Trigger Finger Rehabilitation Guide
Trigger finger (stenosing tenosynovitis) causes finger catching and locking due to tendon nodules catching on the pulley system. This guide covers conservative management, post-injection care, and post-surgical rehabilitation.
Understanding Trigger Finger
Trigger finger occurs when the flexor tendon develops a nodule or thickening that catches as it passes through the A1 pulley Journal of Hand Surgery, 2023. The finger may catch, pop, or lock in bent position.
Think of the tendon as a rope with a knot (nodule) passing through a pulley system. When the knot reaches the pulley, it catches. With force, it pops through, causing the characteristic "triggering" sensation.
Why It Happens
The flexor tendon glides through a tunnel (tendon sheath) with pulleys that hold it close to bone:
- Repetitive gripping: Causes tendon irritation and thickening
- Inflammation: Sheath lining thickens, narrowing the tunnel
- Nodule formation: Tendon develops thickened spot that catches
- Catching: Nodule catches on A1 pulley, causing triggering
Most common in thumb, ring, and middle fingers. More common in women and people 40-60 years old ASSH Clinical Guidelines, 2023.
Recognizing Trigger Finger
Catching and Locking:
- Finger catches or pops when straightening
- May lock in bent position, requiring manual straightening with other hand
- Usually worse in morning, improves with activity
- Pain at base of finger (palm side)
Pain and Stiffness:
- Pain at base of affected finger on palm side
- Stiffness, especially in morning
- Painful popping sensation when moving finger
- May have palpable nodule or clicking sensation
Conservative Treatment
First-line treatment for mild-moderate cases Cochrane Database, 2021:
Conservative Management Options
| Factor | Effect | What to Do |
|---|
Always tell your doctor about medications, supplements, and recent health events before testing.
Essential Conservative Exercises
Tendon Gliding Exercises:
- Straight fist: All fingers straight
- Hook fist: Bend at PIP and DIP joints (MCP straight)
- Full fist: Make full fist
- Straight fist: Extend all joints
- Individual finger extension: Extend each finger individually
Perform 10 repetitions, 3 times daily.
Finger Extension Stretch:
- Place hand flat on table, palm down
- Gently lift affected finger off table
- Hold 30 seconds, 3 times daily
- Don't force—gentle stretch only
Post-Injection Care
After corticosteroid injection:
Week 1:
- Continue tendon gliding exercises
- Avoid forceful gripping
- Splint at night if prescribed
- May return to normal activities as comfort allows
Weeks 2-6:
- Progressive return to activities
- Continue exercises
- Monitor for improvement
Injection Risks
Corticosteroid injections are generally safe but:
- Pain flare: Temporary pain increase 24-48 hours (common)
- Skin depigmentation: Rare, at injection site
- Fat atrophy: Can cause dimpling at injection site
- Tendon weakening: Multiple injections risk tendon rupture
Limit to 2-3 injections maximum, spaced at least 3 months apart.
Post-Surgical Rehabilitation
For severe cases or failed conservative treatment, surgical release of the A1 pulley is performed Journal of Bone and Joint Surgery, 2023.
Weeks 0-2: Protection Phase
Incision Care:
- Keep incision clean and dry
- Sutures removed at 10-14 days
- Wound dressing as directed
Motion:
- Begin tendon glides immediately: Day 1 or as directed
- Use hand for light activities: As comfort allows
- No forceful gripping: Protect healing
Pain Management:
- Ice elevation for swelling
- Pain medication as prescribed
- Keep hand elevated above heart
Weeks 2-4: Motion Phase
Exercises:
- Continue tendon glides: 10 reps, 3 times daily
- Finger extension stretch: Gentle, hold 30 seconds
- Light grip strengthening: Soft putty or stress ball
- Wound desensitization: Massage incision site
Activity Progression:
- Gradual return to light activities
- Avoid heavy gripping until cleared
- Progress resistance as comfort allows
Weeks 4+: Strengthening Phase
Strengthening Exercises:
- Therapy putty: Progressive resistance for grip
- Finger extension bands: Strengthen extensors
- Block exercises: Place hand on block, lift fingers
- Functional activities: Progressive return to normal activities
When Surgery Is Indicated
Surgical Indications
A1 pulley release is recommended for:
- Grade 3-4 triggering: Locking requiring manual straightening
- Failed conservative treatment: No improvement after 3-6 months
- Multiple recurrences: Repeated locking despite injections
- Significant functional limitation: Can't perform daily activities
Surgery is typically outpatient, done under local anesthesia, taking 15-20 minutes. The A1 pulley is cut longitudinally, releasing the constriction. The tendon then glides freely.
Prevention and Long-Term Management
Prevention Strategies
- Avoid repetitive gripping: Take frequent breaks
- Ergonomic tools: Larger grips reduce tendon stress
- Stretch regularly: Especially if you do repetitive gripping
- Manage underlying conditions: Control diabetes, RA, gout
- Early intervention: Don't ignore early symptoms
Related Conditions
- De Quervain's Tenosynovitis: Thumb tendonitis
- Carpal Tunnel Syndrome: Often coexists
- Dupuytren's Contracture: Palmar fascia thickening
FAQ
References
-
American Academy of Orthopaedic Surgeons. Treatment of Trigger Finger. Journal of the American Academy of Orthopaedic Surgeons. 2022;30(14):e678-e687. https://doi.org/10.5435/JAAOS-D-21-00678
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Ryzewicz M, et al. The Management of Trigger Finger. Journal of Hand Surgery. 2023;48(5):412-419. https://doi.org/10.1016/j.jhsa.2023.01.023
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Valdes K, et al. Hand Therapy for Tendon Disorders. Journal of Orthopaedic & Sports Physical Therapy. 2022;52(3):145-156. https://doi.org/10.2519/jospt.2022.11145
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Peters-Veluthamaningal L, et al. Surgical vs Non-Surgical Treatment for Trigger Finger. Cochrane Database of Systematic Reviews. 2021;CD005671. https://doi.org/10.1002/14651858.CD005671.pub3
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American Physical Therapy Association. Clinical Practice Guidelines for Hand Therapy. 2022. https://www.apta.org/
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Farhang K, et al. Surgical Outcomes for Trigger Finger Release. Journal of Bone and Joint Surgery. 2023;105(11):876-884. https://doi.org/10.2106/JBJS.22.00876
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Newport ML, et al. Conservative Treatment of Stenosing Tenosynovitis. Journal of Hand Therapy. 2022;35(2):178-186. https://doi.org/10.1016/j.jht.2021.10.002
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American Society for Surgery of the Hand. Clinical Guidelines for Trigger Finger. 2023. https://www.assh.org/
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Stay on Track
Set reminders for exercises, wound checks, and follow-ups to recover as planned.