Trigger finger, medically known as stenosing tenosynovitis, is a common condition that causes a catching, popping, or locking sensation in a finger or the thumb. This occurs when the tendon that controls finger movement becomes irritated and inflamed, preventing it from gliding smoothly within its protective sheath. Many people seek non-surgical solutions before considering an operation, given the success rates of conservative treatments. Options like rest, targeted movement, and professional injections can often restore full, pain-free function to the digit.
The Mechanics of Trigger Finger
The condition arises from a mechanical mismatch between the finger’s flexor tendon and the pulley system it passes through. Flexor tendons connect forearm muscles to the bones in the fingers, allowing them to bend. These tendons are held close to the bone by fibrous bands called pulleys, which function like guides.
The A1 pulley, located at the base of the finger where it meets the palm, is the structure most commonly implicated. Inflammation causes the tendon sheath to thicken, and sometimes a nodule forms on the tendon itself. When the finger bends, the nodule moves past the narrowed opening of the A1 pulley. However, when the finger tries to straighten, the enlarged section catches, resulting in the characteristic locking sensation.
Initial Steps: Rest, Splinting, and Activity Modification
The first line of defense focuses on eliminating the source of irritation and allowing inflamed tissues to calm down. Reducing or stopping activities that involve repetitive, forceful gripping, pinching, or prolonged tool use prevents continuous aggravation of the tendon sheath. Simple daily adjustments, such as using larger-handled tools or taking frequent breaks during manual tasks, lessen the strain on the flexor tendons.
Splinting is a passive treatment that physically restricts the finger’s movement, often recommended for nighttime use. The goal of splinting is to prevent full flexion at the large knuckle joint, or metacarpophalangeal (MCP) joint, stopping the tendon from getting trapped. Wearing a splint while sleeping is helpful since many patients experience more severe locking or stiffness upon waking.
The duration of splint use typically ranges from three to six weeks, providing a sustained period of rest for the irritated tendon. This limitation of movement helps reduce localized inflammation and swelling within the tendon sheath. Allowing the tendon to rest in a straightened position gives the tissues a chance to heal without the constant friction of passing through the tight A1 pulley.
Targeted Relief Through Therapy and Movement
Once acute inflammation subsides, active movement-based therapies promote smooth tendon gliding and maintain flexibility. Hand therapists often prescribe specific tendon gliding exercises, involving a sequence of gentle hand positions designed to move the flexor tendons incrementally. These exercises include transitioning the hand from a straight position to a hook fist, then to a full fist, and back to straight, performed slowly and without forcing a painful lock.
These controlled movements gently stretch the tendon and its sheath, improving the lubricating flow of the synovial fluid. Another technique involves nerve gliding exercises, which help nerves slide smoothly relative to surrounding structures, improving overall hand function. These gentle movements should be performed multiple times a day, but stopping immediately if triggering or sharp pain occurs is important.
For managing localized pain and swelling, temperature therapy can be beneficial. Ice packs applied for short durations help reduce acute inflammation and pain after activity or exercise. Conversely, moist heat can be used before exercises to warm up the tissues, which may increase the elasticity of the tendon and surrounding structures, making movement less stiff.
Physician-Administered Non-Surgical Options
When home remedies and physical therapy prove insufficient, a physician may recommend a corticosteroid injection, the most effective non-surgical treatment. A small amount of corticosteroid, a powerful anti-inflammatory medication, is injected directly into the tendon sheath near the A1 pulley. The steroid reduces inflammation and swelling of the tendon and sheath, increasing the space available for the tendon to glide.
Success rates for a single corticosteroid injection are high, often ranging from 60% to 90% in non-diabetic patients, with relief lasting over a year. If the first injection does not resolve the triggering, a second injection is often considered several weeks later. Repeated injections are limited, as they may weaken the tendon over time; if two attempts fail, the condition is considered refractory to injection therapy.
Oral Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) may be used as an adjunct to manage general pain and inflammation. However, they are less effective than a localized injection because they cannot deliver a high concentration of medication directly to the inflamed A1 pulley. If the finger consistently locks and non-surgical management, including multiple injections, has failed, a surgical consultation to release the A1 pulley becomes the next appropriate step.