Trigger finger, medically known as stenosing tenosynovitis, is a common condition that affects the tendons responsible for bending the fingers or thumb. This issue arises because the space within the sheath surrounding the flexor tendon becomes narrowed due to inflammation and swelling. The flexor tendons glide through a series of tissue rings called pulleys, which hold the tendons close to the bone. When the tendon or its sheath thickens, often forming a small nodule, it struggles to pass smoothly through the first pulley, known as the A1 pulley, located at the base of the finger in the palm. This mechanical mismatch causes the distinct “catching” or “locking” sensation when the finger is bent or straightened. Repetitive gripping activities or underlying conditions like diabetes and rheumatoid arthritis are frequently associated with its development.
Immediate Techniques for Releasing a Locked Finger
When a finger unexpectedly locks in a bent position, the immediate goal is to achieve gentle, temporary release and reduce acute discomfort. One of the simplest techniques is to immerse the hand in warm water for about five to ten minutes, as the heat helps to relax the tissues and increase blood flow. Following the application of moist heat, you can attempt gentle manual manipulation to straighten the digit. Use your other hand to slowly and steadily apply mild pressure to the locked finger, guiding it into a straight position without forcing it or causing sharp pain.
Applying a cold pack to the base of the affected finger can also help manage the acute swelling and inflammation. Resting the hand by avoiding activities that require forceful or repetitive gripping is another immediate measure. Additionally, a light, circular self-massage can be performed at the tender spot in the palm. These measures provide temporary relief but do not treat the underlying pathology, making follow-up with a medical professional necessary for long-term management.
Non-Surgical Treatment Pathways
For long-term resolution, physicians typically recommend a sequence of conservative treatments that target the inflammation and restore smooth tendon gliding. Non-steroidal anti-inflammatory drugs (NSAIDs), taken orally or applied topically, are often considered a first-line approach to reduce pain and inflammation in the short term, although their long-term effectiveness is limited. Another frequent intervention involves wearing a splint or brace, particularly at night, to prevent the finger from flexing fully and resting the A1 pulley. This immobilization allows the irritated tendon and sheath to calm down and can be effective in reducing morning stiffness and locking.
A highly effective non-surgical intervention is a local corticosteroid injection directly into the tendon sheath at the base of the affected finger. Corticosteroids are potent anti-inflammatory agents that reduce the swelling of the tendon and the pulley, which can resolve the mechanical obstruction and allow the tendon to glide freely again. A single injection can successfully relieve symptoms in a majority of adult patients, with some requiring a second injection if the initial treatment does not provide lasting relief. If two injections fail to resolve the condition, further non-surgical options are typically exhausted before considering surgery.
Physical or occupational therapy, focusing on specific hand exercises, plays an important role in rehabilitation. Therapists guide patients through exercises like tendon gliding, which involves a specific sequence of finger movements to encourage the tendon to move smoothly within its sheath. Strengthening and stretching exercises are introduced to improve overall hand function and flexibility without aggravating the inflammation. These tailored exercises help maintain mobility and prevent stiffness.
Surgical Solutions and Recovery
Surgery is generally considered when conservative non-surgical treatments, particularly corticosteroid injections, have failed to provide a permanent solution. The procedure, known as trigger finger release or tenolysis, is designed to physically relieve the constriction that is catching the tendon. The primary goal is to cut open the A1 pulley, the fibrous ring that has become too tight, allowing the flexor tendon to glide smoothly without catching.
The procedure is minimally invasive, often performed on an outpatient basis using only local anesthesia, and typically takes less than ten minutes. The surgeon makes a small incision in the palm at the base of the affected finger to access and divide the A1 pulley. Immediately after the pulley is released, the restriction is gone, and the patient is usually asked to move the finger to confirm the triggering has stopped.
Recovery is generally rapid, with many patients experiencing immediate freedom of movement in the finger, although complete healing takes longer. Light activities can often be resumed within a day or two, but post-operative care requires attention to wound management and early mobilization. Gentle, active range-of-motion exercises are encouraged early on to prevent the formation of scar tissue and stiffness. While soreness and swelling may persist for several weeks, full recovery typically takes between six and twelve weeks.