Trigger finger, or stenosing tenosynovitis, is a hand condition that can cause significant discomfort and loss of range of motion in the affected finger / fingers. (Yendi, Atilgan, Namadli, & Ayhan Kuru, 2024; Matthews et al., 2019). If you’re experiencing a finger that elicits pain with gripping or gets stuck in a bent position, requiring your active assistance to straighten it, you may be dealing with trigger finger. Here, we’ll break down what this condition is, how it occurs, and the range of treatment options available, both conservative and surgical.
To understand trigger finger, it helps to know about the anatomy of your finger. Each finger has two tendons that allow it to bend and straighten: the flexor digitorum profundus and the flexor digitorum superficialis. These tendons glide through a series of retinacular ligaments, known as pulleys, which keep them in close proximity to the bones and joints, optimising motor control and strength. Think of them like eyelets on a fishing rod! In a finger, there are four annular pulleys and three cruciate pulleys (Reid, 2018). When we bend our fingers, these tendons glide through synovial sheaths that lubricate their movement (Matthews et al., 2019).
Evidence suggests that trigger finger results from a mismatch between a swollen tendon, sheath, pulley, or a combination of all three. The impingement of the flexor tendon causes fibre splitting and reactive intra-tendinous swelling (Reid, 2018). Each time the tendon passes the pulley, it can bunch, causing further inflammation. The high angular load on the A1 pulley during finger flexion (bending) makes it the most common structure to cause the condition (Reid, 2018).
Trigger finger is characterised by the locking or catching of a finger when you try to straighten it. The affected finger may feel stiff, and you might experience pain at the base of the finger or in the palm. Symptoms can range from mild discomfort to severe pain and restricted movement. The condition typically affects the thumb, middle finger, ring finger, or little finger (Ferrara et al., 2020), however it is most common in the middle and ring fingers and can occur in any digit. Micro-trauma from compressive forces, such as repetitive gripping in manual labour, can induce inflammation and injury to the flexor tendon sheath complex.
Diagnosis is based on your clinical presentation and case history taken during the initial appointment, along with a physical examination. To confirm the diagnosis or ascertain the level of thickening of the affected sheath, an ultrasound may be considered (Matthews et al., 2019). Hand therapists in our Adelaide clinics are also very skilled at diagnosing the condition.
Several factors can contribute to the development of trigger finger:
Effective treatment is crucial for several reasons:
Before considering surgery, several conservative treatments can be tried:
A hand therapist can design a custom splint to suit your specific needs. Effective management often involves various splinting strategies:
Design: These splints immobilise the affected finger while allowing the rest of the hand to remain functional. Here are 2 different examples that may be utilised:
Full Hand Orthoses / Splint
Under ultrasound guidance, a sonographer can inject medication that suppresses pain by inhibiting the inflammatory response. This works by reducing the activity of immune cells contributing to inflammation and decreasing the production of pro-inflammatory mediators, such as cytokines, that contribute to pain (Bodor & Flossman, 2009). With reduced inflammation, the tendon can glide more freely in its sheath, alleviating the “catching sensation.” CSI is generally viewed as a short-term solution and is often paired with a splinting protocol. Success rates for CSI range from 64% to 93% (Reid, 2018).
When conservative treatments are ineffective, or if the condition is particularly severe, invasive intervention might be necessary.
Open Surgery: This involves making an incision in the palm to directly access and release the affected tendon sheath (Reid, 2018). Success rates exceed 90%, but risks include injury to digital nerves or arteries, tendon bowstringing, and pain (Wolfe, 2017).
There is also a risk the procedure may develop scar tissue. Hand therapists can assist after the procedure to minimise scar tissue and complications and promote normal finger motion and function.
The goal of surgery is to release the constricted tendon, allowing it to glide smoothly again. There are two main types of surgery for trigger finger:
Most patients experience significant symptom relief from surgery. Recovery typically involves a period of rest followed by hand therapy to restore full function (Huisstede et al., 2014).
If considering surgical intervention, at SA Hand Therapy in Adelaide we pride ourselves on being able to match the problem, patient factors such as personality with best fit surgeon to ensure the most optimal outcomes. We would write a detailed letter to your GP for onward referral if required.
Conservative Splinting
Surgical Intervention
The choice between conservative splinting and surgical intervention should be guided by the severity of the condition, patient preferences, and response to initial treatments. For mild to moderate trigger finger, conservative splinting and adjunct therapies can be effective. For persistent or severe cases, surgical intervention often provides a more definitive solution, leading to quicker and more substantial symptom relief. Consulting with a hand therapist can help determine the most appropriate treatment approach based on individual patient needs and conditions.
Trigger finger can be a frustrating and painful condition but understanding its causes and treatment options can help you manage it effectively. Whether through conservative methods or surgical options, timely and appropriate treatment can alleviate symptoms and restore your hand’s function (Ferrara et al., 2020). If you think you might have trigger finger, consulting with a hand therapist or specialist can help you explore the best course of action for your specific situation.
For more information or to schedule an appointment with a hand therapist, feel free to contact us. We’re here to help you get back to your daily activities with ease.
