Trigger finger or trigger thumb happens when a flexor tendon catches as it passes through the tunnel that holds it against the bone. The finger clicks, locks in a bent position, or has to be straightened with the other hand, and it is usually worst first thing in the morning. It is common, it is not dangerous, and in many cases it settles with a corticosteroid injection. Where it keeps coming back, a short operation releases the tunnel. It takes about 20 minutes as a day procedure, the dressing comes off on day 3 or 4, and most people notice the triggering has gone immediately.
What is trigger finger?
The tendons that bend your fingers run along the palm side of each finger inside a sheath, held close to the bone by a series of fibrous tunnels called pulleys. The pulleys stop the tendon bowstringing away from the bone when you make a fist. The first of them, the A1 pulley, sits at the base of the finger in the palm.
In trigger finger the tendon or its lining thickens where it passes under the A1 pulley. A thickened tendon and a fixed tunnel are a poor combination. The tendon has to squeeze through, which it does with a click, and in more advanced cases it goes through in one direction and then catches on the way back, leaving the finger locked.
Any finger can be affected and so can the thumb, where it is called trigger thumb. The ring finger and thumb are the most common. More than one finger is often involved, sometimes in both hands.
VIEW A VIDEO OF OUR TRIGGER FINGER CONSULT
Dr Paul van Minnen
Dr Nicholas Smith
Symptoms
Most people describe:
- Clicking, snapping or catching as the finger bends or straightens
- A finger that locks in a bent position and has to be straightened with the other hand
- Symptoms that are worst first thing in the morning and loosen through the day
- A tender lump in the palm at the base of the finger, which moves as the finger moves
- Pain in the palm, and sometimes pain felt in the middle joint of the finger rather than where the problem actually is
- In longstanding cases, a finger that will no longer fully straighten at all
The lump in the palm is the thickened tendon, not a growth. It is one of the more common reasons people present worried about a lump in the hand.
Causes and risk factors
In most cases there is no clear cause. Contributing factors include:
- Diabetes. The strongest association by far. Trigger finger is several times more common in people with diabetes, is more likely to involve multiple fingers, and responds less reliably to injection.
- Inflammatory arthritis, particularly rheumatoid arthritis, where the tendon lining thickens.
- Age and sex. Most common between fifty and sixty, and more common in women.
- Other hand conditions. Trigger finger, carpal tunnel syndrome and De Quervain's often occur in the same person, and treating one does not prevent the others.
- Sustained forceful gripping, particularly with tools that press into the palm. The link with ordinary hand use is weak.
Trigger finger in a young child is a different condition. It almost always affects the thumb, it is usually noticed as a thumb held permanently bent rather than as clicking, and it is managed differently.
How it is diagnosed
By examination. The history of clicking or locking, the tender nodule in the palm that moves with the tendon, and reproducing the trigger during the consultation are enough. No scan is needed.
Where the finger is locked and will not straighten, it is worth distinguishing trigger finger from a Dupuytren's cord, which also holds a finger bent. The two feel quite different and can occur together.
Non-surgical treatment
Splinting
A small splint that holds the affected finger straight overnight stops the tendon catching while you sleep and can settle mild, early cases. It works best where symptoms have been present only a few months. It asks for persistence over several weeks and it does not suit everyone.
Corticosteroid injection
An injection of corticosteroid around the tendon sheath reduces the swelling and is often the first treatment offered. It works well, and in a substantial proportion of people one injection is the end of the matter.
Where symptoms return after an injection they tend to return sooner after each subsequent one, and injections are less effective in people with diabetes or where several fingers are involved. We arrange injections under ultrasound guidance rather than injecting in the rooms, so the steroid is placed accurately around the tendon sheath. We would not repeat an injection more than twice in the same finger.
Hand therapy
Our therapists make and fit the splint, work on tendon gliding, and address the grip habits that keep aggravating it. Having therapy on site means this starts the same week rather than after another referral.
Surgery
Trigger finger release divides the A1 pulley, the first of the tunnels, through a small incision in the palm over the base of the finger. That immediately gives the tendon room to glide freely. The pulley is not repaired and hand function does not depend on it being intact. In some cases swollen tissue around the tendon also needs to be removed, which is called a tenosynovectomy.
It is a day surgery procedure using sedation with a local anaesthetic, and it takes approximately 20 minutes. The incision is closed with skin sutures, and a tape bandage covers the wound under a soft hand dressing.
Where more than one finger is affected, they can be released in the same procedure.
A short recovery
The dressing is small. The soft dressing comes off on day 3 or 4, leaving only a tape bandage on the skin. Most people notice the triggering has stopped immediately and are back to ordinary use of the hand within about two weeks.
Recovery, week by week
Indicative, and it varies with how many fingers were released and what you do.
