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    Trigger Finger

    What is trigger finger?

    • Trigger finger/thumb is a painful condition with clicking or locking of the affected finger or thumb as it bends or straightens. This is normally caused by swelling of the tendon or the development of nodules (pea-sized lumps).

    How common is trigger finger?

    • Trigger finger is a rare condition that can affect any finger but most commonly affects the ring finger and thumb.
    • Between 1 – 3% of the population will develop trigger finger in their lifetime (1, 4).

    Should I worry?

    • No.
    • With the correct management, trigger fingers recover well.
    • Trigger finger is not linked to other serious pathologies however, people with certain medical conditions are at a higher risk of developing trigger finger.

    Who is most likely to suffer from trigger finger?

    • Typically, those aged between 40-60 years old are more likely to develop trigger finger (1).
    • Diabetics are at a higher risk of developing trigger finger than non-diabetics (3).
    • Females are more commonly affected (3).

    What are the common symptoms

    • Pain or tenderness at the base of the finger or thumb.
    • Locking when the finger is bent and/or clicking of the flexor tendon during bending and straightening.
    • Some patients may present with a bent finger that needs to be forcefully extended to ‘unlock’ the finger.
    • A painful nodule (pea-sized lump) may be felt (1).

    What can I do?

    There are many things you can do to help recover:

    • Avoid activities that cause pain.
    • If you suspect you are suffering from a trigger finger, it is advised you seek advice from a qualified physiotherapist. Trigger finger is normally managed with rest, splinting, exercises and non-steroidal anti-inflammatory drugs (NSAIDs).
    • In some cases, a corticosteroid injection may be considered.
    • If conservative management fails, surgery is normally considered (1).

    How long will it take to recover?

    • This will depend upon several factors including, but not limited to, medical/lifestyle factors and stage of injury progression.
    • 52% of trigger fingers resolve spontaneously in 18 months (5).
    • If opted for, steroid injection relieves pain and symptoms in 70% of trigger fingers and the recovery afterward can take a few days up to a few weeks (1).
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    1. Introduction

    Trigger finger/thumb is a painful condition characterised by clicking or locking of the affected finger or thumb as it bends or straightens. Trigger finger sometimes develops after an injury, but most trigger fingers develop without a clear cause. The condition is caused by swelling of the tendon or development of nodules within its coat-like sheath, causing the catching and locking.

    Treatment of trigger finger varies between people and in some cases, trigger finger resolves on its own. Treatment of trigger finger may include advice on rest and avoiding activities that cause symptoms, splinting, exercises and anti-inflammatories. More invasive treatments that have been shown to be successful include steroid injection and surgery (1, 3, 5).

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    2. Signs & Symptoms

    3. Causes

    Trigger finger is caused by swelling of one or more of the tendons that bend the fingers or thumb, however, the reason this swelling develops is not fully understood. The swelling of the tendon makes it difficult for the tendon to move within its sheath, resulting in stiffness and pain. If a nodule (small lump) develops from the tendon bunching, this can cause locking or catching of the affected finger/thumb. Repetitive finger movements and local trauma are suggested causes of trigger finger, but this has not been confirmed and most cases of trigger finger have no clear causes (1).

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    4. Risk Factors

    This is not an exhaustive list. These factors could increase the likelihood of someone developing a trigger finger. It does not mean everyone with these risk factors will develop symptoms.

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    5. Prevalence

    Trigger finger most commonly occurs in women and people between the ages of 40 and 60 years old. 2-3% of people will develop trigger finger in their lifetime however, this is significantly higher in the diabetic population where up to 10% of people with diabetes will develop trigger finger at some point in their life (1).

    6. Assessment & Diagnosis

    Musculoskeletal physiotherapists and other appropriately qualified healthcare professionals can provide you with a diagnosis by obtaining a detailed history of your symptoms. A series of physical tests might be performed as part of your assessment to rule out other potentially involved structures and gain a greater understanding of your physical abilities to help facilitate an accurate working diagnosis.

    Your treating clinician will want to know how your condition affects you day-to-day so that treatment can be tailored to your needs and personalised goals can be established. Intermittent reassessment will ascertain if you are making progress towards your goals and will allow appropriate adjustments to your treatment to be made.

