Physioseye

Trigger finger is a condition that is characterised by uneven or ‘catching’ or ‘snapping’ sensations that occur during bending and straightening of the finger. This can occur in any of the fingers and even the thumb, where it is termed ‘trigger thumb’. In the academic literature, the condition is often referred to as ‘trigger digit’ which is an incorporation of trigger finger and trigger thumb. The most common fingers to be affected are the middle and ring fingers. The standard medical name for trigger finger is ‘stenosing tenosynovitis’ or sometimes ‘stenosing tendinopathy’.

The term stenosing tenosynovitis has 4 elements within it: The word ‘stenosing‘ in ‘medical-speak’ means narrowing. In this case, the narrowing relates to a fibrous tunnel that the tendon has to pass through when the fingers are bent or straightened. This tunnel is there to keep the tendon close to the bones of the hand to keep it ‘tracking’ correctly. The tunnel is called the A1 pulley.

The prefix ‘teno‘ means that the condition relates to tendons and ‘synov‘ means that it also involves the sheath that covers the tendon. This sheath is called the ‘synovial sheath‘ which is responsible, in part, for lubrication of the tendon so that it has a ‘friction-free’ passage through or past any structures that it is next to. The synovial sheath is also reinforced by a fibrous covering that protects it from impact and shearing forces, both internally and externally. The suffix ‘itis‘ means that the condition is inflammatory in nature.

Therefore, stenosing tenosynovitis means: narrowing (stenosing) with, or caused by, inflammation (itis) of the covering (synovial sheath) of the tendon (teno).

More recent descriptions of trigger finger have used the term: stenosing tendinopathy. This simply means that there there is narrowing (stenosing) because there is something pathologically (pathy) wrong with the tendon (tendin). The reason for this less specific ‘medical-speak’ is because in recent years there has been some debate about whether or not trigger finger is inflammatory in nature.

Histological studies (studies looking at the condition at a cellular level) have shown that in many cases, there are no inflammatory cells present. Consequently, the presumption has been that the nodule that forms in the tendon could be fibrotic in nature and not inflammatory. As such, there can be no certainty about what actual is going on with the cells and so the use of the suffix ‘itis’ is misleading.

This lack of certainty about the inflammatory nature of the condition brings into question the use of powerful anti-inflammatory agents, such as cortico-steroids, for the condition and/or could explain the relatively low levels of success of the treatment at around 60%.

It is estimated that between 2-3% of the population will get trigger finger over their lifetime.

In the general population, women are 4 times more likely to get trigger finger compared to men. Although it can occur at any age, it does seem to be prevalent in people in their 4th and 5th decades (50’s and 60’s). It is believed to be associated with people who use manual tools, although the evidence for this is weak. There is also a suggestion that trigger finger is more likely to occur in those engaging in rapid and frequent finger movement.

There are certain conditions that are also associated with trigger finger. Some of these conditions, such as diabetes, could be linked to a group of what are called ‘metabolic’ disorders which collectively can culminate in metabolic syndrome. It is estimated that those with diabetes have a 10% lifetime prevalence of trigger finger (digit).

There are other conditions that are more prone to acquiring trigger finger. These are: rheumatoid arthritis; gout; amyloidosis; carpal tunnel syndrome; hypothyroidism; dupuyten’s contracture; De quervain’s disease; and mucopolysaccharidosis. As all of these conditions have their own pathologies, it is important that these are taken into consideration with medical opinion before engaging with treatments for trigger finger.

More information can be found about these conditions in the website by clicking the button below:

Yes, it has a wide level of severity with a spectrum ranging from barely noticeable, through a bit annoying to seriously aggravating through severely disabling.

There are methods by which trigger finger can be graded. These are simple, well established scales that are used in clinical practice. They are called: the ‘Quinnell’ scale first published in 1980 and the ‘Stages of Stenosing Tenosynovitis scale’ published in 1992 by Patel and Basini. Both are similar and attribute grades to the various levels of movement restriction seen in trigger finger.

However, they do not give the full level of ‘severity’ of the condition as the extent to which trigger finger is severe is also a function of the amount of pain experienced and the text to which function is impaired.

For more information on the severity and measurement of trigger finger, click the link below:

The actual cause of trigger finger is unknown. It is one of many conditions that is referred to as ‘idiopathic’ which essentially means of ‘unknown’ origin.’ However, the mechanism by which the signs and symptoms of trigger finger are generated is well understood.

The mechanism is essentially that a nodule forms on tendons of the hand at the point where they pass through a narrow tunnel designed to maintain the correct ‘tracking’ of the tendons (the A1 pulley). When the nodule in the tendon grows to such an extend that it is wider than the opening of the tunnel, it begins to ‘catch’ thus producing the characteristic uneven movement seen in trigger finger. This is essentially the mechanism but the unanswered question is why does the nodule form in the first place?

