Trigger Finger Impormasyon In-depth

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

Non-Operative Management

• Female patients presenting with their first trigger finger have the highest rate of long-term treatment success after a single corticosteroid injection [1].
• Management of trigger finger with 2 steroid injections before surgery is the least costly treatment strategy [14].
• Patients' preferences for trigger finger treatment often change after consulting with a hand surgeon and during treatment, but these choices do not affect treatment satisfaction [4].
• Comparing patients and hand surgeons, there were some differences in treatment preferences and perceived advantages and disadvantages regarding idiopathic trigger finger—differences that might be addressed by a decision aid [36].

Operative Management

• Open trigger finger release is generally a low-risk procedure, although there is potential for complications, some requiring reoperation [2].
• Patients who undergo open trigger finger release surgery in the clinic have complication rates similar to reported complication rates of surgery performed in the operating room [43].
• The authors recommend open surgery for trigger finger and trigger thumb, citing excellent long-term results with no recurrence and no serious complications such as nerve transection or bowstringing [30].
• Local anesthetic infiltration in the palm proximal to the incision site is preferred for open trigger finger release [6].
• A transverse incision about 2 cm long several millimeters distal to the distal palmar crease is used for middle, ring, and small trigger finger releases [6].
• A transverse incision about 2 cm long several millimeters distal to the proximal palmar crease is used for index trigger finger releases [6].
• Trigger thumb releases can be done through incisions either distal or proximal to the metacarpophalangeal joint flexion crease [6].
• The digital nerves on the thumb are more palmar and closer to the flexor sheath than might be anticipated [6].
• The thumb radial digital nerve is especially vulnerable during trigger thumb release [6].
• Trigger thumbs require release of only the A1 pulley, whereas trigger digits require division of the A1 and A0, or proximal palmar pulley [6].
• Pulley division is usually accomplished with an initial opening of the pulley with a No. 15 knife blade and a pair of tenotomy scissors [6].
• For trigger thumb release, the surgeon should avoid cutting too far distally and disrupting the oblique pulley [6].
• The sheath is incised from proximal to distal, approximately 1 cm, and reassessed for triggering [6].
• Persistent triggering implies that either the A1 and palmar pulleys are incompletely released or an alternate site of triggering is present [6].
• When the distal A1 pulley edge is released, the divided pulley leaves are parallel rather than ending in a V-shaped pattern [6].
• Other fingers can be found to trigger at the same surgical setting and can be managed at the same time [6].
• The compression dressing is removed after 48 hours [6].
• Sutures are removed at 10 to 14 days [6].
• Normal use of the finger or thumb is encouraged after surgery [6].

Percutaneous Management

• The study confirms the efficacy and safety of percutaneous trigger finger release but shows no clinical advantage in using pre- or postoperative ultrasonography [15].
• Percutaneous release is permanent, safe, and cost-effective and should be considered as first-line treatment for demonstrable trigger fingers [18].
• While the clinical significance of these findings is unclear, it raises questions regarding the safety and efficacy of percutaneous trigger finger release, even when adding ultrasound guidance [21].

General Clinical Guidance

• The manuscript aims to provide an updated practical guide for clinicians and surgeons reviewing the state-of-art of both the assessment and the treatments of patients with trigger finger to plan tailored rehabilitation management taking advantage of the matching of traditional and novel techniques [3].

Anatomy & Pathophysiology

Demographics and Epidemiology

• Trigger finger occurs in 2% to 3% of the general population [10].
• Women are more commonly affected than men [10].
• The most common demographic group is women older than 50 years of age [7, 8].
• Middle and ring finger involvement is most common in adults [7, 8].
• The order of decreasing prevalence for affected digits is thumb, ring, long, little, and index [10].
• Trigger finger is more common in patients with systemic diseases such as diabetes mellitus (10% to 20% lifetime incidence), hypothyroidism, sarcoidosis, rheumatoid arthritis, and septic tenosynovitis [10].
• Stenosing tenosynovitis is more common in diabetic patients than in nondiabetic patients [9].
• When multiple digits are involved, the possibility of diabetes should be considered [9].
• The average age of female patients with trigger finger was 62 years and of male patients was 64.5 years [70].

