Trigger Finger & Trigger Thumb
A flexor tendon catches as it moves through a thickened pulley, causing pain, clicking, catching or locking in a finger or thumb.
The tendons that bend the fingers and thumb pass through small pulleys that hold them close to the bones. If a pulley thickens or the tendon becomes swollen, the tendon may not glide smoothly.
The result can be a tender spot at the base of the finger or thumb, followed by clicking, catching or a finger that locks in a bent position.
Loading anatomy
Common symptoms
- Pain or tenderness at the base of a finger or thumb on the palm side
- Clicking, catching or popping when the finger bends or straightens
- Stiffness that is often worse in the morning
- A finger or thumb that locks and needs the other hand to straighten it
- A small tender lump in the palm at the base of the affected digit
Causes and contributing factors
- Thickening of the pulley or swelling around the flexor tendon
- Diabetes, inflammatory arthritis or gout may increase the likelihood
- Repeated or forceful gripping can aggravate symptoms
- In many people, no single cause can be identified
How it is evaluated
Diagnosis is usually based on the pattern of catching, where the tenderness is located, and what the finger does during active movement.
The hand is examined while the finger bends and straightens. The surgeon checks whether the tendon is gliding, whether the joint has become stiff, and whether another problem could be causing the restriction.
- History of clicking, catching, locking and morning stiffness
- Examination of the pulley and tendon during active movement
- Assessment of joint motion and nearby nerve symptoms
- Imaging only when the diagnosis is uncertain or another problem is suspected
Nonsurgical treatment
Treatment aims to settle swelling and allow the tendon to glide without catching. Mild cases may improve with time and reduced aggravation.
- Activity modification, particularly reducing forceful repetitive gripping
- A night splint or temporary support to limit painful movement
- Anti-inflammatory medication when appropriate and safe
- A corticosteroid injection around the affected tendon pulley
- Hand therapy when stiffness or altered movement has developed
Surgical treatment
If symptoms continue despite nonsurgical care, or the finger remains locked, surgery may be discussed. The usual operation releases the tight pulley so the tendon can glide more freely.
- Release of the A1 pulley at the base of the finger or thumb
- Careful inspection of the tendon and surrounding tissue when the situation is atypical or recurrent
- Hand therapy if motion remains limited after the release
Clinical detail
The pulley is opened while preserving the remaining pulley system that keeps the tendon close to the bone. Persistent stiffness, recurrent triggering and other causes of limited motion are considered separately.
Recovery
The timing of motion and return to activity depends on swelling, wound healing, stiffness and the demands placed on the hand. Clicking often improves before all tenderness has settled.
- Early gentle movement is commonly encouraged when the wound allows
- Swelling and tenderness around the palm incision may last for weeks
- Hand therapy may be useful when the finger was stiff before surgery
When to seek urgent care
Seek immediate medical attention - an emergency department - if you experience:
- A finger that becomes suddenly locked with severe pain or swelling
- Rapidly increasing redness, warmth, drainage or fever
- Loss of sensation or circulation in the finger
This list is not exhaustive. If something about your hand worries you, have it looked at.
Frequently asked questions
Does trigger finger always need surgery?
No. Activity changes, splinting, therapy and an injection may help. Surgery is considered when symptoms persist, recur, or leave the digit locked or significantly restricted.
Why is the finger worse in the morning?
Tendon and pulley swelling can make the first movements after rest more difficult. Morning stiffness is common, but its cause and significance are assessed along with the rest of the examination.
Related conditions
Tendon Injuries
Cuts, ruptures or damage to the cords that connect muscle to bone and make the fingers and thumb move.
Carpal Tunnel Syndrome
Pressure on the median nerve where it passes through a narrow tunnel at the wrist, which can cause numbness, tingling and weakness in the hand.
Discuss trigger finger & thumb with Dr. Champagne
A consultation begins with understanding your symptoms, how they affect what you do, and what has already been tried.