Trigger Finger - Trigger Thumb

Trigger Finger & Trigger Thumb | Denver, Colorado

A trigger finger (or thumb) is perhaps the most common condition I see in my hand surgery practice in the Denver metropolitan area.

A trigger finger is a condition where a single finger (or thumb) gets stuck after you bend it (see Figure 1). In more mild forms, the finger ‘triggers’ each time you open and close.

This results from swelling along the flexor tendon, a long white soft tissue structure in the palm that contracts to bend your fingers into a fist. As you bend your finger down, that region of swelling slides and gets stuck beyond a crossing band of tissue known as the A1 pulley (see Figure 2).

Your finger will ‘trigger’ each time that swelling slides in and out from under the A1 pulley.

Trigger Finger Diagnosis & Treatment

Trigger finger, or trigger thumb, is a common hand condition that causes locking or catching, resulting in a finger stuck in a bent position. — **Figure 1** - Note the pink nodule of swelling within the flexor tendon that slides under the green A1 pulley with finger flexion, causing a trigger finger.

Currently, a trigger finger is diagnosed by a doctor’s examination. With proper technique, I can feel the nodule sliding underneath the A1 pulley and catching. Rarely are any additional studies necessary.

In mild to moderate forms of trigger finger, a steroid injection is extremely effective. This will be the first line of treatment in most cases.

In patients with diabetes, or those with a finger that locks (you have to pry it open with your other hand), some will choose to skip the injection and proceed to surgery.

Trigger Finger Release Surgery

If injections fail to resolve the issue, many patients elect for surgical release of their trigger finger.

Trigger finger release surgery typically requires a 1 to 1.5 cm incision in your palm. Through this, I access and divide the A1 pulley. Remember, this band is where your finger gets caught when it triggers. I will then examine your tendons and clean up any associated inflammation responsible for the obstruction.

Typical recovery from this surgery involves the removal of three or four stitches about two weeks after surgery. I do ask that you avoid heavy gripping for three weeks so you don’t accidentally separate the wound. Some patients will have mild sensitivity over the scar for the first 4-6 weeks.

Additional Information

If you’d like more information on trigger fingers, please continue reading through my patients’ frequently asked questions below. You can also access my ‘deep dive’ section to the right of the FAQs where I have links to the longer-form articles I have written about various topics related to trigger fingers and their treatment.

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The Basics

A trigger finger is a condition where a finger or thumb clicks or triggers as one makes a fist or straightens the hand. In more advanced cases, the finger may become stuck in the bent (flexed) position.
Anatomically, the tendon develops a nodule of swelling that gets caught as it passes under the A1 pulley (see figure above). However, the true cause of the swelling often remains unknown.
In most cases, this swelling likely occurs from a small unrecognized injury, or the accumulation of repetitive stress to the hand that builds up over time.
Trigger finger can happen to anyone. While there are some risk factors that make it more likely, this condition is extremely common.
Risk factors that make developing a trigger finger more likely include hypothyroidism, diabetes, age, rheumatoid arthritis, and female sex.

Trigger Finger Symptoms & Diagnosis

Classic trigger finger symptoms are a sensation of clicking or ‘triggering’ as you either bend or straighten a finger. In many cases, this can progress and become more pronounced over time.
In severe cases, patients may experience pain in the palm near the base of the affected finger or locking of the digit. Locking occurs when you must use your other hand to force open the bent finger.
There may also be associated swelling of the finger or palm. In some cases, patients feel pain down the finger into the knuckle joints. If the trigger finger persists over a long period of time without treatment, the knuckle joints of the finger can become stiff.
A trigger finger is fairly straightforward to diagnose. I typically begin by watching the finger through range of motion, noting any triggering. I will then place my thumb over the A1 pulley and feel for the nodule sliding underneath as it catches. This confirms the diagnosis of a trigger finger.
Additional imaging is almost never needed for a trigger finger. In rare severe or unusual cases, an ultrasound may help to confirm or rule out a diagnosis.

