Coastal Plastic Surgery & Medi Spa — Erina NSW Trigger Finger
Trigger finger (stenosing tenosynovitis) causes a finger or thumb to catch, click, or lock in a bent position. Our specialist plastic surgeons offer both non-surgical and surgical treatment options, with trigger finger release providing a reliable, long-lasting cure for most patients.
What is trigger finger?
Trigger finger — medically known as stenosing tenosynovitis — is a condition in which a finger or thumb catches, clicks, or locks as it moves. In severe cases, the finger becomes fixed in a bent or, less commonly, straightened position and cannot be moved without assistance.
The condition occurs when the flexor tendon that bends the finger becomes inflamed or thickened, making it difficult to glide smoothly through the tendon sheath (a tunnel of tissue that surrounds and guides the tendon). At the entrance to the sheath is a ring-like structure called the A1 pulley. In trigger finger, this pulley thickens and narrows, catching on a nodule that forms on the tendon as it tries to pass through.
The characteristic clicking, catching, or locking occurs as the thickened tendon catches on the narrowed pulley — similar to a trigger being pulled and released. In more severe cases, the tendon can no longer pass through the pulley at all, and the finger locks in a bent position.
The A1 pulley is the first and most important of five ring-like structures (pulleys) that form the fibrous tunnel through which the flexor tendon passes. It is located at the base of the finger at the level of the palm. Surgical trigger finger release involves cutting this pulley to widen the tunnel, allowing the tendon to glide freely again.
The pulley can be divided safely with minimal impact on hand function, as the remaining four pulleys maintain tendon mechanics and prevent bowstringing.
Trigger thumb is a variant of trigger finger affecting the thumb, which has its own A1 pulley. It presents with the same clicking, catching, or locking — and is treated in the same way. Congenital trigger thumb is also seen in young children and may resolve spontaneously or require surgical release.
Recognising trigger finger
Trigger finger typically develops gradually. Early symptoms are often most noticeable in the morning or after periods of inactivity. The condition can affect any finger or thumb, and multiple fingers can be affected simultaneously.
Who gets trigger finger?
Trigger finger can affect anyone, but certain factors increase the risk. It is more common in women, in people over 40, and is significantly associated with several medical conditions.
Grades of trigger finger
Trigger finger is classified into four grades based on severity. The grade helps guide treatment recommendations.
| Grade | Description | Typical treatment |
|---|---|---|
| Grade I Pre-triggering | Pain and tenderness at the A1 pulley. History of catching but no locking demonstrated on examination. | Activity modification, splinting, NSAIDs |
| Grade II Active triggering | Demonstrable catching or snapping but the patient can actively extend the finger. | Steroid injection; splinting |
| Grade III Passive triggering | Finger locks and requires passive manipulation to extend — cannot extend actively. | Steroid injection or surgical release |
| Grade IV Fixed contracture | Finger is fixed in flexion and cannot be straightened even passively. A fixed joint contracture has developed. | Surgical release; may need joint capsule release |
Trigger finger rarely resolves on its own in adults. Early treatment — even for mild (Grade I or II) symptoms — is preferable to waiting, as the condition tends to progress. A locked finger (Grade III–IV) should be assessed promptly. Grade IV trigger finger with a fixed contracture may require additional procedures to restore full movement.
Patients with diabetes who develop trigger finger may have multiple fingers affected and may have a lower initial response rate to steroid injection. Surgical release remains very effective in diabetic patients, though healing may be slightly slower. Blood glucose management is important in the peri-operative period.
Surgical & non-surgical treatment
Treatment depends on the severity of triggering and the patient's medical history. Non-surgical options are usually tried first for mild to moderate cases. Surgical release is highly effective and is recommended for persistent or severe trigger finger.
Splinting
A finger or hand splint holding the affected finger in extension can reduce triggering by resting the inflamed tendon and pulley. Most effective for mild (Grade I–II) trigger finger. Requires consistent use, particularly at night, for several weeks.
Activity Modification & NSAIDs
Avoiding repetitive gripping activities can reduce inflammation and symptoms in early trigger finger. Anti-inflammatory medications may provide some symptomatic relief but are rarely curative alone.
