What Is Trigger Finger? Symptoms, Causes, Diagnosis, and Treatment

Trigger finger is a condition caused by inflammation of the flexor tendon of the fingers. Flexor tendons bend the finger as if you were squeezing a trigger.

We think of our index finger as our “trigger finger,” but the condition can occur in any finger. It is common in the ring finger, as well as in the thumb, in which case it’s known as a trigger thumb.

The medical term for trigger finger is “stenosing tenosynovitis.”

A tendon is a part of a muscle that connects it to bone. The flexor tendons run along each of your fingers and connect to muscles in your forearm. When these forearm muscles contract, the flexor tendons pull your finger bones in and out to move your fingers.

Each flexor tendon has a sheath that allows it to glide smoothly as the muscle contracts. These tendon sheaths have areas of tissue called pulleys that are extra thick and hold the tendon sheath to the finger bones.

Trigger finger occurs when the A1 pulley, which is the one closest to the palm, becomes inflamed, preventing the tendon from gliding smoothly through it when the finger bends. Over time, the flexor tendon itself may also become inflamed and form a lump of tissue called a nodule; this makes it even more difficult for the flexor tendon to pass through the pulley.

Women are two to six times more likely than men to develop trigger finger, and most adults who get it are in their fifties or sixties.

Trigger finger can be painful, and it can make using the affected hand more difficult. Luckily there are a number of effective trigger finger treatments.

Pain or discomfort might be the first sign you’re developing a trigger finger or trigger thumb. The pain usually starts at the base of the affected finger where it meets the palm.

At first, it may only hurt when you’re trying to use your hand. Over time, however, it may begin to hurt at rest.

You may also have trouble using the finger. It can get stiff, and you’ll have a tough time bending and straightening it. You might also feel a popping or locking sensation when you try to bend or straighten the finger.

Trigger finger is caused by chronic inflammation of the tendon, but the exact cause of the inflammation may not be known. It is more common in people with chronic inflammatory conditions such as rheumatoid arthritis, gout, and diabetes. Some estimates put the lifetime risk of trigger finger at 2.6 percent for the general population, but 10 percent for people with diabetes.

Overuse and injury can irritate the flexor tendons that attach your fingers to the muscles that move them. Inflammation causes the tendons’ protective sheaths to swell and hurt. Trigger finger and trigger thumb may also be caused by repeated gripping motions, as well as holding power tools or other vibrating objects.

Trigger finger and trigger thumb are typically pretty easy to diagnose. Most of the time, you and your doctor will start with a medical history. Be prepared to answer questions such as:

When did it start hurting?
How bad is the pain?
How does the pain feel (throbbing, stabbing, burning, etc.)?
Can you bend and straighten your finger? If not, when did you notice it had become difficult?

Then your doctor will examine your finger. The doctor may manipulate your finger and see where it hurts and how it hurts, as well as look for popping or catching.

An ultrasound can help diagnose trigger finger or rule out other conditions, but if the finger locks, clicks, catches, and is painful, doctors presume it’s trigger finger. Some conditions sometimes confused for trigger finger (and vice versa) include ganglion cysts, finger joint problems, or an out-of-place extensor muscle.

You have a number of treatment options for trigger finger, both conservative and surgical. Most hand specialists will start with nonsurgical treatment, only moving on to surgery if your trigger finger doesn’t get any better.

Conservative Treatment

Your first line of treatment will almost always be nonsurgical. There are a few tactics you can take on your own or with the help of your doctor, including:

Resting the injured hand and trying not to use it
Taking over-the-counter painkillers or nonsteroidal anti-inflammatory drugs (NSAIDs) such as acetaminophen or ibuprofen
Splinting the injured finger
Stretches and range-of-motion exercises
Acupuncture
Adopting an anti-inflammatory diet

Corticosteroids

As an intermediate step between conservative treatments and surgery, your doctor may suggest a corticosteroid injection. Corticosteroids such as prednisone and hydrocortisone are powerful anti-inflammatories that may help bring down the pain and swelling in your A1 pulley when you have trigger finger.