Etiology and Risk Factors

• The precise etiology of trigger finger has not been elucidated [77].
• Repetitive finger movements and local trauma are proposed causes of trigger finger [77].
• Stress and degenerative force account for an increased incidence of trigger finger in the dominant hand [77].
• Trigger finger is possibly associated with repetitive grasping activities [7, 8].
• Repetitive power grip and flexion involved in rowing increase the prevalence of trigger finger [90].
• Patients with greater volar migration of the flexor tendons after carpal tunnel release are at a higher risk of developing trigger finger [88].
• Concomitant trigger finger and carpal tunnel syndrome occurs in 40% to 60% of patients [7, 8].

Pathology and Histology

• Trigger finger is defined as stenosing tenosynovitis of the flexor tendons with mechanical impingement of the flexor tendons at the A1 pulley [10].
• Pathologic examination of affected pulleys demonstrates a proliferation of chondrocytes and increased type III collagen [10].
• The flexor digitorum profundus tendon often demonstrates a pathologic nodule, while the flexor digitorum superficialis is often unaffected [10].
• Histology shows fibrocartilaginous metaplasia of the pulley and/or FDS tendon [7, 8].
• Thickening and hypervascularization of the A1 pulley are the hallmarks of trigger fingers on sonography [52].
• In the thumb, the flexor tendon and A1 pulley thickened significantly only after patients exhibited triggering [92].
• A nodule or thickening in the flexor tendon becomes trapped proximal to the pulley, making finger extension difficult [10].
• The lump palpable in the palm may be the thickened area in the first annular pulley or a nodule or fusiform swelling of the flexor tendon just distal to it [20].
• The tendon nodule usually is just proximal to the anulus at the metacarpophalangeal joint level [20].
• In a rheumatoid patient, a nodule distal to the metacarpophalangeal joint level may cause triggering [20].

Clinical Presentation

• Patients present with pain and tenderness in the palm at the proximal edge of the digital A1 pulley [9].
• Patients frequently note catching or triggering of the affected finger or thumb after forceful flexion [9].
• In more severe cases, the opposite hand must be used to force the finger or thumb passively into extension [9].
• In the most severe cases, the finger becomes locked in a flexed position [9].
• Triggering is often more pronounced in the morning than later in the day [9].
• Pain and tenderness in the distal palm progress to mechanical catching or locking, and may become fixed [7, 8].
• A common complaint is referred pain at the dorsal MCP/PIP area [7, 8].
• Physical examination findings include tenderness to palpation of the flexor tendon at the level of the A1 pulley [10].
• Physical examination findings include palpable triggering or pain with flexion and extension of the finger [10].
• Physical examination findings include nodularity of the flexor tendon just proximal to the A1 pulley [10].
• Physical examination findings may include the presence of a volar retinacular ganglion cyst between the A1 and A2 pulleys [10].
• Physical examination findings may include a fixed flexion deformity of the proximal interphalangeal (PIP) joint [10].
• Local tenderness may be present but is not a prominent complaint [20].
• Pressure accentuates the apparent snapping or triggering of the more distal joints [20].
• Patients frequently state that the problem is in the proximal interphalangeal joint with trigger finger or in the proximal interphalangeal joint with trigger thumb [20].

