Trigger finger

Also called: Stenosing tenosynovitis; finger catching

Relief and prevention Stretch Strength Massage

A finger that catches, clicks or locks when bending, sometimes needing the other hand to straighten it. A nodule on the flexor tendon is snagging on the pulley that holds it against the bone.

How common: 2-3% of the general population; up to 10% in diabetes

Open the Wrist, Hand & Thumb Relief routine All problems

What it is

The flexor tendons run along the palm side of each finger held in place by a series of pulleys. In trigger finger the first pulley thickens, or a nodule forms on the tendon, and the two no longer slide freely - the tendon has to pop through, which produces the catch.

It is a mechanical problem with a mechanical feel: the finger bends smoothly, then snags, then releases with a click. In advanced cases the finger locks bent and has to be straightened with the other hand, and eventually it may not straighten at all.

What it feels like

A click or catch as the finger bends or straightens
Worst first thing in the morning
A tender nodule felt in the palm at the base of the finger
The finger locking bent, needing the other hand to release it
Aching in the palm and the finger, and stiffness

What causes it

Most people have more than one of these at once, and they feed each other. Read the list looking for the two or three that sound like your week rather than for the one true answer — the ones that describe you are the ones worth acting on.

Thickening of the first pulley: The A1 pulley at the base of the finger thickens, narrowing the tunnel the tendon runs through. It is the primary structural change and it is what surgery releases.
A nodule on the flexor tendon: A localised swelling on the tendon has to pass through a narrowed pulley. The pop as it does so is the trigger, and the mismatch between the two is the whole mechanism.
Repetitive or sustained gripping: Occupational and hobby gripping - tools, secateurs, steering wheels, gym bars - loads the pulley repeatedly. It is associated though the relationship is less strong than for other hand conditions.
Diabetes: The strongest medical association. Trigger finger is several times more common in people with diabetes, often affects multiple fingers, and responds less well to injection.
Sex and age: More common in women and most common between fifty and sixty, which alongside the diabetes association points at connective tissue change rather than pure overuse.
Rheumatoid and inflammatory arthritis: Synovial thickening around the tendon narrows the tunnel. Trigger finger in someone with inflammatory arthritis is part of that disease rather than an independent problem.
Hypothyroidism and amyloidosis: Both are associated, through effects on connective tissue and tissue deposition respectively.
Carpal tunnel syndrome and Dupuytren's disease: These conditions cluster together, sharing risk factors and connective tissue changes. Having one raises the likelihood of another.
A previous trigger finger: Once one finger has been affected, others frequently follow, particularly in people with diabetes.

Who tends to get it

People with diabetes, in whom it is several times more common
Women between fifty and sixty
Anyone with rheumatoid arthritis or an underactive thyroid
People with carpal tunnel syndrome or Dupuytren's disease
Anyone in a heavy gripping occupation

What makes it worse, and what settles it

Makes it worse

Repeated forceful gripping, particularly with tools that press into the palm
Repeatedly forcing the finger through the catch, which irritates the tendon further
Leaving a finger locked bent for long periods, which risks a fixed contracture
Poorly controlled diabetes, which is associated with worse outcomes
Delaying treatment until the finger will not straighten at all

Settles it

A splint holding the finger straight, particularly at night, which has good evidence in early cases
Tendon gliding exercises to maintain smooth movement
Modifying grip - padded handles, avoiding tools that press into the base of the finger
Massage of the palm and forearm flexors
Corticosteroid injection, which resolves a majority of cases and is the standard next step

What actually helps

The short version: A1 pulley thickening catches the flexor tendon nodule

Strength work: Hands, Fingers, Forearms, Grip - gentle, avoid heavy sustained gripping while irritable

Stretching: Hands, Fingers, Wrists

Massage: Hands, Fingers - palmar and A1 pulley area

Also worth doing: Tendon gliding exercises; night splint in extension

What the evidence says: Splinting and tendon gliding resolve many early cases. Injection is the usual next step - exercise is an adjunct.

The names above are the Targets qFIT tracks — the Muscle Guide explains what each one does, and Quick Add switches on the Exercises you already have.

The qFIT routine for this

Ready-made routineWrist, Hand & Thumb Relief

qFIT already has this one built. It runs massage first, then stretching, then strength — the order that works on a body that is already sore — and every activity in it carries the reason it is there.

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Get it checked if…

A finger locked in flexion that cannot be passively straightened needs a hand surgeon

And whatever the body part: chest pain or unusual breathlessness on exertion; a fever alongside the pain; unexplained weight loss; pain that is constant and unrelated to how you move; new numbness, weakness or loss of bladder or bowel control; or one calf that is swollen, warm and painful. Any of those, stop and get assessed.

How it usually goes

Splinting and activity modification resolve a proportion of early cases over six to twelve weeks. Corticosteroid injection resolves a majority - though less reliably in people with diabetes - and surgical release is highly effective for those that persist. A finger that has become fixed in a bent position is harder to treat, so it is worth acting before that point rather than waiting to see whether it settles.

Prevalence basis: Hand surgery epidemiology

Others the same routine covers

These share the Wrist, Hand & Thumb Relief routine, so the work is the same. If one of them also sounds like you, that is a reason to expect more from it, not less.

This is general information, not a diagnosis, and it cannot examine you. If it matches you, use it to ask better questions of a clinician rather than to replace one.

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