Trigger Finger or Trigger Thumb

Trigger finger is a type of tendonitis (inflammation of the tendon) which is usually the result of overuse or repetitive motions. This painful condition most often affects the thumb and forefinger. When the thumb or forefinger bend, a nodule which forms on the tendon gets stuck, causing the finger to click or lock in the bent position.

Hand and Wrist Anatomy

Bones of the hand and wrist

Bones of the hand and wrist

The wrist, links the hand to the arm. The wrist is a complex mechanical system of 8 small bones known as the carpal bones. The carpal bones are arranged in 2 interrelated rows. One row connects with the ends of the bones in the forearm—radius and ulna. If you hold your hand in the thumbs-up position, the bone on the top of your forearm is the radius; the one on the bottom is the ulna. The other row of carpal bones connects with the bones of the palm of the hand. The joint surfaces, where the bones meet, are covered with articular cartilage which helps movement.

Knuckle cracking does not serve any beneficial purpose and may be harmful to the fingers due to the stretching of the joint capsule. The hand contains 19 bones: 5 elongated metacarpal bones, which are next to the wrist and make up the palm; 14 phalanges which make up the fingers. Each finger has 3 phalanges, the thumb has 2. These 19 bones collectively form 14 separate joints. The knuckle joints, metacarpophalangeal (MCP) joints, join the fingers to the palm. The interphalangeal (IP) joints are the finger joints. These bones are also covered with articular cartilage.

Muscles and Tendons

The muscles in the forearm and palm all work together to keep the wrist and hand moving, stable, and aligned. The image below shows the bones from the back side of the hand. The red lines indicate where the tendons attach the muscles to the bones.

Bones of the back of the left handTendons are white, flexible fibrous cords at the ends of muscles that attach the muscles to the radius, ulna, carpals, metacarpals and phalanges. When the muscles contact, they pull on the tendons to move the bone. The tendons that run down our fingers are held in place by a series of ligaments, called pulleys, that arch over the tendons forming a “tunnel-like” sheath. Normally, the tendons glide easily through the tunnel. If the tendons get irritated, nodules can form on them that keep the tendon from gliding. The nodules can pop or click as the nodules move under the ligament or even hang up causing the finger to lock. Some tendons also serve as stabilizers.

Trigger finger and thumb is a condition affecting the movement of the tendons as they bend (flex) the fingers or thumb toward the palm. A series of ligaments in a tunnel-like arrangement hold the tendons in place on the bones. A slippery coating, called tenosynovium, surrounds the tendons and keeps the tendons moving smoothly under the ligaments when the hand grasps objects.


Ligaments of the back of the hand

Ligaments of the back of the hand

Ligaments are tough bands of fibrous tissue that join bones together. Six major ligaments give stability to the wrist by joining the radius to the carpal bones and binding the two rows of carpal bones together. These ligaments joint with others to link the wrist to the hand.

Joint Capsule

Other stabilizers in the hand include joint capsules, which are made of fibrous connective tissue that surrounds the joints. A synovial membrane inside the joint capsules provides synovial fluid to lubricate all of the joints.


The median, radial and ulnar nerves are the three major nerves that run the length of the arm through the wrist and down into the hand. These nerves contract specific muscles and gives us sensations of touch, and to feel hot, cold, and pain.

Causes of Trigger Finger

Triggering is usually caused from a thickening in the tendon that forms a nodule. The pulley ligament may also thicken. The constant irritation from the tendon repeatedly sliding through the pulley causes the tendon to swell and form the nodule. Rheumatoid arthritis, partial tendon lacerations, repeated trauma from pistol-gripped power tools, or long hours grasping a steering wheel can cause triggering. Infection or damage to the synovium causes a rounded swelling (nodule) to form in the tendon. Triggering can also be caused by a congenital defect that forms a nodule in the tendon. The condition is not usually noticeable until the baby starts using its hands.

