Trigger finger and thumb

This page was last reviewed 13-08-20

A swelling of the flexor tendon of the involved finger leads to finger triggering. When the finger is flexed, the swelling easily passes proximally but during extension, it is unable to pass through the proximal end of the A1 pulley of the tendon sheath, which is located at the distal palmar crease. Consequently the finger is stuck in flexion but will often suddenly release with a clicking sensation and associated discomfort.

What we will see

Diagnostic difficulties
Symptoms not settling within a few weeks

Specific tests

Clinical examination of joint – palpation (tenderness in palm at level of metacarpal head), range of movement, observed triggering

Trial of therapy pre-referral

If trained, the GP may wish to give up to 2 Local anaesthetic/steroid injections into the flexor tendon sheath

Whom to direct referral to

Trigger finger clinic
- Run by Allied Health Professional under supervision of consultant hand surgeon

First line treatment is often by injection of steroid into the sheath but avoiding injection into the tendon itself. The GP can undertake this if happy to do so. This can be performed in clinic and often takes effect within one week. If symptoms recur the steroid injection can be repeated once or twice. Failure to respond or multiple recurrences are indications for surgical release of the A1 pulley. This can be performed as an outpatient local anaesthetic procedure through a small incision at the distal palmar crease and affords rapid recovery and relief of symptoms with a low recurrence rate.

Trigger digits in children is a completely different entity. They should be managed by a paediatric hand specialist. Trigger thumbs are very common and while trigger thumbs may resolve spontaneously (before the age of 2), there is a significant proportion that will not and would require treatment later on. Trigger fingers in children are very uncommon and would need to be assessed by an expert hand specialist