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Trigger Finger

Original and Lead Editors - Holly Pulket, Hilary Zachary, Angela Dempski, Dana Williams, Shannon Davis as part of the Texas State University's Evidence-based Practice project space

Top Contributors - Angela Dempski, Shannon Davis, Dana Williams, Jess Bell, Holly Pulket, Hilary Zachary, Kim Jackson, Mariam Hashem, Shaimaa Eldib, Candace Goh, Tarina van der Stockt, Evan Thomas, Deconinck Mathieu, Fasuba Ayobami, Ewa Jaraczewska, WikiSysop, Vidya Acharya, Stuart Wildman, Rachael Lowe, Claire Knott, Amanda Ager, Lucinda hampton, Admin, Anas Mohamed and 127.0.0.1

Introduction

Trigger finger, also called stenosing flexor tenosynovitis, is a common cause of hand pain and disability in adults.[1][2] Symptoms include clicking, catching, or locking of a digit during active flexion and extension.[3] The flexor tendons of the hand pass through a fibro-osseous tunnel formed by a series of retinacular pulleys, which hold the tendons close to the bone and allow efficient flexion.[4] There are five annular pulleys (A1–A5) and three cruciform pulleys (C1–C3).[5] Trigger finger is commonly caused by a mechanical mismatch between the flexor tendon and the annular pulleys, usually A1, which is located at the metacarpal head on the palmar aspect of the metacarpophalangeal (MCP) joint.[2] [6][7] [8][9] When the thumb is affected, the condition is referred to as trigger thumb.[10]

Epidemiology/Aetiology

Trigger finger is up to six times more common in women than in men.[11] It typically presents in the fifth or sixth decade of life, with a mean age of around 58 years.[8][12] The estimated prevalence in the general population is 2–3%, rising to around 5–20% in people with diabetes.[13][14][15] Trigger finger can co-exist with other hand and wrist conditions, including carpal tunnel syndrome, De Quervain's tenosynovitis, and Dupuytren's contracture.[6] It is also associated with several systemic conditions, including diabetes mellitus, hypothyroidism, rheumatoid arthritis, renal disease, amyloidosis, and metabolic syndrome.[16][9][17][18][19] The precise aetiology remains uncertain and is generally considered multifactorial. An occupational link has been proposed, with prolonged or forceful gripping activities (such as using hand tools, carrying heavy loads) cited as contributors, although the supporting evidence is inconsistent.[9]

Trigger Finger and Diabetes

Chronic hyperglycaemia is thought to stimulate the cross-linking of collagen in the tendon sheath, leading to a build-up around the flexor tendons. It remains uncertain if tighter glycaemic control reduces the risk of developing trigger finger.[20]

When compared to patients without diabetes, those with trigger finger and diabetes are more likely to have bilateral or multiple digit involvement, more severe symptoms at presentation, and a reduced response to corticosteroid injection (around 66% success vs 90% in non-diabetic patients).[20]

Clinical Presentation

Trigger finger ranges in severity. Early symptoms include a painless clicking or catching during finger movement, which can progress to painful catching or popping, usually at the metacarpophalangeal (MCP) or proximal interphalangeal (PIP) joint. As the condition progresses, the digit may intermittently lock in flexion and require passive extension. In advanced cases, the finger may become fixed in a flexed position.[9]

Patients commonly present with:[9]

  • A tender, palpable nodule in the palmar MCP area
  • Morning stiffness or swelling
  • Pain that may radiate into the palm or distally along the digit[21]
  • Flexion-extension movement deficits
  • Difficulty grasping or holding objects[21]

When trigger finger is recurrent, patients may complain of extensor tendon pain over the PIP and interphalangeal (IP) joints due to the effort required to extend the fingers.[22]

Differential Diagnosis

Several conditions can present similarly to trigger finger and should be considered in the differential diagnosis, including:[2]

  • MCP joint osteoarthritis
  • Fractures and dislocations
  • Extensor digitorum communis subluxation or dislocation
  • Locked MCP joint
  • Avascular necrosis of the metacarpal head
  • Dupuytren's contracture
  • Flexor tendon or sheath tumour (e.g. giant cell tumour of the tendon sheath[23])

Clinical Severity Scales and Outcome Measures

The Quinnell grading system, shown in Table 1, can be used to assess the severity of trigger finger.

