Trigger finger

Trigger finger is a common condition that causes pain and reduced movement in 1 of more of your fingers or thumb. If you have trigger finger it’s hard to bend or fully straighten your finger and it feels like it catches, snaps or locks.

It’s caused by problems with the tendons in your hand and it's called trigger finger because when your finger unlocks, it pops back suddenly, like releasing a trigger on a gun.

It’s more common in the right hand and most often affects your thumb, ring finger or little finger.

Trigger finger can be a nuisance and if it’s not treated your finger may stay stuck in a bent position which can make doing everyday things difficult.

If you can avoid certain activities or movements, your symptoms might improve, but if they don’t, your healthcare provider will probably recommend physical therapy (splinting, stretching, massage), or steroid injections or surgery.

Tendons connect your muscles to your bones. They’re covered by protective tunnels (sheaths) that let your tendons move freely when you move your body.

If the tendons or sheaths in your hand swell or become inflamed, the tendons can get thicker and you get lumps called nodules near the end of your palm. When you move your fingers more, the tendons tend to rub more. This makes the thickening worse and the nodules get bigger. Eventually, the thickening and nodule size increase so much that your finger gets caught in a locked position when you bend it.  

Image credit: Depositphotos

The cause of this isn't clear, but you're at higher risk of getting trigger finger if:

• you're female
• you're over 40 years of age
• you're on renal dialysis
• you use your hand a lot at work, eg, for screwdriving or using tools that press on your palm
• you've had previous hand injuries
• you have other health conditions such as diabetes, rheumatoid arthritis, carpal tunnel syndrome or Dupuytren's contracture.

Common symptoms of trigger finger include: 

• a lump or nodule appearing in your palm
• pain when you move your finger or press on it
• you finger catches or pops when you bend or straighten it
• your finger gets stuck (locked) in a bent position
• you can hardly bend or straighten your finger. 

The triggering may be worse in the morning, or when you grip an object firmly. It usually affects your thumb, little finger or ring finger, although more than 1 finger may be affected at a time.

Your healthcare provider will usually be able to diagnose trigger finger by taking a history (asking questions about what’s happened) and examining your hand. A history might include questions about other health conditions and the type of work you do, as well as your symptoms, when they started and when the triggering happens. 

There are some things you can try to see if they help with your trigger finger.

Loosen your grip

Modifying the handle of any tools or equipment you use can help to reduce the effort involved in gripping and so take tension off the tendon and its sheath. For example, you could put a soft-grip cover over your steering wheel or use pens with a cushioned grip. Think about the equipment you use day-to-day and where there might be an opportunity to make it easier to use.

Massage

• Massage the base of your affected finger or thumb: Apply gentle pressure and use a circular motion while massaging around and over the nodule at the base of your finger or thumb.
• Massage the surrounding area: Massage your fingers, hand, wrist and forearm.
• After massaging is a good time to stretch: Stretching in the prayer position is helpful, or extend your forearm, palm up, and using your other hand gently stretch your fingers and wrist back. Breathe in and out, relax your hand, repeat twice.

Splints

Buddy splint

The easiest option is a buddy splint. To do this, use adhesive medical tape to wrap your finger to the one next to it, above and below the middle knuckles of the 2 fingers. It's a good idea to put something soft between them.

Image credit: Wikimedia Sports Medicine(external link)

If you buddy splint, remove it before showering, and overnight. When you remove the buddy splinting, use your other hand to move your fingers through their full range 5 times to avoid stiffness.

Alternative splint

Another splinting option is a short cylinder splint.

• You can make a home made cylinder splint from a piece of an egg carton from the flat top.
• The cylinder should go around the middle knuckle but leave the end knuckle free.
• Cut a piece of the egg carton so that it wraps around your finger, leaving about 1 cm open at the front (on the palm side).
• Use adhesive medical tape to wrap around the top of the cylinder, the middle (at the level of your knuckle) and at the base.

The cylinder splint is helpful to wear overnight. Just take it off before showering.

If it's your thumb that is triggering, you just need to stop the end of your thumb bending too much. You can either make a cylinder splint, or just make a dorsal splint.

• Cut a piece of the egg part of the carton so that it shapes closely to the back of your thumb when it is just a bit bent.
• It should cover your thumb nail and the part of your thumb just below the end knuckle.
• Wrap adhesive medical tap around the end and around the base.
• Wear it in the same way as the cylinder splint

If your finger or thumb is still clicking even when splinted, don’t wait more than 1 week to see your healthcare provider, or visit a hand therapist. Hand therapists will have a range of other splint options that may help you.

Apps reviewed by Healthify

You may find it useful to look at some joint and bone health apps.

Most people find their trigger finger gets better with rest. It can help to:

• avoid activities or movements that make your pain worse
• avoid gripping objects hard, repeatedly or for a long time
• avoid extreme bending of your finger
• avoid gripping equipment or tools that are narrow and slippery as they require more effort to hold onto
• avoid exercising by squeezing a ball – this will make it worse
• massage your hand and finger.

Talk to your healthcare provider about:

• using a splint to keep your finger in a resting position
• pain relief such as topical or oral NSAIDs.

See the self-care section above for more information about things you can do yourself to manage a trigger finger. 

If these things aren’t successful after 4 to 6 weeks, or earlier if you’ve got severe symptoms, your healthcare provider may recommend treatment such as steroid injections or surgery. 

Steroid injections

Steroid injections involve having cortisone (eg, triamcinolone, dexamethasone or methylprednisolone) injected into your tendon sheath. This is done to ease the inflammation (swelling) and pain. You may need to use a finger splint to help rest your finger for a few days after the injection. Steroid injections usually help, but it will take a few days to weeks for them to work properly. You may find the problem comes back and you need another steroid injection.

Read more about steroid injections. 

Surgery

Surgery might be recommended if your finger doesn’t improve after being treated with physical therapy or steroids. If you need surgery, you’ll be referred to a plastic or orthopaedic surgeon. Surgery for trigger finger is done under local anaesthesia, where your finger is numbed while you’re awake, and aims to get your finger moving freely again. It usually works well and resolves the problem. 

Trigger finger(external link) Ortho Bullets, US, 2021

Video: How to perform a trigger finger (A1 Pulley) injection

(Dr Thomas McClellan, US, 2017)