{"id":4486,"date":"2022-05-03T11:47:20","date_gmt":"2022-05-03T10:47:20","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/triggerfinger\/"},"modified":"2026-04-14T14:15:10","modified_gmt":"2026-04-14T13:15:10","slug":"triggerfinger","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/plasticsurgery\/handsurgery\/triggerfinger\/","title":{"rendered":"Trigger finger and thumb"},"content":{"rendered":"\n<p class=\"has-alert-red-color has-text-color\"><strong><strong><strong>This page is currently under review<\/strong><\/strong><\/strong><\/p>\n\n\n\n<title>Trigger finger and thumb<\/title>\n\n\n\n<p>A swelling of the flexor tendon\nof the involved finger leads to finger triggering. When the finger is flexed,\nthe swelling easily passes proximally but during extension, it is unable to\npass through the proximal end of the A1 pulley of the tendon sheath, which is\nlocated at the distal palmar crease. Consequently the finger is stuck in\nflexion but will often suddenly release with a clicking sensation and\nassociated discomfort.<\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h3 class=\"wp-block-heading\">What we will see<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Diagnostic difficulties<\/li>\n\n\n\n<li>Symptoms not settling within a few weeks<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Specific tests<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Clinical examination of joint \u2013 palpation (tenderness in palm at level of metacarpal head), range of movement, observed triggering<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Trial of therapy pre-referral<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>If trained, the GP may wish to give up to 2 Local anaesthetic\/steroid injections into the flexor tendon sheath<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Whom to direct referral to<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Trigger finger clinic\n<ul class=\"wp-block-list\">\n<li>Run by Allied Health Professional under supervision of consultant hand surgeon<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p>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.<\/p>\n\n\n\n<p><em>Trigger digits in children is a completely different entity<\/em>. 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<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/BSSH-CARPAL-TUNNEL-1.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Plastic Surg \u2013 PIL BSSH CARPAL TUNNEL Aug18opens a new window<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/BSSH-GANGLIA.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Plastic Surg \u2013 PIL BSSH GANGLIA Aug18opens a new window<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/BSSH-OA-THUMB.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Plastic Surg \u2013 PIL BSSH OA THUMB Aug18opens a new window<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Plastic-Surg-PIL-BSSH-TRIGGER-FINGERAug18.pdf\" data-type=\"link\" data-id=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Plastic-Surg-PIL-BSSH-TRIGGER-FINGERAug18.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Plastic Surg \u2013 PIL BSSH TRIGGER FINGERAug18<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.nice.org.uk\/\" target=\"_blank\" rel=\"noreferrer noopener\">National Institute for Health and Care Excellence (NICE)opens a new window<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.guidelinesinpractice.co.uk\/home\/the-scottish-intercollegiate-guidelines-network-sign\/305547.article\" target=\"_blank\" rel=\"noreferrer noopener\">Scottish Intercollegiate Guidelines Network (SIGN)opens a new window<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Wrist-Pain-Algorithm-of-Differential-Diagnoses.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Wrist Pain Algorithm of Differential Diagnoses<\/a><\/li>\n<\/ul>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>This page is currently under review Trigger finger and thumb 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<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":3988,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[563],"class_list":["post-4486","page","type-page","status-publish","hentry","category-triggerfinger"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/plasticsurgery\/handsurgery\/triggerfinger\/\" rel=\"tag\">Trigger Finger<\/a>","rttpg_excerpt":"This page is currently under review Trigger finger and thumb 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","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4486","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=4486"}],"version-history":[{"count":7,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4486\/revisions"}],"predecessor-version":[{"id":27633,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4486\/revisions\/27633"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3988"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=4486"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=4486"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}