Trigger Finger (Finger Disorder)

Overview

Trigger finger, medically known as stenosing tenosynovitis, is a condition that causes one or more fingers to catch or lock when bent. The condition gets its name from the triggering motion that occurs when the affected finger snaps back into position, similar to pulling and releasing a trigger. This happens when inflammation narrows the space within the sheath that surrounds the tendon in the affected finger.

The flexor tendons in your fingers allow you to bend and straighten your fingers. These tendons pass through tunnel-like structures called tendon sheaths, which help guide the tendons and keep them in place. When the tendon sheath becomes inflamed or thickened, it creates a constriction that makes it difficult for the tendon to glide smoothly. This can cause the finger to click, snap, or become stuck in a bent position.

Trigger finger affects approximately 2-3% of the general population, with higher rates in certain demographics. It most commonly affects adults between 40-60 years of age, and women are affected more frequently than men. The ring finger and thumb are the most commonly affected digits, though any finger can be involved. While trigger finger can affect one or multiple fingers, it's more common to have the condition in just one finger at a time.

The condition ranges from mild clicking or catching to severe locking where the finger becomes stuck in a bent position and cannot be straightened without assistance. Early intervention and appropriate treatment can significantly improve outcomes and prevent progression to more severe forms of the condition.

Symptoms

Trigger finger symptoms typically develop gradually and may worsen over time without treatment. The severity can range from mild discomfort to significant functional impairment.

Primary Symptoms

Early Stage Symptoms

• Finger stiffness: Particularly noticeable in the morning or after periods of inactivity
• Mild clicking: Subtle clicking or catching sensation during finger movement
• Tenderness: Pain at the base of the affected finger or in the palm
• Occasional catching: Brief episodes where finger movement hesitates
• Morning symptoms: Worse symptoms upon waking

Progressive Symptoms

• More frequent catching: Finger catches or clicks more often during movement
• Increased pain: Pain becomes more noticeable and persistent
• Finger locking: Finger gets stuck in bent position temporarily
• Need for assistance: May need to use other hand to straighten finger
• Nodule formation: Small bump or thickening at base of finger

Advanced Symptoms

• Severe locking: Finger becomes stuck in bent position for extended periods
• Inability to straighten: Cannot straighten finger without force or assistance
• Constant pain: Persistent pain even at rest
• Functional impairment: Difficulty with daily activities requiring finger use
• Secondary stiffness: Other joints in the finger become stiff

Severity Grading

Grade 1 (Mild)

• Pain and tenderness over flexor tendon sheath
• No clicking or locking
• Symptoms mainly with activity

Grade 2 (Moderate)

• Clicking or snapping with finger movement
• No locking or catching
• Able to actively flex and extend finger

Grade 3 (Severe)

• Locking or catching of finger
• Requires passive extension (using other hand)
• May have intermittent locking episodes

Grade 4 (Very Severe)

• Fixed flexion contracture
• Cannot actively or passively extend finger
• Finger stuck in bent position

Associated Symptoms

• Wrist pain: Pain may radiate to the wrist
• Forearm discomfort: Tension or aching in forearm muscles
• Grip weakness: Reduced grip strength
• Hand fatigue: Hand tires easily with use
• Sleep disturbance: Pain may wake patient at night
• Temperature sensitivity: Symptoms may worsen in cold weather

Finger-Specific Patterns

Thumb Trigger Finger

• Often affects the thumb's ability to grip
• May cause difficulty with pinching motions
• Can affect writing, typing, and fine motor tasks
• May be particularly noticeable when gripping objects

Ring Finger (Most Common)

• May affect grip strength significantly
• Can interfere with activities requiring all fingers
• May cause compensatory overuse of other fingers

Multiple Finger Involvement

• Can affect several fingers simultaneously
• May progress from one finger to others over time
• More commonly seen in people with diabetes or rheumatoid arthritis
• Can severely impact hand function