Anatomical Variations and Associations

• Newer evidence has found a fourth pulley (variable annular pulley) in 75% of patients, which may contribute to stenosis in the thumb [7, 8].
• Concurrent appearance of Dupuytren’s disease and trigger finger was observed in 16% of trigger finger cases [70].
• When considering middle and ring fingers only, Dupuytren’s disease and trigger finger were present in 25% of cases [70].
• The percentage of patients with combined trigger finger and Dupuytren’s disease strongly increases with age [84].
• In the "80+" age group, 50% of trigger finger patients are suffering from both trigger finger and Dupuytren’s disease [84].
• In more progressed stages of Dupuytren’s contracture (Stages II or III), the concomitant appearance of trigger finger and Dupuytren’s contracture is rarely seen [85].
• Advanced extension deficit reduces the range of motion of the tendon and thus causes less mechanical irritation at the A1 pulley [85].
• The tendon becomes slightly thinner distal to the chiasm of the deep and superficial flexor tendon [85].

Classification

• Green Classification Grade I is defined as pain and tenderness at the A1 pulley [7, 8].
• Green Classification Grade II is defined as catching of the finger [7, 8].
• Green Classification Grade III is defined as locking of the finger that is passively correctable [7, 8].
• Green Classification Grade IV is defined as a fixed, locked finger [7, 8].
• Green Classification Grade I is defined as pain over the A1 pulley [10].
• Green Classification Grade II is defined as mechanical catching of the digit without locking [10].
• Green Classification Grade III is defined as mechanical locking of the digit which is passively correctable [10].

Classification

• The Green classification of trigger finger includes four grades: Grade I (pain and tenderness at the A1 pulley), Grade II (catching of finger), Grade III (locking of finger; passively correctable), and Grade IV (fixed, locked finger) [7].
• Clinical presentation of trigger finger involves pain or tenderness in the distal palm that progresses to mechanical catching or locking, and may become fixed [7].
• A common complaint associated with trigger finger is referred pain at the dorsal MCP/PIP area [7].
• In a retrospective review of 90 trigger digits, severity was graded according to Green's classification, with Grade I and II grouped as mild triggering and Grade III and IV grouped as severe triggering [74].
• Percutaneous release for trigger finger is not indicated for Type I triggers because the procedure requires active demonstration of flexion-extension activity, which may not occur sporadically in Type I cases [50].

Clinical Presentation

Epidemiology and Risk Factors

• Women are more commonly affected by trigger finger than men [10].
• The lifetime risk for a trigger finger in the general population is approximately 3% [40].
• Trigger finger is more common in patients with systemic diseases such as diabetes mellitus, hypothyroidism, sarcoidosis, rheumatoid arthritis, and septic tenosynovitis [10].
• Diabetes mellitus is associated with a 10% to 20% lifetime incidence of trigger finger [10].
• Trigger finger is seen in patients with gout, calcific tendinitis, pseudogout, and amyloidosis [10].
• In patients with calcific tendinitis causing triggering, males are affected five times more frequently than females [10].
• Trigger finger patients with metabolic syndrome are at risk of poorer functional outcomes and treatment failure after a single corticosteroid injection than age- and sex-matched controls [24].

Clinical Findings

• Flexor tenosynovitis is characterized by pain and tenderness in the palm at the proximal edge of the digital A1 pulley [9].
• Physical examination findings may include tenderness to palpation of the flexor tendon at the level of the A1 pulley [10].
• Physical examination findings may include palpable triggering or pain with flexion and extension of the finger [10].
• Physical examination findings may include nodularity of the flexor tendon just proximal to the A1 pulley [10].
• Physical examination findings may include the presence of a fixed flexion deformity of the proximal interphalangeal (PIP) joint [10].
• Patients may note a lump or knot in the palm, which may be a thickened area in the first annular pulley or a nodule of the flexor tendon [20].
• The tendon nodule can be palpated by the examiner’s fingertip and moves with the tendon [20].
• Patients frequently state that the problem is in the proximal interphalangeal joint with trigger finger or trigger thumb [20].
• Proximal interphalangeal joint pain in trigger finger patients results from long symptom duration and consequent joint pathology [22].

Classification

• The Green classification for trigger finger includes Grade I: Pain over the A1 pulley [10].
• The Green classification for trigger finger includes Grade II: Mechanical catching of the digit without locking [10].
• The Green classification for trigger finger includes Grade III: Mechanical locking of the digit which is passively correctable [10].
• The Green classification for trigger finger includes Grade IV: Fixed locked finger [10].