The steroid triamcinolone is one of the most effective for trigger finger. Some estimates suggest it will help pain in more than four out of five people who get it. Your doctor will insert the needle and deliver the medicine directly to the tendon sheath. Doctors will usually give up to two injections, six months apart. Corticosteroids are more effective when trigger finger is diagnosed and treated early.

Trigger Finger Surgery

If two corticosteroid injections don’t work to relieve your symptoms, you may need surgery. There are a few types, and they’ll often be done at the same time. The first type of surgery is called a trigger finger release, and it involves cutting the A1 pulley to let the tendon sheath glide smoothly as you flex and extend your finger.

A surgeon who thinks trigger finger release won’t completely fix the problem may remove some of the tendon sheath (called a flexor tenosynovectomy) or even some of the tendon itself. They are generally able to tell once they open your finger how extensive your trigger finger is and how far they may need to go.

Trigger Finger Prognosis and Complications

There’s good news and bad news when it comes to trigger finger prognosis and potential complications. The good news is that it can resolve on its own. In one small study, more than half of people with trigger finger — and nearly three quarters of people with trigger thumb — had their condition go away without any treatment.

The bad news is that if it doesn’t go away on its own, it might stick around forever. You could lose the ability to bend the finger, straighten it, or both. And, if your trigger finger goes untreated and you try to move it, it will likely be painful, with limited range of motion.

Another reason to get treatment: Trigger finger is eminently treatable. It’s the fourth-most common referral to hand surgeons. More than half of cases of trigger finger go away after the first corticosteroid injection. That jumps to 85 percent after the second.

Trigger finger surgery, when it’s necessary, can be even more successful. Open surgery — using comparatively large incisions to open up your finger — has a success rate of 99 percent. Less invasive percutaneous surgery — where the surgeon inserts tools and works under your skin — can be between 74 percent and 94 percent successful, according to estimates.

If you’ve decided to seek a medical professional’s help for your trigger finger (which is almost always a good idea), here are a few questions you can ask to maximize your time with your doctor.

How did my trigger finger happen?

Your doctor will take a medical history from you, asking questions about what your symptoms feel like, when you noticed them, other medical conditions you may have, and what your job and lifestyle are like. Some of these questions are designed to tease out why you developed trigger finger in the first place.

Often, trigger finger has no known cause, but your case might have something specific causing it. Diabetes, rheumatoid arthritis, or another type of inflammatory condition raises the risk, as do jobs and hobbies that have repeated gripping or holding of power tools.

Your doctor may have specific tips for avoiding pain or disability, or treatments that may help specifically for the cause of your trigger finger.

Is there anything you can do for me today?

Your doctor may be able to give you a prescription for more powerful painkillers or nonsteroidal anti-inflammatory drugs (NSAIDs) than are available over the counter. A doctor may also suggest — and be prepared to give you — a corticosteroid injection, which has a high likelihood of helping your symptoms.

What can I do at home?

Your doctor will be able to give you a few potential home-based treatments, such as specific exercises to do, over-the-counter medication to take, and activities to avoid.

Adopting a more plant-based, anti-inflammatory diet can also help. Anti-inflammatory diets such as the Mediterranean diet have been shown to have benefits for inflammatory conditions such as diabetes and rheumatoid arthritis, and such a diet may also improve trigger finger symptoms.

Should I consider surgery?

If this isn’t your first time at the doctor’s office for trigger finger, and especially if you’ve already had corticosteroid shots that haven’t worked, it may be time to consider surgery. Your doctor can explain your surgical options as well as their success rates (extremely high across the board) and the risk of complications (low, but still a possibility).

Trigger finger can be a painful condition that limits your range of motion and decreases your quality of life — but it doesn’t have to stay this way. By being aware of the signs of trigger finger and seeking a diagnosis and treatment as soon as possible, you have an excellent chance of fully recovering.

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