Trigger Finger

What is trigger finger?

The tendons that bend the fingers pass through a series of “rings” (the pulleys of the tendon sheath), which hold them close to the bones and guide them during movement — like the eyelets through which the line of a fishing rod runs. The first of these rings (the A1 pulley), at the base of the finger, is the one usually involved in the condition.

In trigger finger, the tendon or its sheath becomes inflamed and thickened, or a small “nodule” forms on the tendon. As a result, the tendon has difficulty gliding smoothly through the ring. The finger therefore “catches” in a bent position and, when the patient tries to straighten it, the “nodule” passes abruptly through the narrowed ring, causing the characteristic “locking” and the sudden “snap”.

Causes and risk factors

The exact cause is not always clear, but certain factors are associated with an increased risk:

• Repetitive movements and activities that strain the tendons (e.g. forceful, prolonged gripping of tools)
• Diabetes mellitus — an important risk factor
• Rheumatoid arthritis and other inflammatory conditions
• Female sex and age (more common between 40 and 60 years)
• Coexistence with other conditions of the hand (e.g. carpal tunnel syndrome)

Clinical picture – Symptoms

The symptoms usually develop gradually:

• “Locking” or “catching” of the finger in a bent position, with an abrupt “snap” on extension.
• Pain and tenderness at the base of the finger, on the palm side.
• A feeling of a “nodule” or swelling at the base of the finger.
• Stiffness, especially in the morning.
• In advanced cases, the finger may “lock” permanently in a bent position, with the patient unable to straighten it.

The thumb, the middle finger and the ring finger are most often affected, while more than one finger may also be involved.

Diagnosis

The diagnosis of trigger finger is primarily clinical. The characteristic history of “locking” and “snapping”, combined with palpation of the thickened tendon or the “nodule” at the base of the finger, is usually sufficient for the diagnosis. Special imaging tests are not, as a rule, required.

Treatment

Treatment depends on the severity and duration of the symptoms.

Conservative treatment

In the early stages, treatment is often conservative:

• Rest and modification of activities that aggravate the symptoms.
• A splint, which immobilises the finger, especially at night.
• Anti-inflammatory medication.
• Local corticosteroid injection in the area of the pulley — a particularly effective method, which in many cases offers significant and lasting relief.

Surgical treatment

When the symptoms persist despite conservative treatment, or when the finger “locks” permanently, surgical treatment is indicated. The procedure —division of the A1 pulley— “releases” the tendon, so that it glides freely again. It is a short, safe procedure, often performed under local anaesthesia and as a day case, with excellent results.

Recovery

Recovery after surgical release is, as a rule, rapid. The patient is encouraged to move the finger soon after the procedure, in order to avoid stiffness. The “locking” resolves immediately, while any residual tenderness or stiffness improves gradually over a period of weeks. In patients with a long history of “locking” before surgery, full recovery of movement may require a little more time and physiotherapy.

Stages and progression

Trigger finger usually progresses gradually. At first, the patient may simply feel some stiffness or a painless “click” when moving the finger. Gradually, pain appears at the base of the finger together with the characteristic “locking”, which at first is occasional and resolves on its own.

In more advanced stages, the “locking” becomes more frequent and the patient needs to “unlock” the finger with the other hand. In the most severe form, the finger may “lock” permanently in a bent position. Recognising the stage helps in choosing the appropriate treatment: the early stages respond better to conservative treatment, while permanent locking requires, as a rule, surgical release.

Cost of treatment

The cost depends on the type of treatment (conservative, injection or surgical), the type of anaesthesia, the clinic, as well as the insurance cover. Precise information is given on an individual basis, after the clinical assessment. The practice is at your disposal for any relevant information.

More on the factors that determine the cost and on cover by insurance funds: Cost of surgery.

Relationship with other conditions of the hand

Trigger finger does not always occur in isolation. It often coexists with other conditions of “overuse” or inflammation of the tendons and nerves of the hand, such as carpal tunnel syndrome or De Quervain’s syndrome. In addition, it is particularly common in patients with diabetes mellitus or rheumatoid arthritis.

This association has practical significance: in a patient who presents with trigger finger, the doctor often also checks for any coexisting conditions, so that treatment is comprehensive. Good control of underlying diabetes can also help in the overall management.

Frequently asked questions

Why does the finger “lock”?

Because the tendon that bends the finger becomes inflamed and thickened (or forms a “nodule”) and has difficulty gliding through the ring at the base of the finger. The finger therefore “catches” in a bent position and “snaps” abruptly on extension.

Will it go away on its own?

In mild cases, rest and conservative treatment may help. However, when the symptoms persist or the finger locks, targeted treatment is needed (injection or surgery).

Does a cortisone injection help?

Yes, local corticosteroid injection is particularly effective and in many cases offers significant, lasting relief, especially in the early stages.

Is it a major operation?

No. It is a short, safe procedure, often performed under local anaesthesia and as a day case, with excellent results.

Is the cost covered by insurance?

Cover depends on the type of treatment and the insurance policy. The practice can give you detailed information.

Can several fingers be affected?

Yes. Trigger finger can affect more than one finger, at the same time or at different times, especially in patients with predisposing factors such as diabetes. The thumb, the middle finger and the ring finger are most often affected.

Is trigger finger dangerous?

No, it is not a dangerous condition, but it can be particularly bothersome and limit the use of the hand. Without treatment, permanent “locking” in a bent position can lead to stiffness of the joint, which is why early treatment is advisable.