Table 1. Quinnell trigger finger grading scale[24][25]
Grade Clinical Presentation
0 Normal movement
I Uneven movement (sporadic trigger)
II Actively correctable
III Passively correctable
IV Fixed deformity


The Quinnell scale was modified by Green as shown in Table 2.

Table 2. Green's modified trigger finger scale[25]
Grade Clinical features
I (pretrigger) Pain; history of locking; sensitive to palpation above the A1 pulley
II (active) Demonstrable locking, but the patient can actively extend their finger
III (passive) Demonstrable locking; requires passive extension (grade IIIA), or the patient is unable to actively flex their finger (grade IIIB)
IV (contracture) Fixed with a flexion contracture of the PIP

Hand function tests can also be used to assess dexterity and strength:[24]

  • Purdue pegboard test
  • Functional dexterity test
  • Jamar hydraulic hand dynamometer

Relevant patient report outcome measures include:

  • DASH (Disabilities of the Arm, Shoulder, and Hand) and QuickDASH[24]
  • Michigan hand questionnaire[26]
  • Numeric pain rating scale
  • Visual analogue scale

Examination

Trigger finger is primarily diagnosed based on the patient's history and clinical findings. In the subjective history, patients tend to describe symptoms, such as pain and/or clicking/locking at the MCP joint, which affect their ability to grasp and hold objects.[8][22]

Observation

Observe the resting digital cascade of the hand. The affected finger may exhibit a visible flexion lag or sit in a flexed posture relative to the adjacent digits. Evidence of swelling along the flexor tendon sheath in the palm or proximal phalange should also be noted.[22]

Palpation

Palpate for tenderness over the A1 pulley at the distal palmar crease, or the MCP joint crease for the thumb. A nodular thickening may be identified on palpation.[8] Also, palpate the A1 pulley while the patient slowly makes a fist and releases it, feeling for nodular thickening or crepitus.[22]

Movement Assessment

Look for triggering or a fixed flexion contracture at the PIP while the patient actively flexes and extends the digits. Monitor for catching, clicking, or a sudden "pop" as the finger snaps into extension. Note that symptoms are often worse in the morning and improve as the day progresses. If the digit remains locked in flexion, it may need to be passively moved to achieve extension, which can be painful. Note that in chronic cases, capsular contracture of the PIP and/or MCP joint can develop.[8][22]

The following videos show two clinicians assessing trigger finger:

[22]
[27]

Imaging

Ultrasound can be used to determine the site of impingement and identify any pathological changes of the flexor tendons, synovial sheath, and pulley. Common findings include: thickening of the A1 pulley, effusion and hypertrophy of the synovial sheath, and nodular thickening of the flexor tendons.[8] Dynamic sonographic assessment can be used to identify snapping or catching between the tendon and the pulley system in real time.[8]

Management

Conservative Management

Conservative management is the recommended first-line approach for most patients with trigger finger, particularly in early-grade or recently developed cases.

Activity Modification and Patient Education

Initial management focuses on identifying and modifying daily activities that aggravate symptoms (e.g., grasping, acute flexion, or repetitive actions).[8] Practical recommendations include pacing, reducing repetitive gripping activities, and using ergonomic adaptations, such as padded grips and larger-handled tools. Task rotation can also be beneficial.

Splinting

Splinting is an effective short-term conservative treatment for trigger finger, providing symptom relief and functional improvement.[28]

Splinting aims to limit flexor tendon and sheath excursion through the A1 pulley. Trigger finger splints immobilise one joint of the affected finger (e.g., the MCP, PIP or distal interphalangeal joint (DIP)).[29] Most commonly, splints are used to block the MCP joint,[29] either in neutral or slight flexion (10-15°).[28] However, there is no consensus on which joint should be blocked. In practice, selective blocking of each joint can be trialled to identify the splint that best reduces symptomatic catching while remaining tolerable for the patient.[8]

Splinting protocols vary, from full-time use to night use alone. Most protocols advise that splints be worn for at least 6 weeks, and there is evidence to suggest that functional outcomes improve when splints are used for a longer period.[28]

MCP SplintsMCP Splint on Hand

Exercise Rehabilitation

Active tendon gliding exercises and passive stretches are an important part of conservative management to preserve function, but they are unlikely to resolve acute pain or locking on their own.[8]

Commonly prescribed exercises include the hook fist exercise (the palm and knuckles are held straight, and the fingers are bent into a hook position) and the place-and-hold full fist (the affected finger is passively flexed by the unaffected hand into a full fist position).[8]

