Trigger finger causes a painful catching, clicking, or popping sensation when moving a finger or thumb. It often begins with morning stiffness or tenderness at the base of the digit on the palm side of the hand. As the issue progresses, the digit may momentarily lock in a bent position, sometimes requiring the use of the other hand to forcefully straighten it. Trigger finger most often affects the ring finger and thumb.
The Mechanism Behind the Locking
The condition is medically known as Stenosing Tenosynovitis. It stems from a mismatch between the flexor tendon and the pulley system it must slide through. Flexor tendons connect forearm muscles to the finger bones and are housed within a protective tunnel called the tendon sheath. This sheath is secured by ligaments called pulleys, with the A1 pulley being a common site for the issue. Trigger finger develops when the tendon or its surrounding sheath becomes irritated, swollen, and thickened. This thickening causes the tendon to catch or snag as it attempts to glide through the narrow opening of the A1 pulley, leading to the characteristic clicking or popping.
Likelihood of Spontaneous Resolution
Whether trigger finger can heal on its own depends heavily on the individual and the severity of the condition. For most adults, spontaneous resolution is possible but uncommon, especially in moderate to severe cases. Some studies found that just over half of adult trigger fingers resolved completely without treatment. This resolution often took a significant amount of time, averaging approximately eight months from the initial consultation.
The likelihood of self-healing is higher in very mild cases and in young children with congenital trigger finger. The thumb appears to resolve spontaneously more often than other digits, with success rates reported as high as 72%. Underlying health conditions, such as diabetes, generally reduce the chance of a successful spontaneous recovery. For those with diabetes, the condition is often more persistent and less responsive to non-surgical treatments.
Non-Invasive Treatment Options
Non-invasive strategies are effective for managing symptoms and promoting healing without a medical procedure.
Activity Modification and Rest
The simplest and often most beneficial step is activity modification and rest. This involves avoiding repetitive gripping, grasping, and the prolonged use of vibrating tools. Reducing the strain on the tendon allows the inflammation to subside and gives the irritated tissue time to recover.
Splinting and Medication
Splinting is typically used to keep the affected finger straight, especially while sleeping. Wearing a splint at night reduces pressure on the tendon and prevents the finger from locking in a bent position, which can worsen symptoms. Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can help reduce both the pain and the underlying inflammation contributing to the tendon sheath swelling.
Exercise
Gentle stretching and range-of-motion exercises are helpful for maintaining flexibility and preventing stiffness in the joint. While these exercises do not directly treat the tendon’s catching, they improve the overall function of the hand. These conservative measures are most successful when symptoms are caught early, before the locking becomes severe or constant.
Medical and Surgical Solutions
When conservative, non-invasive treatments fail to provide relief after several weeks, or if symptoms worsen, professional medical intervention becomes necessary.
Corticosteroid Injections
The most common first-line medical treatment is a corticosteroid injection administered near or directly into the tendon sheath. This anti-inflammatory medication reduces swelling and irritation around the tendon, allowing it to glide more freely through the pulley system. A single injection can provide long-term success, with resolution rates ranging from 45% to over 70%, though success can be lower in patients with diabetes. If the first injection does not fully resolve the symptoms, a second injection may be considered to increase the cumulative success rate.
Surgical Release
If the trigger finger is severe, the locking is permanent, or if two to three injections have not been successful, surgery is usually recommended. The definitive procedure is called a trigger finger release, which is a minimally invasive operation with a high success rate, typically between 90% and 100%. The surgeon makes a small incision in the palm to cut open the narrowed section of the A1 pulley. This immediately widens the tunnel, allowing the flexor tendon to move without catching. Recovery is generally quick, with patients often able to move the finger right after the procedure, although full recovery from soreness and stiffness can take a few weeks to a few months.