Timeframe
What to expect
Day of surgery
Some or all of your fingers may feel numb or tingly for two to three days because of the local anaesthetic. You can move and use your fingers and thumb for light tasks before you leave hospital.
Days 1 to 4
Keep the soft dressing clean and dry. On day 3 or 4 you can remove the soft dressing, leaving the tape bandage on the skin intact.
Days 4 to 14
The tape bandage can get wet in the shower or when you wash your hand. Dab it dry afterwards. If it separates, use a bandaid to protect the sutures. Use the hand lightly as tolerated and avoid heavy tasks.
Two weeks
Your progress is reviewed by the doctor, hand therapist or practice nurse, and the skin sutures are removed at this visit. If needed, a new tape bandage goes on for another three to five days. The incision or the finger may still be somewhat swollen or tender at this stage.
Two to six weeks
Most people have recovered within the first two weeks. It is not abnormal for the area around the scar to stay tender or swollen for two, and sometimes six, weeks after surgery. Moisturising and massage of the area help.
Six weeks
A further follow up appointment if one is needed to monitor your progress.
Days 4 to 5 onwards
Most people are back to driving and to office and light work at four to five days. Light manual work generally follows at two to four weeks, and heavy work at four to six weeks.
The triggering itself usually stops the moment the pulley is divided. What takes a few weeks is the tenderness in the palm, because the scar sits in the part of the hand you press on every time you grip something.
Risks and complications
Trigger finger release is routine and safe, and complications rarely occur. When they do they can include:
- Wound healing problems or infection. Uncommon, usually superficial, treated with antibiotics.
- Bleeding or bruising. Usually minor and settles on its own.
- Nerve injury. The small nerves to the finger run close to the incision. Injury is uncommon and causes numbness along one side of the finger.
- Stiffness. More likely where the finger had been locked for a long time before surgery, and the main reason to move it early.
- Ongoing tenderness or swelling around the scar, or slower than expected recovery.
- Triggering coming back. Very rare after a complete release. This may require another procedure in the future.
When to be seen sooner
Contact us, or see your GP, if you have:
- A finger locked in a bent position that you cannot straighten at all
- A finger that has stopped triggering but will no longer fully straighten
- Several fingers becoming involved over a short period
- Trigger finger alongside diabetes, where injection is less likely to hold
- Redness, spreading pain or fever after an injection or an operation
A finger that has been locked for months stiffens, and the stiffness can outlast the triggering. If you have had surgery with us and have questions or concerns afterwards, phone the rooms during office hours on (08) 7127 0365.
Frequently asked questions
Is the lump in my palm a tumour?
No. It is the thickened part of the flexor tendon, which is why it moves when you bend the finger. It is one of the most common reasons people come in worried about a lump in the hand.
Should I try an injection first?
For most people, yes. An injection settles trigger finger reliably and for a good proportion of patients it is the end of it. We arrange these under ultrasound guidance. Surgery is the answer where symptoms return, where several injections have already been given, or where the finger is locked.
How long does the operation take, and will I be awake?
Approximately 20 minutes. It is done as a day procedure using sedation with a local anaesthetic, so you will not feel the operation, and you go home the same day.
Will the triggering stop straight away?
Almost always, yes. Dividing the pulley immediately gives the tendon room to glide, and most people notice the click has gone as soon as the anaesthetic wears off. What takes longer is the tenderness in the palm.
When can I drive and go back to work?
Office and light work, usually four to five days, and most people are driving again at that point. Light manual work, two to four weeks. Heavy work involving gripping, vibration or load through the palm, four to six weeks. There is no legislation covering surgery and driving, so the test is whether you can control the car safely, including in an emergency. We will give you a realistic estimate for your specific job before the operation, and a certificate.
Can more than one finger be done at once?
Yes. Where more than one finger on the same hand is affected, they are released in the same procedure, which suits people who want a single recovery.
Will it come back?
Very rarely after a complete release. It is more common for a different finger on the same hand to develop trigger finger later, which is not a recurrence but a new one, and it is treated the same way.
Does having diabetes change anything?
It makes trigger finger more likely, more likely to involve several fingers, and less likely to settle permanently with an injection. It does not change how well the operation works.
What does the surgery cost?
You will receive written informed financial consent setting out the surgeon, anaesthetist and hospital fees, your Medicare rebate and your health fund's contribution before anything is booked. Phone the rooms on (08) 7127 0365 for an estimate.
Do I need a referral?
A referral from your GP or another specialist means you can claim a Medicare rebate on the consultation. We can see you without one, but the rebate will not apply.
Written and clinically reviewed by Dr Paul van Minnen, MD, PhD, EBOPRAS, FRACS (Plast)
Last reviewed 9/9/2026