Functional Impact

• Daily activities: Difficulty with:
  • Gripping objects
  • Buttoning clothes
  • Using tools or utensils
  • Typing or writing
  • Playing musical instruments
• Work activities: May affect job performance, especially for:
  • Manual laborers
  • Office workers who type extensively
  • Healthcare workers
  • Musicians
  • Artists and crafters
• Sports and hobbies: Impact on recreational activities requiring hand dexterity

Symptom Timing and Patterns

• Morning stiffness: Symptoms often worst upon waking
• Activity-related: May worsen with repetitive finger use
• Weather sensitivity: Some people notice worse symptoms in cold or humid weather
• Rest improvement: Symptoms may improve with rest and finger immobilization
• Progressive nature: Generally worsens without treatment

Causes

Trigger finger is caused by inflammation and thickening of the tendon sheath that surrounds the flexor tendons in the finger. This creates a constriction that interferes with normal tendon movement.

Anatomical Background

Understanding normal finger anatomy helps explain what goes wrong in trigger finger:

• Flexor tendons: Thick cords that connect finger muscles to finger bones
• Tendon sheaths: Tunnels that guide and lubricate tendons
• Pulleys: Ring-like structures that hold tendons close to bones
• A1 pulley: The most common site of constriction in trigger finger
• Synovial fluid: Lubricant that allows smooth tendon gliding

Primary Pathophysiology

Inflammatory Process

• Initial inflammation: Tendon sheath becomes inflamed and swollen
• Thickening: Chronic inflammation leads to sheath thickening
• Narrowing: Thickened sheath creates a constriction
• Nodule formation: Tendon may develop thickening or nodules
• Mechanical friction: Increased friction worsens inflammation

Tendon Changes

• Tendon thickening: Chronic irritation causes tendon swelling
• Fibrosis: Scar tissue formation within tendon
• Nodular changes: Development of nodules on tendon surface
• Loss of elasticity: Tendon becomes less flexible

Contributing Factors

Mechanical Causes

• Repetitive gripping: Repeated forceful gripping activities
• Prolonged grasping: Sustained grip positions
• Repetitive finger flexion: Frequent bending and straightening
• Tool use: Regular use of tools requiring grip strength
• Musical instruments: Playing instruments requiring repetitive finger motion
• Sports activities: Gripping sports equipment

Occupational Causes

• Manual labor: Jobs requiring repetitive hand use
• Manufacturing work: Assembly line or production work
• Healthcare workers: Repetitive hand movements during patient care
• Office workers: Extensive computer use and typing
• Musicians: Professional or amateur instrument playing
• Farmers: Agricultural activities requiring grip strength

Medical Conditions

Diabetes Mellitus

• Strong association: 10-20% of diabetics develop trigger finger
• Multiple finger involvement: More likely to affect several fingers
• Poorer outcomes: May respond less well to conservative treatment
• Metabolic effects: High blood sugar affects tendon health
• Advanced glycation: Sugar molecules bind to tendon proteins

Rheumatoid Arthritis

• Inflammatory arthritis: Systemic inflammation affects tendons
• Synovial inflammation: Joint lining inflammation spreads to tendons
• Multiple joint involvement: Often affects several fingers
• Immune-mediated: Autoimmune attack on synovial tissue

Other Inflammatory Conditions

• Gout: Crystal deposits can affect tendon sheaths
• Psoriatic arthritis: Inflammatory arthritis with skin involvement
• Lupus: Systemic autoimmune condition
• Scleroderma: Connective tissue disorder

Hormonal Factors

Gender Differences

• Female predominance: Women 4-6 times more likely to be affected
• Hormonal influences: Estrogen may affect tendon health
• Pregnancy: Increased risk during and after pregnancy
• Menopause: Hormone changes may increase risk

Thyroid Disorders

• Hypothyroidism: Low thyroid hormone increases risk
• Metabolic effects: Affects protein synthesis and repair
• Tissue changes: Can cause tissue thickening and swelling