Symptoms of Trigger Finger

With the finger straight, the nodule is at the far edge of the surrounding ligament. When flexing the finger, the nodule passes under the ligament, but becomes stuck at the near edge. The nodule cannot move back through the tunnel and the finger locks in the flexed “trigger” position and may be hard to straighten.

Diagnosis of Trigger Finger

Trigger finger and thumb is easily seen and diagnosed on physical exam. A click can usually be felt as the nodule snaps under the first finger pulley. If the condition isn’t treated and gets worse, the nodule can swell to the extent that it gets caught in the pulley ligament locking the finger in a bent position. A locked finger or thumb is usually diagnosed as Trigger Finger or Trigger Thumb.

Prevention/Treatments of Trigger Finger

Unfortunately, a physical therapist can do little once a finger or the thumb develops triggering. A cortisone injection into the sheath may stop the triggering by reducing the inflammation and shrinking the nodule, but this treatment probably won’t last. The usual treatment for a trigger finger is surgery to open the pulley that is obstructing the nodule and keeping the tendon from sliding smoothly.

Surgery to Correct Trigger Finger

Depending on how bad your symptoms are will determine the type of surgery your doctor will recommend. The goal of surgery is to make the tendon sheath large enough to allow smooth movement of the tendon through the pulley system of the tendon sheath. You may need to see a physical or occupational therapist after surgery to regain range of motion and to stretch and strengthen the muscles in your hand.


  1. I have had trigger finger and thumb for several years. It’s hard to remember exactly how long because my hands have hurt continuously ever since a car accident in 2009 caused bulging discs in my neck. It started with my right thumb. After the first cortisone wore off in about six months, my doctor sent me to the surgeon. Literally the day before my surgery, my left thumb started locking open, however it was no where near as painful as the other locking closed. I tried to show the surgeon but he claimed not to see it. The incision healed quickly but I’m left with the lump at the base of my thumb and I can’t close it completely. Additionally, it swells at times and becomes painful, just as before, without the locking.

    Since that time, not only do I have it in my left thumb, but in my right ring finger, and left middle finger. Since I’m left handed, I never understood why my doctor sent me to have surgery on my right hand but not on the left. I keep going for excruciating cortisone shots into that massive painful lump at the base of each finger and thumb, which provide, at best, nine months of relief.

    I never heard of the percutaneous treatment. The article explained how it’s done but not how effective or long lasting the results. I am not diabetic nor do I have RA or gout. This condition must have developed from my gardening and weed pulling. Gardening is my ONLY means of exercise and is great therapy for my PTSD. So it’s not something I can give up. Yet I’m not able to effectively control the pain in the digits affecte and I’m afraid that more fingers will develop the condition. I dread having to go to the doctor’s because of covid19, but I need to find a way to get this condition under control!

    Has anyone had the percutaneous procedure done? If so, how well did it work? Did it get rid of the lump in the palm? One person mentioned using turmeric. How do you do that and how effective is it? I won’t rule out the surgery since I need to be able to use my hands, but since the pandemic, I don’t like to take the risk of being exposed. I have enough structural problems. Risking covid19 isn’t on my to do list!

  2. Valerie Gibbs says

    My right thumb knuckle started clicking after repetitive usage. I used a splint for about two weeks. I then decided to do thumb exercises because keeping my thumb immobile was not good. I needed to use it, so that it wouldn’t become permanently immoble. It now is stiff in the mornings and not in the early evenings most days. It’s been about 2 months since the injury and I hope it will get increasingly better. I am also using turmeric for inflammation . I think this is a good article about nuckle injuries. I hope my Injury is not due to arthritis, as I am 67 years old. So will see.

