Trigger finger is a condition where a finger, or the thumb, catches as it bends and then snaps straight. Each finger has a flexor tendon that slides through a series of tunnels on the palm side, held in place by bands called pulleys. At the base of the finger the first pulley can thicken, or the tendon can develop a small nodule. The nodule then catches on the edge of the pulley, so the finger clicks or locks. In the thumb it is called trigger thumb.
Symptoms
- A tender lump at the base of the finger in the palm, felt when pressing.
- Clicking or catching as the finger bends and straightens.
- Stiffness and locking in the morning that eases through the day.
- A finger that stays bent and has to be straightened with the other hand.
- In longer-standing cases, a finger that no longer straightens fully.
The ring finger and thumb are often affected, though any finger can be. More than one finger can be involved, and both hands in some people.
Who gets trigger finger
It is more common in people with diabetes, and it is seen more often in women. It also occurs with rheumatoid arthritis and with repeated forceful gripping, such as tools and long hours of carrying bags. It can occur together with carpal tunnel syndrome or De Quervain's tenosynovitis. Often no clear reason is found.
How it is assessed
The diagnosis is made by examination: the doctor feels the tender nodule at the base of the finger and watches the finger bend and straighten. Scans are usually not needed. An X-ray may be done if there is a history of injury or if arthritis of the finger joints is suspected. A few other conditions can look similar, such as arthritis of a finger joint, a thickened cord in the palm (Dupuytren's contracture) and an old tendon injury, and these are separated by examination.
Trigger finger treatment without surgery
Early trigger finger often settles without an operation. After assessment, treatment may include:
- Resting the hand from the gripping task that provokes it, and changing how the task is done, for example using a padded grip on tools.
- A small splint that keeps the affected finger straight at night, worn for a few weeks as advised.
- Gentle stretching and finger exercises, as shown by the doctor or hand therapist.
- Pain-relieving medicines or gels, as advised.
- Where indicated, one injection around the tendon sheath may be considered for short-term relief; blood sugar can rise for a few days in people with diabetes.
If diabetes is present, good blood sugar control matters for the hand as well as for general health, and the doctor will take it into account when planning treatment.
Trigger finger surgery: when is it discussed
Surgery is considered when the finger stays locked, when triggering keeps returning after non-surgical treatment, or when it is limiting the use of the hand.
The operation is an open trigger finger release. A small cut is made in the palm over the base of the finger, and the tight first pulley is divided so that the tendon can slide freely. It is usually done as a day-care procedure under local anaesthesia, with the patient awake. The finger is moved straight away on the table and in the first days at home.
A dressing is worn for a short time and stitches are usually removed at about two weeks. The palm can stay tender for some weeks, and gripping heavy loads is built up gradually. General risks include a tender scar, stiffness, infection, injury to a small nerve beside the finger, incomplete relief, and the problem returning.
What happens if it is left alone
Some mild cases settle by themselves. In others the catching becomes more frequent, and the finger can start to stay bent. Over months a finger that is kept bent can lose some of its straightening, and the joint may stiffen, which is harder to recover than the catching itself. This is why a finger that locks every morning, or that needs the other hand to open it, is worth showing to a doctor rather than waiting.
In daily life, thicker handles on tools and kitchen utensils, holding bags with the forearm rather than the fingers, and warming the hand in water before stretching can make the early weeks easier.
When to see a doctor
- A finger that locks repeatedly or cannot be straightened without help.
- Catching that has lasted several weeks and is not settling.
- Several fingers catching, or both hands affected.
- A finger that is bent and cannot straighten even with help.
A hot, red, swollen finger or palm, especially with fever, needs urgent medical care.
How to book
Bookings are through WhatsApp or the clinic and hours page, for Mahavir Health Campus, Athwa Gate.