Age-Related Changes

• Tendon degeneration: Natural aging affects tendon quality
• Reduced elasticity: Tendons become stiffer with age
• Decreased healing capacity: Slower recovery from minor injuries
• Cumulative wear: Years of use lead to wear and tear
• Peak incidence: Most common in 40-60 age group

Genetic Factors

• Family history: Some families have higher rates
• Connective tissue genetics: Inherited differences in tendon structure
• Inflammatory response: Genetic variations in immune response
• Predisposition: Some people more susceptible to tendon problems

Trauma and Injury

Acute Trauma

• Direct injury: Trauma to palm or finger base
• Crush injuries: Damage to tendon sheath
• Lacerations: Cuts affecting tendon or sheath
• Fractures: Hand or finger fractures

Microtrauma

• Repetitive stress: Small, repeated injuries accumulate
• Overuse: Excessive use without adequate rest
• Poor technique: Improper body mechanics during activities
• Inadequate warm-up: Not preparing tendons for activity

Environmental Factors

• Cold exposure: Cold weather may increase stiffness
• Vibration: Exposure to hand-arm vibration
• Tool design: Poorly designed tools increase stress
• Work environment: Ergonomic factors in workplace

Other Contributing Factors

• Carpal tunnel syndrome: May occur together with trigger finger
• De Quervain's tenosynovitis: Other forms of tendon inflammation
• Dupuytren's contracture: Hand condition affecting connective tissue
• Previous hand surgery: Scarring from prior procedures
• Infections: Previous tendon sheath infections

Idiopathic Cases

In many cases, no clear cause can be identified:

• Unknown trigger: No obvious precipitating factor
• Multifactorial: Likely combination of factors
• Individual susceptibility: Personal risk factors
• Subclinical factors: Unrecognized contributing elements

Risk Factors

Several factors increase the likelihood of developing trigger finger. Understanding these risk factors can help with prevention and early identification:

Demographic Risk Factors

Age

• Peak incidence: Most common between ages 40-60
• Increased risk with age: Risk continues to rise after 40
• Rare in children: Uncommon before age 20
• Elderly risk: Continues to be common in older adults

Gender

• Female predominance: Women 4-6 times more likely to be affected
• Hormonal factors: Estrogen may influence tendon health
• Pregnancy-related risk: Increased risk during and after pregnancy
• Menopause: Hormonal changes may increase susceptibility

Medical Conditions

Diabetes Mellitus

• Highest risk factor: 10-20% of diabetics develop trigger finger
• Type 1 and Type 2: Both types increase risk
• Duration-dependent: Risk increases with longer diabetes duration
• Poor control: Higher blood sugar levels increase risk
• Multiple finger involvement: More likely to affect several fingers

Rheumatoid Arthritis

• Inflammatory arthritis: 15-20% of RA patients affected
• Systemic inflammation: Affects tendon sheaths throughout body
• Multiple joints: Often involves several fingers
• Bilateral involvement: Commonly affects both hands

Thyroid Disorders

• Hypothyroidism: Significantly increases risk
• Hyperthyroidism: May also increase risk
• Metabolic effects: Affects protein synthesis and tissue repair
• Treatment response: May improve with thyroid hormone optimization

Other Medical Conditions

• Gout: Crystal deposits can affect tendon sheaths
• Amyloidosis: Protein deposits in tissues
• Carpal tunnel syndrome: Often occurs together
• De Quervain's tenosynovitis: Other tendon inflammation
• Dupuytren's contracture: Connective tissue disorder

Occupational Risk Factors

High-Risk Occupations

• Manual laborers: Construction workers, mechanics
• Manufacturing workers: Assembly line, production work
• Healthcare workers: Nurses, therapists, surgeons
• Musicians: Professional and amateur players
• Office workers: Extensive computer use
• Farmers: Agricultural activities
• Cooks and chefs: Repetitive cutting and gripping