Trigger Finger Treatment

The first thing you can do if developing a trigger finger is…wait. Oftentimes, a trigger finger will come and go. If not terribly painful or functionally limiting, give it some time.
If your trigger finger is particularly bad first thing in the morning, but then loosens up through the day, sleeping in a finger splint can be effective. Anything that holds the finger straight overnight will keep the nodule of swelling within the A1 pulley and prevent worse triggering in the morning.
If you choose this route, please do not use the splint during the day or for longer than about 6 weeks. Doing this runs a risk of prolonged or permanent finger stiffness.
While keeping your finger gently moving is always a good idea, there are unfortunately no specific stretches or exercises to help with a trigger finger.
While some patients ultimately benefit from exercises known as tendon glides, the overall benefit has been found to be small and unreliable. Because of this, therapy is not a routinely recognized method of treating a trigger finger.
YES! In fact, in most cases, steroid injections are the mainstay of trigger finger treatment.
In this procedure, a small amount of steroid is placed under the A1 pulley. This will coat your tendon in anti-inflammatory steroid medicine. This will shrink the nodule of swelling over 2-3 weeks after injection, allowing the tendon to glide smoothly again.
While the research numbers we see vary slightly over time, an easy ballpark estimate to remember is that > 90% of trigger fingers improve or resolve with the first injection. And 50% are cured with just one injection!
If you do need a second injection, there is another 50/50 cure rate with the second attempt.
If two or more injections fail, we begin to consider surgery. A third injection here or there is not unreasonable. But if this path is not working, we move on to the next.
Additionally, patients on insulin for diabetes may wish to skip injections. Steroids will often skyrocket blood sugars, and this can be difficult to manage in the days after injection.
Lastly, if your finger is routinely locking as it triggers, requiring significant force to unlock, you are less likely to benefit from injection. Many such patients choose surgery over injection.

Trigger Finger Surgery

The surgery for trigger finger is called a trigger finger release. In this procedure, a 1 to 1.5 cm incision is made in your palm. Through this, I access and divide the A1 pulley.
I will then examine your tendons and clean up any associated inflammation responsible for the obstruction. I always confirm that your finger has full, smooth range of motion before leaving the operating room.
Yes. Before finishing your surgery, I will confirm that the tendon is gliding smoothly.
If you have chosen awake surgery, I will ask you to make a fist and confirm it is no longer triggering. If asleep, I will move your finger back and forth to confirm no further triggering.
Trigger finger release surgery is a day surgery typically performed in an outpatient surgery center. In most cases, anesthesia options are up to you.
Some patients elect to have numbing medicine injected into their palm (like the dentist) and remain wide awake for the 15-minute procedure.
Other patients will choose a ‘twilight’ sedation (similar to a wisdom tooth extraction or colonoscopy procedure) during which they feel asleep but are breathing on their own without the need for a breathing tube.
Following trigger finger release surgery, you will have 2-3 sutures in the palm. All my patients have a visit with a Certified Hand Therapist within 10-14 days of surgery. Often, sutures are ready for removal at that time and they are removed by the therapist. Any concerns are communicated directly to me by my team.
I will then meet with you approximately 3 weeks after surgery to evaluate your healing process. Many patients are healed and appropriate for release from care at that time.
Restrictions are fairly simple after trigger finger release surgery. The surgical dressing must stay on and dry for the first 5 days after the procedure. Finger movement and light to moderate use of the hand is allowed and encouraged. But you must take care not to do anything vigorous enough to tear the stitches or disrupt wound healing.
Fortunately, the risks of trigger finger release surgery are low. Any surgery has risks associated with anesthesia, pain, bleeding, and infection.
Additionally, there is a very small risk of adjacent structure injury (nerves, blood vessels).
Ultimately, your decision for surgical treatment of a trigger finger is just that - your decision.
Trigger fingers are not inherently dangerous. They can often be painful and certainly functionally limiting.
If you decide not to pursue trigger finger release surgery at this time, the most important thing to look out for is your finger's range of motion. Because it is uncomfortable to have a trigger finger, your brain may subtly begin moving your finger less and less.
This can add up to notable finger stiffness over time. Set aside some time each day for finger stretching exercises if you have decided to delay trigger finger surgery.
While some trigger fingers ultimately resolve, this outcome is highly unpredictable.