Trigger Finger

Trigger finger, also called stenosing tenosynovitis, occurs when the tendon that bends your finger catches as it glides through a small pulley in the palm. The result is pain, clicking, or locking of the finger or thumb.

The ring finger is the most common, followed by the thumb, then the middle finger. The small finger and the index finger are uncommonly affected.

For some people, this is a nuisance. For others, it interferes with sleep, work, and simple daily tasks. Fortunately, treatment is often straightforward and very effective.

Common Symptoms

Common symptoms include:

Pain or tenderness in the palm at the base of the affected finger or thumb
A “click,” “snap,” or “catch” when moving the finger
Locking of the finger in a bent position, sometimes requiring the other hand to straighten it
Stiffness in the morning
A small, tender lump or “nodule” in the palm
Stiffness of the knuckle - especially common in the middle finger - to the point where it no longer fully straightens

Symptoms may start mildly and become more frequent or more painful over time.

Why It Happens

Trigger finger is caused by a mismatch between the size of the tendon and the opening (pulley) it passes through. When the tendon sheath becomes inflamed or thickened, the tendon no longer glides smoothly.

Risk factors include:

Repetitive gripping or forceful hand use
Diabetes
Pregnancy
Thyroid disease
Inflammatory conditions like RA, Sjogren's, PsA, Gout
Previous hand trauma

In many patients, there is no specific trigger. The condition simply appears and gradually progresses.

Diagnosing Trigger Finger

Diagnosis is based on:

A careful history of your symptoms
Physical exam focused on the affected finger or thumb
Observation of catching, clicking, or locking during motion
Palpation of a tender nodule or thickening in the pulley

X-rays are usually not necessary unless there is concern for arthritis or another underlying issue.

Nonsurgical Treatment Options

Many cases of trigger finger can be improved with nonsurgical care:

Rest and activity changes: Reducing repetitive forceful gripping or tool use
Anti-inflammatory medication: As appropriate, to reduce pain and swelling
Splinting: Sometimes helpful, especially overnight - too much splinting can cause stiffness, though
Corticosteroid injection: A precisely placed injection around the tendon sheath can reduce inflammation and allow the tendon to glide again

Steroid injections are often highly effective, especially early in the course of the condition. Some patients require more than one injection over time.

Surgical Treatment

Surgery is considered when:

Locking is frequent or persistent
Symptoms significantly affect function or sleep
Injections provide only short-lived or incomplete relief
The finger is stuck in a bent position

The procedure, called trigger finger release, relieves the catching by carefully opening the pulley and allowing the tendon to move freely.

Trigger finger release is typically:

Performed under local anesthesia
Done on an outpatient basis
Completed through a small incision in the palm

During surgery, the tight pulley is released, and the tendon is checked to ensure smooth motion.

Recovery:

Light finger movement is encouraged immediately after surgery
Stitches are removed after about 10–14 days
Most patients return quickly to daily activities, with some temporary tenderness in the incision
Grip strength improves gradually over several weeks

For most patients, the locking does not return once the pulley is released.

For those patients whose middle finger did not fully open before surgery due to stiffness of the PIP/knuckle, that may never fully improve. Sometimes it does get better after a long time and much effort - doing hand exercises can help.

My Philosophy

I focus on:

Explaining the condition in clear, straightforward language
Starting with conservative treatments that have a real chance of success
Offering precise, efficient surgery when needed
Minimizing downtime and helping you return to the tasks you care about

The goal is to remove the constant annoyance of a catching finger, so your hand feels predictable again.