Specific Work Activities

• Repetitive gripping: Tools, equipment, or objects
• Prolonged grasping: Sustained grip positions
• Forceful pinching: Precision grip activities
• Repetitive finger flexion: Frequent bending movements
• Vibrating tools: Power tools that vibrate
• Heavy lifting: Activities requiring strong grip

Lifestyle and Activity Risk Factors

Sports and Hobbies

• Golf: Gripping clubs and repetitive swinging
• Rock climbing: Sustained gripping positions
• Tennis: Racquet gripping and repetitive motion
• Weight lifting: Gripping weights and bars
• Knitting/crocheting: Repetitive finger movements
• Gardening: Tool use and repetitive motions
• Playing instruments: Guitar, piano, violin, etc.

Daily Activities

• Excessive smartphone use: Repetitive scrolling and gripping
• Computer gaming: Prolonged controller or mouse use
• Craft activities: Sewing, woodworking, pottery
• Home maintenance: DIY projects and repairs

Anatomical Risk Factors

• Hand size: Smaller hands may be at higher risk
• Finger length: Certain finger proportions
• Tendon anatomy: Anatomical variations in tendon structure
• Joint laxity: Hypermobile joints may increase risk

Previous Injuries

• Hand trauma: Previous injuries to hand or fingers
• Tendon injuries: Prior tendon lacerations or ruptures
• Fractures: Hand, wrist, or finger fractures
• Surgery: Previous hand or wrist surgery
• Infections: Prior tendon sheath infections

Medications and Treatments

• Statins: Cholesterol-lowering medications may increase risk
• Aromatase inhibitors: Breast cancer treatments
• Fluoroquinolone antibiotics: May affect tendon health
• Corticosteroids: Long-term use may increase risk

Environmental Factors

• Cold exposure: Working in cold environments
• Vibration exposure: Hand-arm vibration syndrome
• Ergonomic factors: Poor workplace ergonomics
• Tool design: Poorly designed tools or equipment

Genetic and Family History

• Family history: Some families have higher rates
• Connective tissue disorders: Inherited conditions affecting tendons
• Genetic variations: Differences in collagen or inflammatory responses
• Ethnic factors: Some populations may have higher risk

Protective Factors

Some factors may reduce risk:

• Regular exercise: Maintaining hand and finger flexibility
• Proper ergonomics: Good workplace and activity setup
• Adequate rest: Allowing recovery time between activities
• Proper technique: Using correct body mechanics
• Equipment modification: Using ergonomic tools and equipment
• Gradual activity increase: Slowly building up activity intensity

Risk Factor Interactions

• Multiple factors: Having several risk factors increases overall risk
• Synergistic effects: Some combinations particularly problematic
• Diabetes plus repetitive use: Particularly high risk combination
• Age plus gender: Older women at highest risk
• Medical conditions plus occupational factors: Compounding risk

Modifiable vs. Non-Modifiable Risk Factors

Non-Modifiable

• Age and gender
• Genetic factors
• Some medical conditions
• Previous injuries

Modifiable

• Activity patterns
• Ergonomics
• Blood sugar control (in diabetes)
• Exercise and conditioning
• Work practices

Diagnosis

Trigger finger is primarily diagnosed based on clinical examination and patient history. The diagnosis is usually straightforward, and additional testing is rarely needed unless complications are suspected.

Medical History

Symptom Assessment

• Onset and duration: When symptoms began and how they've progressed
• Symptom character: Description of clicking, catching, or locking
• Pain location: Where pain is felt (finger, palm, wrist)
• Functional impact: How symptoms affect daily activities
• Timing patterns: When symptoms are worse (morning, activity, rest)
• Triggering factors: Activities that worsen or improve symptoms

Medical and Social History

• Underlying conditions: Diabetes, rheumatoid arthritis, thyroid disease
• Previous injuries: Hand, wrist, or finger trauma
• Medications: Current and recent medications
• Occupational history: Work activities and hand use patterns
• Hobbies and sports: Recreational activities involving hands
• Family history: Similar problems in relatives