    7. Self-Management

    As part of the sessions with your physiotherapist, they will help you to understand your condition and what you need to do to help the recovery from your trigger finger. This may include resting the affected finger by modifying activities and splinting the affected finger or thumb. It is important that you try and complete the exercises you are provided as regularly as possible to help with your recovery (1).

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    8. Rehabilitation

    Below are some exercises created by our specialist physiotherapists targeted at addressing trigger finger. In some instances, a one-to-one assessment is appropriate to individually tailor targeted rehabilitation. However, this programme provides an excellent starting point.

    9. Trigger Finger Rehabilitation Plan

    Treatment Plan

    This programme focuses on maintaining the range of motion in your fingers, maintaining strength in the muscles around your affected finger and promoting gliding of the tendon within its sheath. Pain should not exceed 4/10 on your self-perceived pain scale whilst completing this exercise programme.

    Treatment Plan - Rating
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    10. Return to Sport/Normal Life

    For patients wanting to achieve a high level of function or return to sport (especially catching and throwing sports), we would encourage a consultation with a physiotherapist as you will require further progression beyond the advanced rehabilitation stage.

    As part of a comprehensive treatment approach, your musculoskeletal physiotherapist may also use a variety of other pain-relieving treatments to support symptom relief and recovery. Whilst recovering, you might benefit from a further assessment to ensure you are making progress and to establish the appropriate progression of treatment. Ongoing support and advice will allow you to self-manage and prevent future reoccurrence.

    11. Other Treatment Options

    • Patients who do not respond favourably to appropriate conservative management might benefit from a cortico-steroid injection. Some studies show that patients will experience pain and triggering relief 3 weeks following injection (8).
    • For patients who have failed appropriate conservative management and not responded favourably to injection, surgery might be considered a viable option. The two types of surgery for trigger finger are open trigger finger release surgery and percutaneous trigger finger release surgery.
    • A relatively new type of treatment called extracorporeal shockwave therapy has been shown to have some benefits in treating trigger finger (7). However, more research needs to be completed in this area thus it is not a commonly used method of treatment

    12. Links for Further Reading

    https://www.nhs.uk/conditions/trigger-finger/treatment/
    https://www.bssh.ac.uk/patients/conditions/18/trigger_fingerthumb
    trigger finger | Search results page 1 | Evidence search | NICE

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    Book an Appointment

    Please book an appointment with one of our physiotherapists if you think you are suffering from this condition and would like to find out more.

    We have Pure Physiotherapy clinics across the country including Norwich, Ipswich, Manchester, Bolton, Wakefield and Sheffield. Please view our clinics to find the closest physiotherapy clinic for you.

    References

    1. Makkouk, A.H., Oetgen, M.E., Swigart, C.R. & Dodds, S.D. (2008). Trigger finger: etiology, evaluation, and treatment. Current Reviews in Musculoskeletal Medicine, 1, 92-96.
    2. Jeanmonod R, Harberger S, Waseem M. (2021). Trigger Finger. StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459310/.
    3.  Stahl S, Kanter Y, & Karnielli E. (1997). Outcome of trigger finger treatment in diabetes. J Diabetes Complications;11, 287-90.
    4.  Kuczmarski, A.S., Harris, A.P., Gil, J.A. & Weiss, A.P.C. (2019). Management of diabetic trigger finger. The Journal of hand surgery, 44, 150-153.
    5.  McKee, D., Lalonde, J., & Lalonde, D. (2018). How Many Trigger Fingers Resolve Spontaneously Without Any Treatment?. Plastic surgery, 26, 52–54.
    6.  Goshtasby PH, Wheeler DR, Moy OJ. (2010). Risk factors for trigger finger occurrence after carpal tunnel release. Hand Surg;15, 81-7.
    7. Yildirim P, Gultekin A, Yildirim A, Karahan AY, & Tok F. (2016). Extracorporeal shock wave therapy versus corticosteroid injection in the treatment of trigger finger: a randomized controlled study. J Hand Surg Eur;41, 977-983.
    8.  Peters‐Veluthamaningal, C., van der Windt, D.A., Winters, J.C. & Meyboom‐de Jong, B., (2009). Corticosteroid injection for trigger finger in adults. Cochrane Database of Systematic Reviews.
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