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Trigger Finger

Checked: 23-03-2021 by Sandi Littler Next Review: 23-03-2022

Overview

Trigger finger is a condition that affects one or more of the hand's tendons, making it difficult to bend or straighten the affected finger or thumb.

If the tendon becomes thickened and inflamed it can "catch" in the tunnel it runs through (the tendon sheath). This can make it difficult to move the affected finger or thumb and can result in a clicking sensation.

Trigger finger is also known as stenosing tenosynovitis or stenosing tenovaginosis. It usually affects the thumb, ring finger or little finger. One or more fingers can be affected, and the problem may develop in both hands. It is more common in the right hand, which may be because most people are right-handed.

Sometimes, trigger finger is an associated condition resulting from an underlying illness that causes inflammation of tissues of the hand, such as rheumatoid arthritis. Some patients with rheumatoid arthritis have inflammation around the tendons of the palm of the hand that could develop into trigger finger.

Dupuytren’s contracture can also increase the risk of developing trigger finger. In Dupuytren's contracture, the connective tissue in the palm of the hand thickens, causing one or more fingers to bend into the palm of the hand.

Other long-term conditions, such as diabetes are also sometimes associated with trigger finger.

Who to Refer

In some people, trigger finger may get better without treatment.

However, if it is not treated, there's a chance the affected finger or thumb could develop a fixed flexion deformity, which will make performing everyday tasks difficult.

Conservative methods of treatment should always be pursued in the first instance either by a General Practitioner (GP), or First Contact Physiotherapist (FCP). Treatment options include:

Rest and medication – avoiding certain activities and taking non-steroidal anti-inflammatory drugs (NSAIDs) may help relieve pain
Splinting the affected finger to a plastic splint to reduce movement
Tendon gliding exercises - see You Tube video
Corticosteroid injections to reduce swelling

If management in primary care is not effective or not available then consider referral to the Musculoskeletal Interface (MSKI) Service .

Referral

Referrals should be made via the Musculoskeletal Interface (MSKI) Service which is usually available via managed referral on most EMIS systems. Referrals will be triaged, assessed and treatment offered where appropriate - including onward referral for surgery where indicated.

Surgery on the affected sheath involves releasing the affected sheath to allow the tendon to move freely again. It is usually used when other treatment options have failed.

Referrals to secondary care (also via MSKI) for surgical intervention for trigger finger will only be funded by the ICB where the criteria within the Surgical Correction for Trigger Finger in Adults Criteria Based Access Policy have been met.

Resources

NHS website - Trigger Finger

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

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