If you would like to see a video on the mechanism and treatment of trigger finger, click on the link below:

Yes, there are many supposed ‘natural’ remedies for trigger finger. They range from the sublime to the ridiculous and, although some have been tested clinically, none has been adequately assessed using robust scientific methods. This fact has moved certain authoritative bodies to deem that these approaches are not worth pursuing.

Instead, it is recommended that first line treatment should be two steroid injections, and should this fail, followed by surgery. It might come as no surprise that these declarations come from a group of hand surgeons. You may therefore not be surprised that they don’t recommend a diet of turmeric and wearing copper-tipped gloves! Naturally they have concluded that the most useful interventions are theirs.

However, if we are taking a scientific approach to this, by looking at the best available evidence, which we should, then we will see that they are correct: the scientific evidence shows that what they say is true. That said, there could be a reason for this: the reality is, that evidence involves expensive trials and funding tends only to be available for ‘medical’ rather than ‘alternative’ approaches. If there is a mismatch between the funding for these different approaches, then there is likely to be a commensurate difference in the type of studies carried out.

So, from a scientific point of view, there are no ‘proven’ natural treatments for trigger finger. Of course, anecdotally, there are many and there is no doubt that some people will attribute improvement to these various remedies. The problem is that the natural history (what happens if you do nothing in particular) of trigger finger is that around 30% of cases resolve spontaneously within 2 years. So, if you happen to be one of those people who acquires trigger finger and then tries a ‘natural’ remedy, let’s say turmeric, as this appears to be the current wonder ingredient for just about everything, and your trigger finger spontaneously resolves then you are going to attribute it to turmeric.

The only way that we can safely attribute turmeric is by doing a randomised controlled trial which would be very expensive. No ‘big pharma’ company will fund it as, well, what’s in it for them? Only a reduction in sales of their cortisone drugs. Are surgical societies going to fund it? Unlikely, because if it works that means fewer operations and less income.

When we think of standard ‘natural’ treatments, we think of: rest; finger splinting; massage; exercise; heat; and any combination thereof. However, the problem with all of these relates to: what combination and what is treated? For example, take massage: what do we massage? How hard? For how long? How frequently? Over how many week or months? You see, you can ask these questions for each of these ‘natural’ interventions. In the end, it leads only to uncertainty and confusion and who would want to fund a research study with that as a basic starting point?

The other problem with ‘natural’ treatments is that most require application for long periods of time with, at the end of this, only a moderate chance of success. Most people want a fast acting intervention with better than a moderate chance of success.

Only one approach has been demonstrated to be effective over a short period and that is the ManTTr Protocol that was published in the Journal of Bodywork and Movement Therapies in January 2025 where a series of massage techniques are used to bring about a visible change in trigger finger within a single treatment session. Although this shows promise, no well designed, fully powered trials have been undertaken to test it.

If you would like to access the full reference to this article on the ManTTr Protocol, please click the link below (see article 18 in the list):

The best way to record progress (or otherwise) is using a daily diary. This is not unique to trigger finger as diaries are used to ‘track’ progress (and regression) of a number of chronic problems. By ‘chronic problems’ it is generally meant that the problem has persisted for 3 months or more. As it is not uncommon for trigger finger to grind on for years and years, it is most definitely classed as a chronic condition.

Chronic conditions such as asthma and migraine headaches are commonly ‘monitored’ using patient diaries and they have been demonstrated to have beneficial effects. In trigger finger, this is for a number of reasons: Firstly, a diary provides us with a baseline-state of the key factors associated with trigger finger. Typically these are: movement quality, pain, sleep and function. By measuring the state of each of these at a particular point in time, it tells us how troublesome the condition is in relation to these factors now. Secondly, we can monitor fluctuations over time and thirdly, graphically plot how each factors might change in relation to each other as various interventions are performed. Fourthly, as the data increases, we may be able to see tends over time.

Diaries can take many forms. You can look on-line to find pre-made templates or you can make your own. If you are interested in seeing how I recommend constructing and completing a diary, take a look at the video below:

Certainly there is plenty of advice on the internet that recommends this course of action. There also many anecdotes of people giving an account of their experience of doing this and it resulting in resolution. However, in my experience (and the experience of others) this course of action can result in causing increased pain. This is because there is an element within trigger finger that can be inflammatory. If something is inflamed, it is broadly agreed that the best course of action is not to aggravate it and even rest it or undertake a process of ‘active rest’.

The best explanation for those who claim that massaging the palm does work probably relates to the relative severity of the trigger finger, in that most cases where this ‘works’ are mild. Mild cases can resolve spontaneously in 30% of cases whereas more severe cases tend to worsen over time. It is likely, therefore, that those claiming success from massaging the palm have mistakenly attributed resolution to this intervention.

