Trigger finger is due to inflammation (and thickening) of the tendons in your palm that help to bend your fingers (called flexor tendons). Tendons are strong fibrous soft tissue structures that connect muscles to bone to produce movement. The finger flexor tendons enter a tunnel (called the A1 pulley) as they approach the finger and a size mismatch can lead to pain and mobility issues as the tendon becomes too swollen for the tunnel or pulley. Both the tendons and the pulley can become inflamed and lead to triggering.

Pain in your palm or finger upon movement is commonly associated with a painful catching, clicking or sticking of the finger in a bent position. It is common for mornings to be worse than other times of day, and many will use the opposite hand to help straighten the finger (which produces pain).

Trigger finger is common and the cause remains unknown for most people. Inflammatory conditions like rheumatoid arthritis can cause tendon inflammation and lead to triggering. Diabetes is a common association with trigger finger (especially when sugar levels are poorly controlled). Trigger finger can also occur in those with thyroid problems or following a hand or wrist injury. 

Some of the potential symptoms of trigger finger are listed below.

Typically present:

• Pain in the palm and/or finger or thumb with movement.

• Tenderness when pressing on the site of pain (in the palm).

• Catching, clicking or sticking of the finger (that is painful to straighten) and often worse first thing in the morning.

Sometimes present:

• Swelling in the palm or finger.

• Finger locked or flexed rigidly in towards the palm (unable to straighten).

• Stiffness of the finger.

Rarely present:

• Altered finger sensation (e.g. numbness) in the affected finger.

It is important to correctly diagnose trigger finger and exclude other causes of finger pain and altered movement; such as arthritis and other tendon disorders.

The diagnosis is usually made on the history (your symptoms) and clinical examination. Assessment with an ultrasound scan is sometimes required if the diagnosis is unclear.

• Non-surgical treatment options include simple painkillers, massage with topical anti-inflammatory gel and, sometimes, hand therapy. An injection of steroid (e.g. cortisone) at the site of the tunnel (A1 pulley) in your palm can be an effective treatment for persistent symptoms. It is not uncommon for more than one steroid injection to be required for more long-term relief.

• Surgical treatment is trigger finger release, whereby the tunnel (A1 pulley) overlying the tendon in the palm is opened up to provide more space for the tendon to glide. The tendons can also be inspected at the time of surgery and any inflammation excised.

Matthew offers all the above treatments. He can refer you for hand therapy if required.

Trigger finger surgery is usually performed under local anaesthesia. Matthew typically uses the WALANT anaesthetic technique which avoids the use of an arm tourniquet (avoiding tourniquet pain). Click here for an overview of the different types of anaesthesia and the general risks of hand surgery.

The specific risks associated with trigger finger/thumb surgery will be discussed if surgery is an option. 

You can read more detailed information about trigger finger on the Lothian Hand Unit website. 

The British Society for Surgery of the Hand (BSSH) has an informative webpage on trigger finger, which can be downloaded as a patient information leaflet PDF.