Physical Examination

Visual Inspection

• Finger position: Resting position and alignment
• Swelling: Localized swelling at finger base or palm
• Deformity: Any visible finger deformities
• Skin changes: Redness, warmth, or other skin changes
• Nodules: Visible bumps or thickening

Palpation

• Tenderness: Pain with pressure over A1 pulley
• Nodule detection: Palpable thickening or nodule
• Tendon movement: Feeling tendon motion during finger flexion
• Swelling assessment: Degree and location of swelling
• Temperature: Local warmth suggesting inflammation

Range of Motion Testing

• Active motion: Patient moves finger independently
• Passive motion: Examiner moves finger
• Triggering assessment: Observing clicking or catching
• Locking episodes: Finger getting stuck during movement
• Joint mobility: Movement of individual finger joints

Functional Testing

• Grip strength: Measuring overall hand strength
• Pinch strength: Testing pinch grip between fingers
• Fine motor skills: Testing dexterity and coordination
• Activity simulation: Reproducing problematic movements

Specific Diagnostic Tests

Trigger Finger Tests

• Active flexion test: Patient bends finger to reproduce symptoms
• Passive extension: Examiner straightens locked finger
• Resisted flexion: Testing against resistance
• Tendon palpation: Feeling tendon movement during finger motion

Provocative Tests

• Repeated motion: Multiple finger flexion/extension cycles
• Sustained grip: Holding grip position to reproduce symptoms
• Morning stiffness assessment: Testing after period of rest

Grading and Classification

Clinical Grading System

• Grade 0: No symptoms
• Grade 1: Pain and tenderness over A1 pulley
• Grade 2: Catching or clicking sensation
• Grade 3: Locking requiring passive correction
• Grade 4: Fixed flexion contracture

Functional Classification

• Mild: Minimal functional impact
• Moderate: Some difficulty with daily activities
• Severe: Significant functional limitation
• Complete: Unable to use finger normally

Imaging Studies

When Imaging May Be Needed

• Atypical presentation: Unusual symptoms or findings
• Multiple finger involvement: Several fingers affected
• Failed treatment: Poor response to initial treatment
• Suspected complications: Concern for other conditions
• Pre-surgical planning: Detailed anatomy assessment

Imaging Options

• Ultrasound:
  • Can visualize tendon and sheath thickening
  • Dynamic imaging shows tendon movement
  • Non-invasive and readily available
  • Can guide injection procedures
• MRI:
  • Detailed soft tissue visualization
  • Can show extent of inflammation
  • Useful for complex cases
  • Expensive and not routinely needed
• X-rays:
  • Usually not helpful for trigger finger
  • May be done to rule out fractures
  • Can show arthritis in finger joints

Laboratory Tests

Blood tests are rarely needed but may be considered if:

• Systemic disease suspected: Rheumatoid arthritis, diabetes
• Multiple finger involvement: Suggesting systemic cause
• Atypical presentation: Unusual symptoms or rapid progression
• Poor treatment response: Failed conservative management

Possible Tests

• Blood glucose/HbA1c: Screen for diabetes
• Rheumatoid factor: Screen for rheumatoid arthritis
• Anti-CCP antibodies: More specific for rheumatoid arthritis
• ESR/CRP: Markers of inflammation
• Thyroid function tests: Screen for thyroid disorders
• Uric acid: Screen for gout

Differential Diagnosis

Conditions that may mimic trigger finger:

Tendon Disorders

• Tendon rupture: Complete tear of flexor tendon
• Tendinitis: Inflammation without triggering
• De Quervain's tenosynovitis: Thumb tendon inflammation
• Flexor tendon sheath infection: Bacterial infection

Joint Disorders

• Arthritis: Joint inflammation and stiffness
• Joint contracture: Fixed joint position
• Ligament injury: Damage to finger ligaments

