Trigger finger, medically known as stenosing tenosynovitis, is a common condition where a finger or thumb catches or locks when bent. This occurs because inflammation has caused the flexor tendon or its surrounding sheath to thicken, preventing smooth gliding through the narrow tunnel called the A1 pulley at the base of the finger. The path to recovery begins with a general practitioner and may progress to specialized care depending on the severity of the symptoms.
The First Stop Initial Diagnosis and Conservative Options
The initial point of contact for a patient experiencing the symptoms of trigger finger is typically a primary care physician (PCP), family doctor, or general practitioner. These doctors perform the initial clinical diagnosis, which involves a physical examination and reviewing the patient’s symptoms, such as tenderness or a palpable nodule at the base of the finger. Initial management focuses on the most conservative, non-invasive treatment options.
The PCP will often recommend a period of rest and activity modification, advising the patient to avoid repetitive gripping or prolonged forceful hand use. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, may be suggested to help manage pain and reduce swelling. Simple splinting, often worn at night, is another common first-line approach, aiming to keep the finger straight and prevent the tendon from catching. If these basic measures fail to resolve the catching or locking sensation after several weeks, the PCP will facilitate a referral to a specialist for more targeted non-surgical treatment.
Specialists Handling Advanced Non-Surgical Care
When conservative measures are insufficient, the patient is typically referred to a specialist, such as an orthopedic physician. These specialists manage the definitive non-operative treatment, most commonly the targeted corticosteroid injection. This procedure involves injecting a potent anti-inflammatory medication, often mixed with a local anesthetic, directly into the flexor tendon sheath near the A1 pulley.
The injection works by reducing the inflammation and swelling of the tendon, allowing the flexor tendon to glide freely again. This treatment is highly effective, often resolving symptoms in about 70% of patients, and the relief can last for over a year. While orthopedic specialists are the primary providers, pain management physicians or rheumatologists may also administer these injections, especially in patients with underlying inflammatory conditions like rheumatoid arthritis. If the first injection provides only temporary relief, a specialist may allow for a second injection, though the effectiveness can diminish with subsequent attempts.
When Surgery Is Necessary and Who Performs It
If two corticosteroid injections fail to provide lasting relief or if the finger remains locked in a bent position, surgery becomes the recommended course of action. This procedure, known as a trigger finger release, is performed by a surgical specialist. The most common specialists are orthopedic surgeons or plastic surgeons who have completed fellowship training in hand surgery or upper extremity surgery.
The procedure is minimally invasive and involves releasing the tight A1 pulley. The surgeon makes a small incision in the palm, usually under local anesthesia, to access and surgically divide the constricted pulley. Releasing the pulley creates more space for the inflamed tendon to move without restriction, restoring the smooth motion of the finger. Choosing a fellowship-trained hand specialist is preferred, as their dedicated experience with the hand’s delicate anatomy can lead to optimal outcomes, especially in complex cases or those requiring a percutaneous release technique.
The Role of Post-Treatment Therapy
Following either advanced non-surgical treatment or surgery, Occupational Therapists (OT) and Physical Therapists (PT) play a role in ensuring a full recovery. Their intervention focuses on preventing stiffness, which is a common post-treatment complication, and improving the hand’s overall dexterity.
Therapists guide patients through a structured program of gentle range-of-motion and tendon-gliding exercises. For patients recovering from surgery, therapy includes scar management techniques to prevent tissue adhesion and swelling reduction strategies. Later in the recovery process, the therapist introduces light strengthening exercises, such as using putty or resistance bands, to fully restore the hand’s grip and pinch strength. This focused rehabilitation ensures the patient can return to their daily activities with a fully functional and pain-free hand.