Understanding trigger finger and modern treatment options

Trigger finger, or stenosing tenosynovitis, is a condition where a finger becomes stuck in a bent position due to inflammation of the tendon sheath, but it’s highly treatable with rest, splinting, or minor procedures.

Mr Simon Harrison, highly specialised consultant orthopaedic surgeon with expertise in treating adult hand and wrist conditions, takes a look at trigger finger in expert detail.

What causes a finger to lock or click?

The condition arises when the flexor tendon that bends the finger swells and fails to glide smoothly through the tight tunnel known as the pulley system at the base of the finger. This swelling creates a nodule on the tendon that catches on the edge of the pulley, causing the finger to snap or lock when straightened. The friction from repeated movement or systemic conditions like diabetes often triggers this thickening, affecting up to 2 per cent of the general population.

Patients typically experience pain at the palm side of the affected joint, particularly in the morning or after gripping objects. As the condition worsens, the finger may become permanently fixed in a bent position, requiring manual manipulation to straighten. Without intervention, the mechanical obstruction prevents normal hand function, making simple tasks like turning a key or holding a cup difficult.

How is the condition diagnosed and initially managed?

Diagnosis is primarily clinical, based on the patient's history and the physical sensation of a catch or click during movement. A specialist will palpate the tendon sheath to identify tender nodules and observe the range of motion without needing complex imaging for most cases. Initial management focuses on reducing inflammation through rest, avoiding repetitive gripping, and using splints to keep the finger extended while sleeping.

Steroid injections into the tendon sheath are the most effective non-surgical treatment, providing relief in approximately 70 per cent of cases within the first few weeks. These injections reduce the swelling around the tendon, allowing it to slide freely again. If symptoms persist despite conservative measures, or if the finger locks permanently, surgical intervention becomes necessary to release the constricted pulley.

• Apply ice packs to the base of the finger to reduce immediate swelling and pain.
• Avoid activities that require forceful gripping or repetitive finger movements.
• Wear a night splint to keep the finger straight and prevent morning stiffness.

What does surgical release involve and how quickly do patients recover?

Surgical release is a minor procedure that involves cutting the constricted pulley to create more space for the tendon to move. Performed under local anaesthetic as a day case, the surgery takes less than 15 minutes and allows for immediate improvement in finger mobility. The incision is small, usually healing within two weeks, though full strength returns gradually over several weeks of gentle mobilisation.

Recovery is rapid, with most patients resuming light duties almost immediately after the wound has healed. Stitches are removed after 10 to 14 days, and physiotherapy may be recommended to restore full dexterity if stiffness persists. The success rate for open or needle release is exceptionally high, with recurrence rates being very low compared to other orthopaedic procedures.

Specialist surgeons bring extensive expertise in managing complex adult hand and wrist conditions, ensuring precise technique and minimal tissue trauma. Private care offers the advantage of immediate assessment and scheduling, bypassing long waiting lists for elective hand surgery. Patients benefit from dedicated post-operative support tailored to their specific recovery needs, ensuring a swift return to normal daily activities and work.

References

• National Institute for Health and Care Excellence (NICE). De Quervain's tenosynovitis and trigger finger: diagnosis and management. NICE Guideline [NG23], 2022.
• British Society for Surgery of the Hand. Guidelines for the Management of Trigger Finger. BSSH, 2023.
• Huisstede BM, et al. Interventions for trigger finger. Cochrane Database of Systematic Reviews, 2021.
• American Academy of Orthopaedic Surgeons. Stenosing Tenosynovitis (Trigger Finger). AAOS, 2023.