Trigger Finger

Trigger finger, also called stenosing tenosynovitis, develops when a short fibrous tunnel at the base of the finger, the A1 pulley, thickens and narrows. The tendon that bends the finger has trouble sliding through it, and where it repeatedly catches it can form a small knot. The catching, clicking, or snapping you feel as you bend or straighten the finger is the tendon forcing its way past the narrowed spot. The ring finger and thumb are affected most often. The pulley does not return to normal on its own once it has thickened, but trigger finger can be treated effectively, and most people recover well.

Common symptoms include:

• Catching or clicking when you bend or straighten the finger, usually the first sign
• Pain at the base of the finger in the palm, sometimes with a tender knot
• Stiffness, especially in the morning, that eases with use and returns after rest
• Locking in a bent position, sometimes needing the other hand to straighten it

Trigger finger is diagnosed from the history and a physical exam, looking for tenderness at the base of the finger in the palm, a nodule on the tendon, and the characteristic catching or locking when the finger moves. No imaging is needed for typical cases. Ultrasound is sometimes used to confirm a tendon nodule or to guide an injection accurately.

Most people begin with nonsurgical care, and many respond well, especially when symptoms are mild or recent:

• A corticosteroid injection beside the tendon at the pulley, the most effective nonsurgical option for most patients
• A splint that holds the finger straight to rest the tendon, most useful early
• Activity changes to reduce sustained gripping or pinching during a flare

Surgery is considered when injections have not given enough relief, when the finger locks and will not straighten even with help, or when other health conditions make injections a poor choice. Trigger finger release opens the narrowed pulley through a small incision in the palm so the tendon can glide freely.

• Trigger finger releaseHand & Wrist

For a fuller explanation, including anatomy, diagnosis, and the full range of treatment:

• Trigger Finger — AAOS OrthoInfo