Trigger Finger

Are your fingers catching, locking, or getting stuck? Do you have to pop your finger out straight after wringing out a washcloth or gripping the steering wheel? Are your fingers sore and stiff in the morning? If so, you may have a condition known as trigger finger.

This painful condition has nothing to do with hunting, shooting or pulling a trigger! Rather, the name comes from the catching or “triggering” sensation with finger motion.

Trigger Finger: What is it?

Stenosing tenosynovitis, commonly known as trigger finger, is a condition of the tendons in the fingers and thumbs. The tendons are the cords that connect the muscles to the bones to move the fingers and thumbs. When they become irritated, they thicken and do not glide smoothly. This makes it difficult to bend or straighten the fingers.

Symptoms: What does Trigger Finger feel like?

Trigger finger causes pain and stiffness in the fingers. This is often worse in the morning, but gradually improves as the finger loosens up with use. As the condition worsens, it can cause a clicking or ratcheting sensation. Ultimately, the finger may become so stiff that it locks in a bent position.

When the finger is more forcefully extended, the finger pops out straight. This can feel like the popping is coming from the joint or knuckle. Often, there is pain at the base of the finger in the palm and sometimes a lump or nodule is present as well.

Causes

The cause of trigger finger is usually unknown or multi-factorial.

Medical Factors: Certain medical conditions like diabetes and rheumatoid arthritis increase an individual’s risk of developing trigger finger.

Activity Factors: Repetitive, forceful or prolonged gripping activities can aggravate the tendons and be involved in the development of trigger finger.

Evaluation: How is Trigger Finger diagnosed?

Physical Exam: Trigger finger is diagnosed clinically by examining the hand and finger. When the finger is actually catching or locking, the diagnosis is clear.
X-rays: Sometimes, X-rays may be obtained to assess for other conditions such as arthritis that may cause pain and stiffness in the fingers or thumbs.

Treatment

Non-operative treatment

Activity Modification: Resting the hand or finger can allow the inflammation to settle down.
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Anti-inflammatories such as ibuprofen or naproxen can help reduce the discomfort associated with trigger fingers.
Splinting: Wearing a splint to keep the finger straight at night can provide some relief, particularly for the morning pain and stiffness.
Hand Therapy: Exercises can help with improving the range of motion and controlling swelling in the finger.
Steroid Injections: Cortisone injections into the tendon sheath can help to relieve the inflammation and triggering and can be curative, particularly in individuals without diabetes.

Surgery

If the symptoms persist or return after non-operative treatment, surgery may be recommended. Surgery for trigger fingers involves releasing the tight band known as the A1 pulley that constricts the tendon. This allows the tendon to glide freely again. The procedure can be done awake with just local anesthetic or with a light sedation.

Risks of surgery are low and include, but are not limited to, ongoing stiffness in the finger; persistent or recurrent triggering of the finger that may require deeper surgery to address; nerve, tendon, or blood vessel damage; infection or wound healing problems; and painful scar tissue.

Recovery: What Can Be Expected?

Trigger finger release surgery is an outpatient procedure, meaning patients go home the same day as surgery. Light use of the hands is permitted immediately after surgery. A light, soft dressing is applied to the hand. Splints are usually not necessary. Washing the hand is often allowed within days after surgery.

If you have significant symptoms in both hands, surgery can be done on both at the same time or one at a time depending on your preference. The hands can be used for getting dressed, eating, going to the bathroom, and other light daily activities immediately after surgery.

Sutures are usually removed 1–2 weeks after surgery. Once the incision is healed, activities can be gradually advanced as tolerated. If you are struggling with stiffness, formal hand therapy may be recommended. Very often, simple home exercises are adequate to regain full function in the finger and hand. While the incision heals in 1–2 weeks, it can take 4–6 months for the swelling, stiffness, and discomfort to fully resolve.

It is possible, but exceedingly rare, for trigger fingers to persist or come back after surgery. If they do, another surgery may be necessary to remove a portion of the tendon that is not gliding smoothly. This is more common in patients with diabetes. For the vast majority of people, surgery takes care of the problem for life. While other fingers or digits may be affected in the future, surgery is not done on normal fingers just to keep them from being affected later in life.

Man playing piano after being treated for trigger finger

Frequently asked questions about Trigger Finger

How do I know if I need trigger finger surgery?

If you have been diagnosed with stenosing tenosynovitis or a trigger finger or thumb and the symptoms have not gone away with non-operative treatment including anti-inflammatories, rest, and possibly cortisone injections, then it may be time to consider surgery.

What if I don’t treat my trigger finger?

In general, there is not a rush or urgency to treat a trigger finger. However, if left untreated, occasionally the finger will get stuck in a locked position or the joints in the finger may get stiff, making it more challenging to get back full motion of the finger after surgery.

Why are trigger finger symptoms often worse in the morning?

We tend to sleep with our fingers clenched for prolonged periods of time which leads to increased swelling in the lining of the tendons that move the fingers. This leads to stiffness or locking of the fingers as you move them but gradually gets worked out as the fingers get loosened up.