Manual therapy approaches — including soft tissue mobilisation of the flexor tendons and forearm musculature, joint mobilisation, and gentle stretching — may complement exercise. Dosage should be tailored to symptoms.[8]

Adjunct Modalities

Heat, ultrasound, and contrast baths are sometimes used as adjuncts to address stiffness and improve tissue extensibility:[8]

  • Superficial heat (hot packs, paraffin wax) and deep heat modalities (therapeutic ultrasound, diathermy) may improve tendon and pulley extensibility prior to stretching or exercise.
  • Ice may be useful in acute presentations with marked synovial inflammation, applied for 10–15 minutes 2–4 times daily.
  • Contrast bathing — alternating hot and cold immersion — may reduce localised swelling and stiffness.
  • Extracorporeal shockwave therapy (ESWT) — delivers focused acoustic pressure waves to stimulate tissue healing and modulate local nociceptors.[8] While some studies have reported promising results for ESWT in trigger finger, further research is required to establish its efficacy compared to other treatments.[30][31]

Corticosteroid Injections

Corticosteroid injections (CSI) are an effective first-line treatment for trigger finger.[32] Corticosteroid injection is generally recommended when symptoms persist after 4-6 weeks of conservative treatment. Corticosteroid injections are thought to reduce soft tissue swelling, allowing improved movement of the flexor tendons. They can be performed either with or without ultrasound guidance.[8]

Potential complications include:[8]

  • Subcutaneous tissue atrophy
  • Bleeding
  • Skin hypopigmentation
  • Tendon and pulley ruptures
  • Deep-site infections

Caution is needed in patients with diabetes, who may experience transient elevation of blood glucose levels following injection.[8]

Operative Management

Surgery is generally indicated if trigger finger cannot be successfully managed with conservative treatment. However, there is no consensus on the optimum surgical approach (e.g., open, percutaneous or endoscopic).[33]

Open release remains the gold standard approach. A small incision is made in the palmar crease, just proximal to the A1 pulley of the affected finger. The A1 pulley, which is fully visible during this procedure, is released, and the flexor digitorum superficialis and profundus tendons are decompressed.[34]

Percutaneous release is a minimally invasive technique that uses a needle or specialised blade to divide the A1 pulley through the skin. It can be performed with or without ultrasound guidance, with the latter allowing real-time visualisation of the tendon and neurovascular structures.[35] The minimally invasive approach is associated with a lower risk of wound breakdown and infection, faster healing, and quicker return to usual activities.[36]

Endoscopic release uses smaller incisions and an endoscope to visualise the tissues. Recovery from endoscopic release may be quicker and scarring reduced.[37]

Postoperative Rehabilitation

Postoperative rehabilitation focuses on restoring range of motion, managing the surgical scar, and a gradual return to activity.

Once the wound has fully closed, scar management techniques, such as silicone scar pads at night and gentle scar massage, can be introduced.

Active range of motion exercises help to maintain tendon gliding and prevent stiffness. Dosage should be tailored to the individual, but must always follow the surgeon's protocol. Commonly used exercises include:[12]

  • Digit blocking — the metacarpophalangeal (MCP) joint is held in extension while the patient actively flexes the PIP and DIP joints. This can be performed with all fingers together or individually.
  • Tendon gliding — sequential hand positions (extension → hook fist → composite fist → straight fist → tabletop → extension).
  • Finger abduction and adduction — with the hand flat on a table or the palm facing upwards, the fingers are moved apart and together to maintain the function of the intrinsic muscles (interossei and lumbricals).