Nerve Disorders

• Carpal tunnel syndrome: Median nerve compression
• Ulnar nerve compression: Nerve compression at elbow or wrist
• Digital nerve injury: Finger nerve damage

Other Conditions

• Dupuytren's contracture: Palmar fascia thickening
• Ganglion cyst: Fluid-filled cyst
• Tumor: Benign or malignant masses
• Infection: Abscess or cellulitis

Documentation and Assessment

• Symptom severity: Using standardized scales
• Functional impact: Activities affected
• Work limitations: Impact on job performance
• Quality of life: Overall impact on daily living
• Patient goals: Treatment expectations and priorities

Treatment Options

Treatment for trigger finger depends on the severity of symptoms and how long the condition has been present. Options range from conservative management to surgical intervention, with most people responding well to non-surgical treatments when started early.

Conservative Treatment

Rest and Activity Modification

• Activity avoidance: Temporarily avoid activities that worsen symptoms
• Ergonomic modifications: Adjust tools, workspace, and techniques
• Frequent breaks: Take regular rest periods during repetitive activities
• Grip modification: Use lighter grip strength when possible
• Tool adaptations: Use ergonomic tools with larger, padded grips
• Work modification: Temporary changes to work duties

Splinting

• Night splinting: Most common approach
  • Keeps finger in extended position during sleep
  • Prevents morning stiffness and catching
  • Typically worn for 6-10 weeks
  • Custom or off-the-shelf options available
• Daytime splinting: For severe cases
  • Limits finger flexion during activities
  • May interfere with function
  • Usually reserved for failed night splinting
• Splint design considerations:
  • Should immobilize MCP joint in extension
  • Allow PIP and DIP joint movement when possible
  • Comfortable for long-term wear
  • Easy to apply and remove

Medication

Oral Anti-inflammatory Medications

• NSAIDs (Non-steroidal Anti-inflammatory Drugs):
  • Ibuprofen: 400-600mg three times daily
  • Naproxen: 220-440mg twice daily
  • Diclofenac: 50mg twice daily
  • Take with food to reduce stomach irritation
  • Course typically 2-4 weeks
• Benefits: Reduce inflammation and pain
• Limitations: Modest benefit, potential side effects
• Precautions: Monitor for GI upset, kidney function

Topical Medications

• Topical NSAIDs: Diclofenac gel applied 2-4 times daily
• Advantages: Lower systemic side effects
• Application: Apply to palm and finger base
• Duration: Can be used for several weeks

Corticosteroid Injections

Procedure Details

• Location: Injection into tendon sheath at A1 pulley
• Medications used:
  • Triamcinolone acetonide (most common)
  • Methylprednisolone
  • Betamethasone
• Technique:
  • Local anesthesia (lidocaine) often mixed
  • 25-27 gauge needle
  • Injection at distal palmar crease
  • Ultrasound guidance sometimes used
• Volume: Typically 0.5-1.0 mL total volume

Success Rates

• First injection: 60-90% success rate
• Complete resolution: 40-60% never recur
• Temporary improvement: Additional 20-30% get temporary relief
• Multiple injections: Success rate decreases with repeated injections
• Long-term outcomes: Many people remain symptom-free

Patient Selection

• Best candidates:
  • Grade 1-2 trigger finger (no locking)
  • Symptoms present less than 6 months
  • No diabetes or well-controlled diabetes
  • Single finger involvement
• Limited effectiveness:
  • Grade 3-4 trigger finger (with locking)
  • Multiple finger involvement
  • Poorly controlled diabetes
  • Chronic symptoms (>1 year)

Risks and Side Effects

• Common side effects:
  • Temporary pain at injection site
  • Skin color changes (lightening)
  • Fat atrophy at injection site
  • Temporary blood sugar elevation (diabetics)
• Rare complications:
  • Tendon rupture (<1%)
  • Infection (<1%)
  • Nerve injury (very rare)
  • Allergic reaction (very rare)