Corticosteroid Injection
A steroid injection into the tendon sheath at the A1 pulley reduces inflammation and is the most effective non-surgical treatment. A single injection resolves symptoms in approximately 50–60% of patients. A second injection may be offered if the first provides partial relief. Less effective in long-standing or Grade III–IV trigger finger, and in patients with diabetes or rheumatoid arthritis.
Trigger Finger Release (Open)
A small incision is made in the palm over the A1 pulley, which is divided under direct vision. This permanently widens the tendon tunnel and eliminates the catching and locking. Performed under local anaesthetic as a short day procedure. The success rate is over 95% and recurrence is rare. The finger can typically be moved immediately after surgery.
Percutaneous (Needle) Release
The A1 pulley is divided using a needle inserted through the skin without a surgical incision. Can be performed in the clinic under local anaesthetic. Suitable for selected cases of trigger finger, particularly when the nodule on the tendon is not too large. Requires experience to avoid injury to adjacent neurovascular structures.
Release with Joint Capsulotomy
In Grade IV trigger finger with a fixed contracture, simple pulley release alone may be insufficient to restore full finger extension. Additional release of the joint capsule (capsulotomy) and sometimes the volar plate may be required. Hand therapy following surgery is essential to regain full movement.
Trigger finger release is a short day procedure under local anaesthetic. The finger can be moved from the moment of surgery. A dressing is applied for 10–14 days. Most patients return to light activities within a few days and heavy or manual work within 2–4 weeks. Hand therapy may be recommended for Grade IV cases or if pre-operative stiffness is significant. Grip strength and comfort continue to improve over several weeks.
Other hand surgery services
Our specialist plastic surgeons
Trigger finger release at Coastal Plastic Surgery is performed by our FRACS-qualified specialist plastic surgeons, who have training and experience in all aspects of hand surgery.
Common questions about trigger finger
Trigger finger in adults rarely resolves spontaneously. In the early stages, activity modification and splinting may reduce symptoms, but the underlying thickening of the tendon sheath tends to progress without treatment. A steroid injection provides lasting resolution in approximately 50–60% of patients. Surgical release is very effective for persistent or severe cases. Early treatment generally gives better outcomes than waiting for the condition to progress to a fixed contracture.
A single corticosteroid injection into the tendon sheath resolves triggering in approximately 50–60% of patients. A second injection may be offered if the first provides partial relief — the combined success rate of two injections is approximately 70–75%. Steroid injection is less effective in patients who have had symptoms for a long time, in Grade III–IV trigger finger, and in patients with diabetes or rheumatoid arthritis. If two injections have not resolved the problem, surgical release is generally recommended.
Trigger finger release is a short day procedure performed under local anaesthetic in-rooms. The operation itself takes approximately 10–15 minutes. A small incision is made in the palm over the A1 pulley, which is divided under direct vision. The finger can be moved immediately after surgery. A dressing is applied for 10–14 days and the wound is reviewed at that time.
Recurrence after surgical trigger finger release is rare — the success rate is over 95%. Once the A1 pulley has been divided, the tendon can move freely and the triggering does not return. This makes surgical release a more durable solution than steroid injection, which has a recurrence rate of 30–50% over 12 months. If triggering recurs after surgery, revision release can be considered, though this is uncommon.
Yes — surgical trigger finger release is safe and effective in patients with diabetes. Steroid injections should be used with caution in diabetic patients as they can cause a temporary rise in blood glucose. If a steroid injection is given, blood glucose monitoring in the days following the injection is advisable. Surgical release is often recommended as the first-line treatment for trigger finger in diabetic patients. Good peri-operative blood glucose control supports optimal wound healing.
Yes — trigger finger release is a medical procedure that attracts a Medicare item number. Applicable rebates will be included on your formal quote following consultation. Private health insurance may contribute to costs if the procedure is performed in a hospital or accredited day surgery facility. Most trigger finger releases are performed under local anaesthetic in our rooms, which is the most cost-effective option for patients. Your surgeon will discuss costs at consultation.
Suffering from a clicking or locking finger?
Book a consultation with our specialist plastic surgeons at our Erina practice to have your trigger finger assessed and discuss the most appropriate treatment for your situation.