References

  1. ↑ Yanko E, Thomson C, Bourassa R, Gasmo C, Le T, Crockett K. A collaborative interdisciplinary approach for trigger finger management. J Hand Ther. 2025 Jul-Sep;38(3):508-521.
  2. ↑ 2.0 2.1 2.2 Jordaan PW, Klumpp R, Zeppieri M. Triggering, clicking, locking and crepitus of the finger: A comprehensive overview. World J Orthop. 2023 Oct 18;14(10):733-740.
  3. ↑ Liang YS, Chen LY, Cui YY, Du CX, Xu YX, Yin LH. Ultrasound-guided acupotomy for trigger finger: a systematic review and meta-analysis. J Orthop Surg Res. 2023 Sep 13;18(1):678.
  4. ↑ De Las Heras J, Simón de Blas C, Salaberri GJ, Krompas I, Olewnik L, Quinones S, et al. What is new in flexor tendon pulleys and the gaps between them in triphalangeal fingers of the hand? J Anat. 2024 Jul;245(1):12-26.
  5. ↑ Bouredoucen H, Bouvet C, Taihi L, Laredo JD, Schöffl V. The climber's finger: imaging of finger flexor tendon pulley injuries. Eur J Radiol. 2026 May;198:112757.
  6. ↑ 6.0 6.1 Lunsford D, Valdes K, Hengy S. Conservative management of trigger finger: A systematic review. Journal of Hand Therapy. 2019 Apr 1;32(2):212-21.
  7. ↑ Shohda E, Sheta RA. Misconceptions about trigger finger: a scoping review. Definition, pathophysiology, site of lesion, etiology. Trigger finger solving a maze. Adv Rheumatol. 2024 Jul 11;64(1):53.
  8. ↑ 8.00 8.01 8.02 8.03 8.04 8.05 8.06 8.07 8.08 8.09 8.10 8.11 8.12 8.13 8.14 8.15 8.16 Donati D, Ricci V, Boccolari P, Origlio F, Vita F, Naňka O, Catani F, Tarallo L. From diagnosis to rehabilitation of trigger finger: a narrative review. BMC Musculoskelet Disord. 2024 Dec 23;25(1):1061.
  9. ↑ 9.0 9.1 9.2 9.3 9.4 Makkouk AH, Oetgen ME, Swigart CR, Dodds SD. Trigger finger: aetiology, evaluation, and treatment. Current Reviews in Musculoskeletal Medicine. 2008 Jun 1;1(2):92-6.
  10. ↑ Deskur A, Deskur Z. Surgical Treatment and Rehabilitation of Trigger Thumb and Finger. Central European Journal of Sport Sciences and Medicine. 2017;17(1):61-6.
  11. ↑ Currie KB, Tadisina KK, Mackinnon SE. Common Hand Conditions: A Review. JAMA. 2022 Jun 28;327(24):2434-2445. Erratum in: JAMA. 2023 Aug 22;330(8):772. doi:
  12. ↑ 12.0 12.1 Szmiga L. Trigger Finger Course. Physiopedia Plus, 2020.
  13. ↑ Bianchi S, Gitto S, Draghi F. Ultrasound Features of Trigger Finger: Review of the Literature. Journal of Ultrasound in Medicine. 2019 Dec;38(12):3141-54.
  14. ↑ Chopin C, Le Guillou A, Salmon JH, Lellouche H, Richette P, Maillet J. Treatment of Trigger finger by ultrasound-guided needle release of a1 pulley: A series of 105 cases. Joint Bone Spine. 2022 Nov;89(6):105433.
  15. ↑ Sirtori C,Chang MC, Lombardo MDM,Brutus JP, Pegoli L. The outcomes of 2,154 endoscopic trigger finger releases. Hand Surgery and Rehabilitation. 2024;43(3):101701.
  16. ↑ Löfgren JP, Zimmerman M, Dahlin LB, Nilsson PM, Rydberg M. Diabetes mellitus as a risk factor for trigger finger -a longitudinal cohort study over more than 20 years. Front Clin Diabetes Healthc. 2021 Nov 2;2:708721.
  17. ↑ Guggenheim L, Kang Y, Furniss D, Wiberg A. Identifying non-genetic factors associated with trigger finger. J Plast Reconstr Aesthet Surg. 2024 Jul;94:91-97.
  18. ↑ Wen J, Syed B, Khalil R, Shehabat M, Alam M, Sedighi R, et al. Percutaneous A1 pulley with corticosteroid injection for trigger finger release: a systematic review. J Orthop Surg Res. 2025 Apr 29;20(1):431.
  19. ↑ N JHS, L AHAF, R GVG, da Silveira DCEC, B PN, Almeida SF. Epidemiology of trigger finger: metabolic syndrome as a new perspective of associated disease. Hand (N Y). 2021 Jul;16(4):542-545.