Finally, although this is a commonly suggested intervention, and one that could be considered intuitively reasonable, there is no credible scientific evidence for its effectiveness.

Under some circumstances it may and in other circumstances it may not.

This is because current thinking relating to the pathology of trigger finger is rather blurred. Historically, trigger finger was viewed as an inflammatory condition but histological studies have identified that few if any inflammatory cells are present in the nodule (in the tendons) that causes the triggering. However, inflammatory cells have been observed in the ‘synovial sheath’ that covers the tendons in which the nodule forms.

If there is an inflammatory component to the condition, it would make sense that a period of rest would be beneficial. However, we need to be clear about what we mean by rest.

If rest means avoiding the use of the hand completely and instead using the unaffected hand only, then my personal view is that no, this is not recommended. If, however, ‘rest’ means putting the finger into a well fitting, removable splint for extended periods, then I would say yes, this would make good sense.

The reason that ‘hand use avoidance’ is not advocated is because it results in the disuse of the whole of the hand, not just the affected finger. In extreme cases this can result in muscle wasting and joint stiffening in the whole of the affected hand.

However, the use of finger splints needs to be carefully controlled. Firstly, the finger must be taken out of the splint several times a day and allowed to move through it’s full range of motion to prevent stiffening. Don’t forget, that it is likely that there is an inflammatory component to trigger finger and inflammatory processes tend to bind structures together.

As such, keeping the finger in a splint for too long will allow the inflammatory processes to bind structures together which can cause a worsening of the condition. However, this can be mediated by frequent removal of the splint during which the finger is moved through its full range.

Secondly, use of a splint allows for use of the affected hand without aggravating the affected finger. In this way, ‘active rest’ can be achieved. This essentially means that the ‘affected’ part of the body is used, albeit in a limited way, while at the same time avoiding activity and intervention that may cause aggravation.

Care, however, should be exercised when using a splint, particularly during activity, as full capability of the hand cannot be achieved.

In order to answer this question, we need to be clear about what we mean by ‘exercise’.

Exercises come in many forms. For example: we can use resistance as a means of improving strength; or perhaps we could use high levels of repetition to improve endurance; or we could attempt to lengthen the affected structures by stretching. Finally we could, design a series of exercises that mimic everyday activities in order to work towards a functional outcome.

It is clear that for each of these underlined words, they could be suffixed by adding the word exercises: strength exercises; endurance exercises; stretching exercises; and functional exercises.

The question then is would these be suitable for trigger finger? If we consider each in turn, we might get an idea.

There is no doubt that one of the complaints that people with trigger finger make, particularly when pain is an issue, is that they lose strength in their grip. However, this weakness is driven by what is known as ‘pain inhibition’ which is a neurological response to pain designed to discourage the usage of injured body parts. As such, it doesn’t make much sense to do strengthening exercises as these would make no difference to the condition as pain is the driver of the weakness. That said, strength should be tested initially as it can be a useful marker of improvement should the painful symptoms abate.

Endurance exercises are usually those that require rapid movements of muscles during limited exposure to resistance. In fact, one of the actions that is believed to cause trigger finger are occupations that involve rapid and repeated movements of the fingers. If this is truly the case, then doing these activities after trigger finger has developed is unlikely to help.

Stretching exercises might be of benefit under certain circumstances but when performed they should be gentle and not forced. They must always be undertaken under expert guidance.

Functional exercises can be carried out with care. Simple exercises such as empty-handed gripping and finger stretching can be useful. These should be carried out slowly and should cover the full range of motion of the fingers. These movements can be transferred into specific actions such as holding tin cans in readiness to be opened or holding a glass and filling it up with cold water. Attempting to comb hair or lifting cold, empty kettles and pans are also extensions of this activity. This maintains functional abilities of the hand and so minimises the effects of movement avoidance strategies.

This depends on the nature of the problem and the nature of the stretch. They should always be done under expert supervision and instruction. This is because excessive stretching of the fingers can cause ‘shearing’ of scar, or fibrous tissue that may have accumulated around the sheath, nodule or A1 pulley. If excessively sheared, this might damage the tissue and thereby restart or exacerbate the ongoing inflammatory cascade.

In general, yes, it does. However, the application of heat alone is very unlikely to resolve the problem. That said, when your hands are cold, trigger finger tends to become more painful and the actual quality of finger movement worsens.

On a basic level, it is a good idea to wear gloves on cold days and if possible, use a hand warmer. The application of heat has two effects. Firstly, it acts as a subduer of pain and secondly it warms and softens the tissues that come into contact with it.

The best way to use heat with trigger finger is to immerse the hand (and the forearm) into comfortably warm water (not hot water) for ten minutes twice per day. During the emersion, you should fully open and close the hand into a fist repeatedly throughout the 10 minute session.