Trigger finger is a condition that affects the tendons in the hand. When the affected finger or thumb is bent towards the palm, the tendon gets stuck and the finger clicks or locks.
It's also known as stenosing tenosynovitis or stenosing tenovaginosis.
Trigger finger can affect one or more fingers. The symptoms can include pain, stiffness, clicking and a small lump in the palm at the base of the affected finger or thumb (known as a nodule).
You should make an appointment to see your GP if you think you may have trigger finger, so they can examine your hand and offer advice about treatments.
What causes trigger finger?
Tendons are fibrous cords that join bone to muscle. They allow the bone to move when the muscle contracts. In the hand, tendons run along the front and back of the bones in the fingers and are attached to the muscles in the forearm.
The tendons on the palm side of the hand (flexor tendons) are held in place by strong bands of tissue, known as ligaments, which are shaped in arches over the tendon. These ligaments form a tunnel on the surface of the bone, which the tendons slide through. This tunnel is known as a tendon sheath.
Trigger finger occurs if there is a problem with the tendon or sheath, such as swelling, which means the tendon can no longer slide easily through the sheath and it can become bunched up to form the nodule. This makes it harder to bend the affected finger or thumb. If the tendon gets caught in the opening of the sheath, the finger can click painfully as it is straightened.
The exact reason why these problems develop is not known, but several things may increase the likelihood of trigger finger developing. For example, it is more common in women, people who are over 40 years of age, and people with certain medical conditions.
Conditions that can increase your risk of trigger finger include conditions that affect the hand, such as Dupuytren’s contracture. They may also include some long-term conditions, such as diabetes and rheumatoid arthritis.
How trigger finger is treated
In some people, trigger finger may get better without treatment.
However, there is a chance that the affected finger or thumb could become permanently bent if not treated, which will make performing everyday tasks difficult.
If treatment is necessary, several different options are available, including:
Rest and medication – avoiding certain activities and taking non-steroidal anti-inflammatory drugs (NSAIDs) may help relieve pain.
Splinting – this involves strapping the affected finger to a plastic splint to help ease your symptoms.
Corticosteroid injections – steroids are medicines that may be used to reduce swelling.
Surgery on the affected sheath – surgery involves releasing the affected sheath to allow the tendon to move freely again. This is a relatively minor procedure generally used when other treatments have failed. It can be up to 100% effective, although you may need to take two to four weeks off work to fully recover
Trigger finger illustration
Symptoms of trigger finger
Trigger finger usually affects your thumb, ring finger or little finger. More than one finger can be affected and the condition may develop in both hands.
Trigger finger is more common in the right hand, possibly because most people are right-handed.
Symptoms of trigger finger can include:
pain at the base of the affected finger or thumb when you move it or press on it
a nodule (a small swollen section of tendon) at the base of the affected finger or thumb
stiffness or clicking when you move the affected finger or thumb, particularly first thing in the morning
If the condition gets worse, your finger may get stuck in a bent position and then suddenly pop straight. Eventually, it may not fully straighten.
Trigger finger in children
Although it's less common than trigger finger in adults, children between the ages of six months and two years old can develop trigger thumb.
This can affect the child's ability to straighten their thumb, but it is rarely painful and many cases gets better without treatment.
When to see your GP
You should make an appointment to see your GP if you think your or your child may have a trigger finger or thumb.
Causes of trigger finger
Trigger finger is usually caused by swelling of one of the tendons that run along your fingers and thumbs, although the exact reason why this occurs is not fully understood.
This swelling makes it difficult for your tendon to slide through the tunnel surrounding the affected tendon (the tendon sheath), causing the pain and stiffness associated with trigger finger.
The swelling can then lead to a section of tendon becoming bunched into a small lump (nodule) at the base of the affected finger or thumb – a bit like pulling a piece of string through a hole that is too small.
If a nodule forms, the tendon can get stuck in the tendon sheath, causing the affected finger or thumb to become temporarily stuck in a bent position. The affected tendon may then suddenly pop through the sheath, releasing your finger like the release of a trigger.
Who is most at risk?
The exact cause of trigger finger is not fully understood and, in most cases, is never known. However, several things may increase your risk of developing trigger finger:
your gender – trigger finger is more common in women than men
your age – trigger finger is more common in adults in their 40s and 50s
a previous hand injury – trigger finger may be more likely to develop after injuring the base of your finger or palm
Other health conditions
You may be more likely to develop trigger finger if you have any of the following conditions:
diabetes – a long-term condition that causes a person's blood sugar level to become too high
rheumatoid arthritis – a long-term condition caused by a problem with your immune system (the body’s defence system), resulting in pain and stiffness in your joints
gout – a short-term condition that causes inflammation (swelling) in one or more of your joints
amyloidosis – a condition where an abnormal protein called amyloid builds up in organs, such as your liver
underactive thyroid – where your body does not produce enough of certain hormones
carpal tunnel syndrome – a condition that affects the nerves in your wrist, causing pain and tingling
Dupuytren’s contracture – a condition that causes one or more fingers to bend into the palm of your hand
De Quervain’s disease – a condition that affects the tendons in your thumb, causing pain in your wrist
Treating trigger finger
The treatment for trigger finger depends on the severity of your symptoms and how long you have had them.
Some cases of trigger finger get better without treatment, so your GP may recommend that you avoid activities that cause the pain to see whether this helps relieve your symptoms.
Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may also be helpful in relieving any pain.