  20. ↑ 20.0 20.1 Dimitri-Pinheiro S, Pimenta M, Cardoso-Marinho B, Torrão H, Soares R, Karantanas A. Diabetes: a silent player in musculoskeletal interventional radiology response. Porto Biomed J. 2021 Jan 26;6(1):e112.
  21. ↑ 21.0 21.1 Colbourn J, Heath N, Manary S, Pacifico D. Effectiveness of splinting for the treatment of trigger finger. Journal of Hand Therapy.2008; 21(4):36-343.
  22. ↑ 22.0 22.1 22.2 22.3 22.4 22.5 ROHBirmingham. Hand Examination demonstration for Trigger Finger - The Royal Orthopaedic Hospital. Available from: http://www.youtube.com/watch?v=7NMj_yU1SG0 [last accessed 6/5/2026]
  23. ↑ Dib N, Ghanem W, Ezzeddine H, Otayek J, Badra M, Moucharafieh R. An uncommon etiology for a common condition: giant cell tumor of the tendon sheath presenting as trigger finger: a case report and review of the literature. J Orthop Case Rep. 2026 Jan;16(1):92-96.
  24. ↑ 24.0 24.1 24.2 Brozovich N, Agrawal D, Reddy G. A critical appraisal of adult trigger finger: pathophysiology, treatment, and future outlook. Plast Reconstr Surg Glob Open. 2019 Aug 8;7(8):e2360.
  25. ↑ 25.0 25.1 Belloti JC, Sato ES, Faloppa F. Trigger finger treatment. Rev Bras Ortop (Sao Paulo). 2020 Sep 22;57(6):911-916.
  26. ↑ Koopman JE, van Kooij YE, Selles RW, Slijper HP, Smit JM, van Nieuwenhoven CA, et al. Determining the minimally important change of the Michigan hand outcomes questionnaire in patients undergoing trigger finger release. J Hand Ther. 2023 Jan-Mar;36(1):139-147.
  27. ↑ NHS Derby and Derbyshire ICB. Trigger Finger exam. Available from: http://www.youtube.com/watch?v=VldMTN6PGdg [last accessed 6/5/2026]
  28. ↑ 28.0 28.1 28.2 McKenna ES, Co N, Brancaccio H, Soper B, Borole A, Han Y, Kirschenbaum D, Katt BM. Efficacy of splinting in managing adult trigger finger: a systematic review of short-term outcomes. J Hand Surg Glob Online. 2025 Nov 21;8(1):100881.
  29. ↑ 29.0 29.1 Leong LX, Chai SC, Howell JW, Mohd Rasdi HF, Abdul Rahman NR. Relative motion splints versus metacarpophalangeal joint blocking splints in the management of trigger finger: Study protocol for a randomized comparative trial. PLoS One. 2024 Aug 13;19(8):e0307033.
  30. ↑ Ferrara PE, Codazza S, Maccauro G, Zirio G, Ferriero G, Ronconi G. Physical therapies for the conservative treatment of the trigger finger: a narrative review. Orthop Rev (Pavia). 2020 Jun 26;12(Suppl 1):8680.
  31. ↑ Chen YP, Lin CY, Kuo YJ, Lee OK. Extracorporeal shockwave therapy in the treatment of trigger finger: a randomized controlled study. Arch Phys Med Rehabil. 2021 Nov;102(11):2083-2090.e1.
  32. ↑ Patrinely JR Jr, Johnson SP, Drolet BC. Trigger finger corticosteroid injection with and without local anesthetic: a randomized, double-blind controlled trial. Hand (N Y). 2021 Sep;16(5):619-623.
  33. ↑ Fiorini HJ, Tamaoki MJ, Lenza M, Gomes Dos Santos JB, Faloppa F, Belloti JC. Surgery for trigger finger. Cochrane Database Syst Rev. 2018 Feb 20;2(2):CD009860.
  34. ↑ Elahi MA, Pollock JR, Moore ML, Haglin JM, Lai C, Hinckley NB, Renfree KJ. Tendon sheath incision for surgical treatment of trigger finger. JBJS Essent Surg Tech. 2023 Jan 4;13(1):e21.00041.
  35. ↑ Uçar BY. Percutaneous surgery: a safe procedure for trigger finger? N Am J Med Sci. 2012 Sep;4(9):401-3.
  36. ↑ Rajeswaran G, Healy JC, Lee JC. Percutaneous release procedures: trigger finger and carpal tunnel. Semin Musculoskelet Radiol. 2016 Nov;20(5):432-440.
  37. ↑ Brown AM, DellaMaggiora RJ, Tsai EY, Kulber DA. Endoscopic Retrograde Approach for Trigger Finger Release: A Cadaver Study. Plast Reconstr Surg Glob Open. 2020 Dec 21;8(12):e3294.
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