How do I know if my symptoms are due to arthritis versus trigger finger?

Arthritis can cause pain and stiffness but the telltale triggering or catching sensation associated with trigger finger is not seen with arthritis. Your doctor’s examination of the hand and fingers is useful in telling if your pain is due to arthritis or a trigger finger. If necessary, an X-ray can be useful in differentiating the cause of your pain as well.

Can you have trigger fingers on both hands operated on at the same time?

Yes. This is based on patient and surgeon preference. With current surgical techniques, light use of the hands is permitted right away for activities such as dressing, feeding and using the restroom.

How painful is trigger finger surgery?

Everyone’s pain threshold and pain experience is different. Many people manage the pain with just acetaminophen (Tylenol) and/or ibuprofen (Advil) after surgery. The average number of stronger prescription pills taken is 3–5 pills over the first day or two.

Are you awake for trigger finger surgery?

Trigger finger surgery is often done with a light sedation and then numbing the area over the base of the finger with a local anesthetic. However, with advances in wide-awake local anesthesia no tourniquet (WALANT) techniques, the surgery can also be done with just local anesthetic without sedation, eliminating the need to fast as well as the risks of anesthesia for patients with medical issues or prior problems with anesthesia.

How long will I be out of work after trigger finger surgery?

This depends on the nature of your work and the willingness of your work to accommodate light duty. Low-demand activities such as clerical work can often be resumed within days after surgery. Higher demand activities can be resumed as tolerated often between 4–6 weeks after surgery.

When can I drive after trigger finger surgery?

You should not drive while taking narcotic pain medications. Once you are off the prescription pain medications and your pain is manageable enough to allow you to safely operate a vehicle, you may resume driving. Often this is within a few days after surgery. Visit with your surgeon for their specific recommendations.

Physicians

The following physicians specialize in the treatment of Trigger Finger:

David B. Jones Jr., MD

R. Blake Curd, MD

Joshua J. Meaike, MD

Dustin P. Collins, MD

Joshua J. Meaike, MD

Radial Pulse Therapy is used to treat forms of tendinitis and pain in joints.

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Discussing ”Avocado Hand“ with Dr. David Jones

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Testimonials

I highly recommend Dr. Jones to anyone having issues with their hands. I made an appointment with Dr. Jones based on a recommendation from someone who has the opportunity to work with him in the OR. I was told he was a very good surgeon and ‘one of the nicest people you will ever meet’. I was extremely happy with my first visit. He believes surgery should be a last resort and recommended a cortisone shot and splints to wear as needed. So far this has been very effective for me. Great results!

Deb in Sioux Falls, SD HealthGrades online review

GREAT DOCTOR!!! So professional, but still down to earth!! Love this Doctor!! 2 surgeries by him, and will only have him again!! Does a beautiful job on my hand!! Thanks Dr. Jones!!!!! Highly recommend Dr. Jones!!

RateMDs online review

I have been very pleased with the professionalism and quality of care that Dr. Jones has demonstrated. He has been very compassionate and dedicated to making sure that I gain back as much function in my hands as possible. He was proactive in managing the pain after surgery by using a nerve block. This allowed me to focus on healing rather than focusing on the pain.

On October 10th I finally had Carpal Tunnel Relief Surgery to hopefully help the problem. Dr. David Jones Jr. with the Orthopedic Institute @orthoisf in Sioux Falls did the surgery. The first thing I noticed within a couple days of surgery is that I was sleeping through the night, and dreaming. Now that may sound strange but I haven’t really had dreams at night for years because I was constantly waking up and never able to reach a deep sleep where dreams happen. The next thing I noticed is that my hands were not going numb and were pain free when I would drive a car or hold my phone. On October 23, thirteen days after surgery I returned to the Orthopedic Institute to see Dr. Jones for a checkup and to get my stitches removed. I decided to make the the 4 hour round trip on my bike. My hands never went numb one time and I had no pain! I could not be happier with the outcome! Why did I wait so long to get this done?! #relief #letsride#TeamUpOI

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Trigger Finger

Trigger Finger: What is it?

Symptoms: What does Trigger Finger feel like?

Causes

Evaluation: How is Trigger Finger diagnosed?

Treatment

Non-operative treatment

Surgery

Recovery: What Can Be Expected?

Frequently asked questions about Trigger Finger

Physicians

David B. Jones Jr., MD

R. Blake Curd, MD

Joshua J. Meaike, MD

Dustin P. Collins, MD

Related Articles

Joshua J. Meaike, MD

Why do My Joints Hurt When I Move Them?

The Best Treatment for Plantar Fasciitis and Tennis Elbow

David B. Jones Jr., MD

Let’s “Jam” About Jammed Fingers

Is the Bone Broken or Fractured?

3 Causes of Stiff, Painful Fingers

5 Treatment Options for Carpal Tunnel Syndrome

Discussing ”Avocado Hand“ with Dr. David Jones

3 Common Causes of Thumb Pain

4 Ways a Hand Therapist Can Benefit Your Life

4 Surefire Signs of a Top-Notch Carpal Tunnel Surgeon

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Testimonials

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