Strapping your affected finger or thumb to a plastic splint can ease your symptoms by stopping your finger from moving. If your finger is particularly stiff in the morning, it may help to use a splint overnight. Your GP can advise you how long you need to wear the splint for.
While using a splint can be helpful for some people, it is generally less effective than the other treatments described below, particularly in the long-term.
Corticosteroids are medicines that can be used to reduce swelling. In cases of trigger finger, liquid corticosteroids are injected into the tendon sheath (the tunnel that the tendon slides through), at the base of your affected finger or thumb.
Corticosteroids are thought to work because they reduce swelling of the tendon, allowing the tendon to move freely again. This can sometimes happen within a few days of having the injection, but it usually takes a few weeks.
Corticosteroid injections are estimated to be an effective treatment for 50–80% of people with trigger finger. However, they are generally less effective in people with certain underlying health conditions, such as diabetes and rheumatoid arthritis.
A corticosteroid injection can permanently improve trigger finger, but the problem recurs after treatment in some cases. You can have a second injection if the effect wears off, but this is generally less effective than the first injection.
The risks of corticosteroid injections for trigger finger are small, but it very occasionally causes some thinning or colour change in the skin at the site of injection. There is also an extremely small risk of infection.
If the above treatments do not work or are unsuitable, surgery may be recommended. This involves cutting through the affected section of the tendon sheath that attaches the tendon to the bone in your finger, so that your tendon can move freely again.
Whether surgery is recommended will depend on how much pain you are in, whether it is associated with other medical problems, such as rheumatoid arthritis, and how much it is affecting your life.
In most cases, trigger finger is a nuisance rather than a serious condition. However, if it is not treated, the affected finger or thumb may become permanently stuck in a bent position or, less commonly, in a straightened position. This can make it difficult to carry out everyday tasks.
Surgery is very effective and it is rare for the problem to recur in the treated finger or thumb, although you will need to take some time off work and there is a risk of complications (see below).
The operation takes around 20 minutes, and you will not need to stay in hospital overnight. The procedure is usually performed under local anaesthetic, so you will be awake but unable to feel any pain in your hand.
There are two types of surgery:
open trigger finger release surgery
percutaneous trigger finger release surgery
If you have rheumatoid arthritis, these types of surgery may not be recommended because they can cause your finger to drift sideways. Instead, a special procedure, called a tenosynovectomy, may be necessary. This involves removing part of the tendon sheath to allow the tendon to move again.
Open trigger finger release surgery
If you have open trigger finger release surgery, the surgeon will give you an injection of local anaesthetic into the palm of your hand.
A small incision (cut) is made in the palm of your hand along one of the natural creases, which may mean the scar will be less noticeable. The surgeon carefully cuts through the tendon sheath to make it wider. The wound will then be closed with stitches and covered with a light bandage.
Percutaneous trigger finger release surgery
Percutaneous means 'through the skin'. As with the open method of surgery, the surgeon will inject your hand with a local anaesthetic. However, instead of making an incision in your palm, a needle is inserted into the base of the affected finger. The needle will be used to slice through the ligament.
As percutaneous surgery does not involve an incision, you will not have a wound or scar. However, the procedure is slightly more dangerous than open surgery and may be less effective at resolving the problem. Important nerves and arteries are very close to the tendon sheath and these can easily be damaged. For this reason, open surgery is usually the preferred method.
Recovering from surgery
After the procedure, you should be able to move your finger straightaway. The dressings can usually be removed after a few days to make movement easier, and full movement should return within a week or two.
If you have had open surgery, your palm may feel sore immediately after the procedure, but any discomfort should pass within two weeks.
You can start driving again as soon as you feel it is safe for you to drive, which is usually after three to five days.
You may be able to write and use a computer immediately.
You can play sports after around two or three weeks, once your wound has healed and you can grip again.
When you can return to work will depend on your job. If you have a desk job or a job that involves light manual duties, you may not need any time off work. If your job involves manual labour, you may need up to four weeks off.
If you have had surgery on more than one finger, your recovery period may be longer.
If you have had percutaneous surgery rather than open trigger finger release surgery, your recovery period may be shorter, as you will not have a wound on your palm.
Caring for your wound
If you have had open surgery, your surgeon should tell you how to care for the wound in your palm. Washing it with mild soap and warm water is all that is usually required.
If you have stitches, you will be told if you need to return to hospital to have them removed. Some stitches are dissolvable and will disappear on their own in around three weeks.
You may be left with a small scar running along your palm, where the incision was made.
If your finger was quite stiff before surgery, you may need specialised hand therapy after your operation to loosen it. Discuss this with your surgeon before the operation. The type of therapy may include:
Physiotherapy – manipulation, massage and exercise can help improve your range of movement.
Occupational therapy – if you are struggling with everyday tasks and activities, either at work or at home, an occupational therapist will give you practical support to make those tasks easier.
Complications from surgery
Trigger finger release surgery is a safe procedure. However, as with any type of surgery, there are some risks. Complications are rare, but could include:
stiffness or pain in the finger
a tender scar
nerve damage (if a nerve is damaged during surgery, you may never recover the full sensation in the affected area)
tendon bowstringing, where the tendon is in the wrong position
complex regional pain syndrome (CRPS), which causes pain and swelling in your hand after surgery – this usually resolves itself after a few months, but there can be permanent problems
Before your operation, ask your surgeon about the possible complications and risks.
Treating children with trigger finger
Trigger finger in children will often improve without treatment as the child gets older, although splinting and simple hand stretches may help.
Steroid injections are not normally used in children, but surgery under general anaesthetic can be carried out if necessary.