they can’t slide easily within the sheath and feel like they are catching or getting stuck. A bump (also called a nodule) may also form on the inflamed tendon, making it even harder for the tendon to glide through its sheath. This nodule often catches on a part of your tendon called the A1 pulley.

Commonly, trigger finger is linked to activities that involve repetitive gripping or the prolonged use of tools that press on the tendon, straining it over time.

Who can get trigger finger?

Anyone can develop trigger finger, but it is more common in people between the ages of 40 and 60, and affects more women than men. Having a job or a hobby where you use your hands or fingers a lot, such as farming, gardening, playing a musical instrument, or certain sports can also increase your risk of developing trigger finger.

Trigger finger is common in people who have undergone surgery for carpal tunnel syndrome, especially within the first six months after surgery.

People with certain health conditions are more likely to develop trigger finger. This includes people with:

• Diabetes
• Osteoarthritis
• Rheumatoid arthritis
• Gout
• Underactive thyroid
• Amyloidosis
• Dupuytren’s contracture
• De Quervain’s disease

How is trigger finger diagnosed?

Trigger finger is diagnosed by assessing your symptoms and examining your hand and finger.

Your consultant may ask:

• What your symptoms are
• When you first noticed symptoms
• Whether your symptoms get worse when you perform certain activities, or at certain times of the day
• Whether you have a job, or hobbies, where you use your hands and fingers a lot
• Whether you have had recent surgery on your hand or fingers
• Whether you have any chronic (long-term) medical conditions

Your consultant will examine your finger and may try to straighten it to feel for any locking or clicking, and to assess your level of pain and how stiff your tendons are.

What tests are used to diagnose trigger finger?

Trigger finger is normally diagnosed using a combination of your symptoms and an examination of your finger. In some cases, your consultant may want to look at your finger in more detail using diagnostic imaging, such as an X-ray or ultrasound scan.

If an underlying health condition is suspected, your consultant may order further tests, like a blood test.

How is trigger finger treated?

Trigger finger may occasionally get better without treatment, but in most cases, the condition gets worse, and the affected finger may become stuck in a permanently bent position. 
Treatment for trigger finger can be non-surgical, or surgical.

Non-surgical treatments for trigger finger

Non-surgical treatments are normally tried first.

Rest

Giving your finger a break from activities that cause pain can help improve symptoms. It's important to avoid actions that involve repetitive gripping or use of force.

Medication

Medication in the form of non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen can help relieve pain and inflammation. Always read the patient information leaflet carefully before taking any medications and ask your consultant or pharmacist if you have any questions.

Splinting

Wearing a splint on your finger can help by keeping it straight and limiting its movement. This can also help to reduce inflammation, pain and locking. If you experience pain, stiffness, and locking in the morning, it may help to wear a finger splint overnight. Splinting may be a good option for people who don’t want, or can’t have, steroid injections.

Steroid injections

Sometimes, a medication called a steroid can reduce swelling and inflammation. A steroid injection for trigger finger involves injecting a corticosteroid into the base of the affected finger. It is an effective treatment for trigger finger and helps relieve symptoms in around 70% of cases.

A steroid injection may permanently relieve your symptoms, but sometimes your symptoms can come back, and you may need to have a second injection. Steroid injections may be unsuitable for people with certain medical conditions like diabetes and rheumatoid arthritis.

Surgical treatment for trigger finger

If non-surgical treatments don't relieve your symptoms, your consultant may recommend surgery to treat your trigger finger.

Surgery works by widening the synovial tunnel, releasing the tendon, and allowing your finger to move properly again.

Surgery for trigger finger is performed as a day case under local anaesthetic, meaning you’ll usually be able to go home on the same day. The procedure normally takes around 20 minutes.

There are two procedures that can treat trigger finger:

Open trigger finger release surgery

In this procedure, after injecting the area with a local anaesthetic, your consultant will make a small incision (cut) at the base of the affected finger. They will then carefully cut and widen the tendon sheath, releasing the tendon, and allowing full movement of your finger. The incision is then closed with stitches and a sterile bandage is applied.

Percutaneous release surgery

This type of surgery does not require any surgical incisions (cuts), and you will not have a surgical wound or any scarring after your surgery. Percutaneous release surgery has a slightly higher risk of complications than open surgery, as there are important nerves and arteries close to the tendon sheath that may be damaged during the procedure. Some consultants prefer to perform open trigger finger surgery for this reason.

During percutaneous release surgery, your consultant will use a needle to cut through the ligament and loosen the tendon. In some cases, your consultant may use ultrasound to guide them and reduce the risk of damage to the surrounding structures.

When should I see a doctor?

Make an appointment with an orthopaedic consultant if you notice any symptoms of trigger finger. An early diagnosis will allow you to start treatment as soon as possible and may prevent your condition from getting worse and making it difficult for you to perform some day-to-day tasks.

Seek urgent medical attention if:

• Your symptoms start suddenly, and you are unable to move one of your fingers or thumb
• You have heat, pain, swelling or numbness in your finger joint

Can trigger finger be prevented?

Sometimes it may not be possible to prevent trigger finger, but there are some steps you can take to reduce your risk, including:

• Avoid overusing, or putting undue stress on your hands, fingers, and thumbs
• Take regular breaks when doing repetitive tasks that put a lot of stress on your hands
• Learn the correct technique and posture when taking part in sports or activities
• Start any new activities slowly and build up your activity level gradually to avoid injury

Conclusion

Trigger finger is a relatively common condition, particularly amongst women over the age of 50. Though not dangerous, it can get worse over time and may make performing certain activities and tasks difficult. Trigger finger can be treated in several ways, and the earlier treatment begins, the more effective it tends to be. If you have symptoms of trigger finger, make an appointment to see a consultant today.