Physical Therapy

Therapeutic Exercises

• Tendon gliding exercises:
  • Promote smooth tendon movement
  • Performed multiple times daily
  • Progressive finger positions
  • Gentle, controlled movements
• Stretching exercises:
  • Finger and wrist stretches
  • Hold stretches 15-30 seconds
  • Perform several times daily
  • Focus on maintaining flexibility
• Strengthening exercises:
  • Grip strengthening (when appropriate)
  • Finger strengthening exercises
  • Progressive resistance training
  • Functional strengthening activities

Manual Therapy

• Soft tissue mobilization: Massage and manual pressure
• Joint mobilization: Gentle joint movement techniques
• Tendon mobilization: Specific tendon movement techniques
• Scar tissue management: If post-surgical

Modalities

• Heat therapy: Warm soaks, paraffin baths
• Cold therapy: Ice for acute inflammation
• Ultrasound: Deep heating to promote healing
• Electrical stimulation: May help with pain and healing

Surgical Treatment

Indications for Surgery

• Failed conservative treatment: No improvement after 6 months
• Severe symptoms: Grade 3-4 trigger finger with locking
• Failed injections: No response to 2-3 steroid injections
• Functional limitation: Significant impact on daily activities
• Patient preference: Desire for definitive treatment
• Multiple fingers: Several fingers affected

A1 Pulley Release

The standard surgical procedure:

• Open release:
  • Small incision in palm
  • Direct visualization of A1 pulley
  • Complete division of A1 pulley
  • Ensure smooth tendon gliding
  • Local anesthesia often sufficient
• Percutaneous release:
  • Small needle used to cut pulley
  • No open incision required
  • Ultrasound guidance may be used
  • Faster recovery
  • Slightly higher recurrence rate

Surgical Outcomes

• Success rate: 95-100% resolution of triggering
• Pain relief: Excellent pain relief in most cases
• Function restoration: Normal finger function typically restored
• Recurrence: Very rare (<2%)
• Complications: Low overall complication rate

Surgical Complications

• Common minor complications:
  • Wound tenderness (temporary)
  • Swelling and stiffness
  • Scar sensitivity
• Rare complications:
  • Infection (<1%)
  • Nerve injury (<1%)
  • Tendon injury (very rare)
  • Persistent symptoms (rare)
  • Bowstringing (tendon moves away from bone)

Postoperative Care

Immediate Post-Surgery (0-2 weeks)

• Wound care: Keep incision clean and dry
• Pain management: Over-the-counter pain medications
• Early motion: Gentle finger movement encouraged
• Activity restrictions: Avoid heavy gripping or lifting
• Follow-up: Wound check at 1-2 weeks

Recovery Phase (2-6 weeks)

• Progressive activity: Gradually increase hand use
• Therapy: Physical therapy if needed
• Scar management: Massage and mobility exercises
• Return to activities: Gradual return to normal activities

Full Recovery (6-12 weeks)

• Full activity: Return to all normal activities
• Strength recovery: Complete strength typically returns
• Final outcome: Assess final result

Treatment Selection Algorithm

First-Line Treatment

• Mild symptoms (Grade 1-2): Splinting + NSAIDs
• Activity modification and ergonomics
• Patient education

Second-Line Treatment

• Steroid injection if conservative treatment fails
• Physical therapy for persistent symptoms

Third-Line Treatment

• Surgery for failed conservative treatment
• Consider surgery earlier for severe locking (Grade 3-4)

Special Considerations

Diabetic Patients

• Multiple finger involvement: More common
• Poorer injection response: Lower success rates
• Surgery consideration: May need earlier surgical intervention
• Blood sugar monitoring: After steroid injections

Pediatric Trigger Finger

• Different pathology: Usually congenital trigger thumb
• Observation first: May resolve spontaneously
• Surgery timing: Usually after age 1-2 years
• Excellent outcomes: Surgery very successful in children