  3. shelleyrae says

    donald, i live with a diabetic, type 3 – brittle diabetic. and my father has had arthritis in every joint of both hands and feet my whole life. neither one like to keep up with doctors orders. a physical therapist who works specifically in hand therapy might be good. I’ve gone through it myself. heat might help, as in a low setting heating pad. another way to heat up a hand is giving someone a massage or rubbing the neck of a cat or dog,. i put lotion on alot. if you use anything with camphor/memthol/capsaicin, make sure you have no open cuts, and do not touch your eyes. since i do home health care i buy exam gloves. many times i will slather my hands then cover it with the exam gloves for about an hour. helps the medicine soak in and stay there. and as with most joints, you want to keep out moving – use it or lose it, especially if arthritis has set in. hope this helps

  4. D. Sida Roberts says

    Completely agree with your quest; unfortunately, the writers do not answer all those important questions that are vital to us. I am like you: Type 1 Insulin-dependent… for 50 years next month, with A1C results mostly in the 5.6-6.5 range throughout my diabetes!
    I think the best we have is to search on our own and apply whatever solution works for each one, in conjunction with our medical practitioners.
    My immediate suggestion is to write something like “diabetes IDDM trigger finger” in the online search line and go from there!

  5. Mitchell Miller says

    I tried the hand splint with metal plate trying to rest my hand off and on for more than two years trying to prevent my hand from moving. The problem for me is something always came up causing me to immediately reinjure my hand. The original problem was carpal tunnel varied by nerve tests completed by a neurologist over a year apart that indicated substantial change for the worse. Now the thumb started locking up and 2 shots of cortisone about a month apart didn’t help. I was miserable with this thumb triggers that caused sever pain. I elected to have both surgeries to be done at the same time as a outpatient. The surgery was less than 30 minutes but the suture healing took about 10 days. Hand now works fine and no numb fingers and smooth use of the thumb. I enjoyed the entire article as it is written with great praise. I hope my experience helps someone worrying about hand surgery because for me I was out of options to avoid surgery.

  6. Donald C. Poppke says

    I have has. U,tip,please trigger fingers for over 20 years (I am a type one diabetic )Several of been corrected surgically but after a few years the triggering ireoccurred. I would like to see an article about chronic trigger finger and chronic tendinitis my hands are in constant pain if I use them to do anything, like mowing the lawn is there a systemic way to treat chronic inflammation?

  7. Cindy Schmidler says

    Thank you!

  8. A very useful article which gives adequate technical information without using unnecessarily esoteric language.
    However, ”the tendon can swell enough that it gets caught” is, to say the least, clumsily and inelegantly verbose and doesn’t quite make good sense. ”The tendon can swell sufficiently to be caught” would be crisper and more readily comprehensible.

  9. Jacqueline Velzy says

    Francisco: Same condition here. 8 weeks of locking (trigger) that started out as horrible pain, now some pain but mostly irritation that my hand cannot grasp or close I had the same condition in my thumb and was treated with cortisone 8 years ago, which helped it heal and no problem since. My doctor refused to do the injection this time, I don’t know why. Creams will relieve swelling but won’t solve the problem it seems.

  10. Misty Dakota says

    Thank you for this valuable information. As a bus driver that was injured on the job, this gave me the knowledge to fight to have the injuries corrected! Thank you again!

  11. Laura Hunter says

    I experience my left middle finger getting stuck and oainfil clear to my palm burning is there anything recommended

  12. Willow Parkhill says

    Thank You – This was completely helpful. y right thumb is getting un-usable. This is a big issue. I can’t write comfortably or open containers; a lot of tasks are painful. Thankfully I’m not in a position, as I was formerly, that would require near constant use of my hands.
    I’m a great believer in the body’s ability to repair itself if given my support. With that, I plan to see which foods may add directly to the health of my ligaments and the tenosynovium. Plus, I ‘m resting my hand and taking care with tasks where I need to use my right hand. I’ve even started a mindfulness project of using my left hand if I can. This is an adjustment since I’m right handed and habitually and naturally use my right for almost everything.

    Having HealthPages provide a starting point and probable diagnosis has been a great benefit. Thank you for providing the detailed and useful information.

    Sincerely– Willow Parkhill

  13. My condition with the ring finger trigger is not really bad….I do not feel pain….. sometimes I notice this effect……at the present I am puting some imflamation cream,
    somehow I have not noticed too much difference….but I am able to use my hand.
    What do you reccommend me ??.. do I keep using the cream?……..

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