Trigger Finger (Stenosing Tenosynovitis)

Stenosing tenosynovitis disrupts the normal gliding of the finger tendon and gradually makes the usual hand movements more difficult. At first, a person feels stiffness, then a painful clicking appears, and at later stages the finger becomes fixed in a bent position. 

Today, we will look at the mechanism of development of this problem, its typical causes, main symptoms, principles of diagnosis, and approaches to treatment. After reading this article, you will learn when observation and conservative management are sufficient and when doctors consider surgery.

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What Stenosing Tenosynovitis Is and Why Finger “Clicking” Occurs

In international sources, this condition is usually described as trigger finger or stenosing tenosynovitis. Its essence is that the flexor tendon passes through a narrowed part of the tendon canal in the area of the A1 annular ligament (A1 pulley), so movement becomes uneven and painful.

Clicking occurs when a thickened portion of the tendon or its nodule passes through a tight canal with a mechanical obstruction. During its clinical evaluation, attention is paid to locking, tenderness near the base of the finger, and the nature of the movement limitation.

The problem is localized in the area of the tendon and its sheath, not in the articular cartilage or ligaments. That is why the pain intensifies during movement, especially during flexion and subsequent extension.

Causes of Trigger Finger Development

In modern clinical practice, repetitive forceful hand movements, accompanying systemic diseases, older age, and small repetitive tendon injuries are identified as the main risk factors.

Excessive Strain on the Hand

The risk is increased by actions that require a strong or prolonged grip. These include:

• working with tools;
• frequent squeezing of objects;
• repetitive finger movements;
• loads in which the hand repeatedly shifts from a firm grip to relaxation.

Under such conditions, the tendon rubs against the narrowed part of the canal. This maintains irritation, local inflammation, and further tissue thickening, which causes the condition to progress more quickly.

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Associated Diseases

Most often, doctors name diabetes mellitus and rheumatoid arthritis as risk factors. In patients with such chronic diseases, the problem occurs more often, and the response to injection and other conservative treatment may be weaker than in people without accompanying conditions.

If there is already a systemic inflammatory disease in the medical history, the doctor assesses not only the finger itself, but also the overall condition of the hand. This is necessary in order not to miss other sources of pain and stiffness that produce a similar clinical picture.

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Age-Related Changes and Tendon Microtrauma

The condition is more often recorded in older people, especially after the age of forty. Microtrauma that accumulates gradually and does not always have one clear episode of injury in the medical history also plays a separate role.

Because of repeated overload, the tendon sheath becomes irritated, and the tendon itself glides worse. Over time, this progresses from early discomfort to stable mechanical locking of movement.

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Main Symptoms and Stages of the Disease

The clinical picture usually develops gradually. At first, a person feels discomfort during the first movements, and then pain, clicking, and difficulty with full extension are added.

Early Manifestations

At the initial stage, complaints are not always severe. More often, morning stiffness, tenderness in the palm near the base of the affected finger, and a feeling that the movement is not entirely free appear.

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Early signs:

• stiffness after sleep or prolonged rest;
• pain on the palmar surface near the base of the finger;
• a feeling of obstruction during movement;
• local tenderness when pressed.

Such symptoms do not always interfere with everyday activities yet, but it is precisely at this stage that the patient notices the change in the usual movements of the hand most clearly.

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Progression: Pain, Clicking, Finger Locking

Later, the symptoms become more pronounced. Painful clicking appears during movement, and the finger may suddenly remain in a bent position and straighten only after additional effort with the other hand.

In more advanced stages, the locking is no longer episodic. In severe cases described by the AAOS, the finger may not straighten at all without the intervention of a medical specialist.

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Which Doctor Treats It and When to Seek Help

At first, patients consult a family doctor, who evaluates the symptoms and chooses the tactics for further action. If the problem does not go away, interferes with everyday activities, or progresses, the patient is usually examined by an orthopedic traumatologist, surgeon, or hand specialist.

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It is worth making an appointment with a doctor sooner if:

• the trigger finger locks regularly and has to be straightened with the other hand;
• the pain intensifies and interferes with gripping, writing, or fine everyday movements;
• the symptoms do not decrease after reducing the load;
• there is accompanying diabetes, rheumatoid arthritis, marked swelling, or rapid deterioration of function.

This approach reduces the risk of persistent contracture, prolonged stiffness, and more difficult recovery after treatment.

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Diagnosis of Stenosing Tenosynovitis

In most cases, diagnosis is limited to an examination. The doctor clarifies the complaints, the duration of symptoms, the type of load on the hand, the presence of diabetes or a rheumatoid process, and then evaluates the actual movement of the finger during the examination.

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Clinical Examination

During the examination, the doctor looks for four basic signs:

1. Tenderness over the tendon canal.
2. Thickening or swelling of the sheath.
3. Active locking during movement.
4. Reduced smoothness of tendon gliding.

It is this set of symptoms that, in most cases, makes it possible to draw a conclusion. The doctor also assesses whether full passive and active extension is preserved. This is important because prolonged fixation of the finger affects the prognosis for mobility and the choice of further tactics.

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Is Ultrasound or Additional Examination Needed

In most cases, X-ray and MRI are not needed. A typical picture is often established already during the conversation and physical examination. 

Ultrasound is used selectively when it is necessary to clarify the condition of the tendon, the sheath, or to exclude other hand pathology. In modern reviews, ultrasound is described as a useful tool for visualizing ligament thickening, a tendon nodule, and the cause of locking during movement.

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Surgical Treatment: When It Is Necessary

Not every patient needs surgery. At first, conservative treatment is usually considered: reducing the provoking load, night splinting, pain relief, exercises for gentle mobilization, and, when indicated, a corticosteroid injection into the area of the tendon canal.

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Indications for Surgery

Surgical treatment is considered when conservative treatment methods do not provide sufficient symptom control. A separate indication is a situation in which the finger is already locked in flexion and does not straighten even after careful assistance with the other hand.

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The main indications for surgery are:

• persistent finger locking;
• pronounced pain and loss of hand function;
• no effect after non-surgical management;
• recurrence after injection treatment;
• increasing stiffness with the risk of permanent limitation of movement.

The essence of the intervention is the release of the ligament and restoration of free tendon gliding. Such an operation is usually performed on an outpatient basis under local anesthesia, through a small incision or using another minimally invasive technique.

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Recovery After the Intervention

After surgery, most patients are advised to begin restoring finger movements early. During the first days, pain, swelling in the palm, and tenderness in the area of the incision persist, while the complete disappearance of stiffness takes several days longer than skin healing.

If rigidity, swelling, or pain lasts longer than expected, the doctor may add physiotherapy. After surgery, it is important to follow recommendations regarding dressings, load, and exercises, because this is what affects the return of hand function.

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Possible Complications and Prevention of Recurrence

Without treatment or in the case of a late visit, the disease may progress to persistent locking and prolonged stiffness of the finger. After surgical intervention, there are also risks, although they are less common: infection, injury to the digital nerve, persistent clicking, scar tenderness, or incomplete restoration of extension.

To prevent recurrence, it is important to reduce repetitive forceful strain on the hand, adjust the work routine in time, and not ignore morning stiffness or repeated episodes of locking. In the presence of diabetes or rheumatoid inflammation, control of the accompanying condition together with the relevant specialist is also additionally important.