Differential Diagnosis and Associated Conditions

• Other conditions such as intraarticular disorders (e.g., loose bodies, degenerative joint disease, and fractures) and common extensor tendon subluxation can cause similar symptoms to idiopathic trigger finger [20].
• There is a predisposition for carpal tunnel syndrome and trigger finger to present in the same hand [54].
• Carpal tunnel release does not cause new incidence of trigger finger in the operative hand [54].
• Pediatric trigger finger is a distinct ailment from adult trigger finger [33].
• A secondary cause must be sought whenever long fingers are affected in pediatric trigger finger [33].

Investigations

Clinical Examination and Classification

• Trigger finger is characterized by pain and tenderness in the palm at the proximal edge of the digital A1 pulley [9].
• The Green classification Grade I is defined as pain over the A1 pulley [7, 8, 10].
• The Green classification Grade II is defined as catching of the finger or mechanical catching of the digit without locking [7, 8, 10].
• The Green classification Grade III is defined as locking of the finger or mechanical locking of the digit which is passively correctable [7, 8, 10].
• The Green classification Grade IV is defined as a fixed, locked finger [7, 8, 10].
• Observing the triggering of the digit guides the patient's treatment and assists in diagnosing trigger finger [23].

Imaging

• Ultrasound can detect various lesions in clinical trigger fingers, and some ultrasound findings correlated with clinical findings [66].
• Advanced imaging is critical for identifying bony prominences causing locking when common etiologies are absent [71].
• Metacarpal head osteochondroma is an atypical cause of "trigger finger" that supports the inclusion of this condition in the differential diagnosis [71].
• Volar wrist ganglion can present as trigger finger and has been treated with interventional radiological measures rather than open surgery [68].

Treatment

Non-Operative Management

• Corticosteroid injections are effective in 57% of patients with trigger finger [12].
• Corticosteroid injections are effective in 60% of patients with trigger finger [20].
• Corticosteroid injections are effective in 65% to 90% of patients without diabetes who receive one or two injections [10].
• Steroid injections were an effective first-line intervention for the treatment of trigger finger [27].
• The current evidence supports the use of corticosteroid injection as a first-line treatment for trigger finger [41].
• A single corticosteroid injection for trigger finger has a 45% long-term success rate [29].
• Diabetic patients are generally less responsive to corticosteroid injection for trigger finger [7, 8].
• There is no difference in efficacy between soluble and insoluble corticosteroid preparations for trigger finger injection [7, 8].
• Splinting is an effective short-term conservative treatment for trigger finger, offering symptom relief and functional improvement comparable to corticosteroid injections [28].
• Initiating conservative treatment with the MCP joint blocking splint has positive outcomes in 77% of subjects with trigger finger [57].
• Use of the DIP joint splint was effective in about half of subjects with trigger finger [57].
• Orthoses are effective for non-surgical management of pediatric and adult trigger finger using various orthotic options [58].
• A randomized trial found no differences in patient-reported outcomes for pain or function or in reduction of trigger finger severity at 52 weeks among splint alone, steroid alone, and combination treatments [56].
• The authors of a trial comparing splint, steroid, and combination treatments recommend splinting alone as the least invasive option [56].
• The use of an injection without lidocaine is recommended to treat trigger finger [55].

Operative Management

• Surgical release of the A1 pulley provides satisfactory results in >90% of patients with trigger finger [10].
• Approximately 97% of patients have complete resolution after operative treatment for trigger finger [20].
• Open release is an effective treatment for trigger finger with limited need for nonprescription drugs, since almost all patients reported full resolution of triggering within 6 weeks [61].
• In patients with rheumatoid arthritis, the preference is to excise a slip of the FDS tendon rather than to release the A1 pulley because these patients are at risk for ulnar drift at the MCP joint [7, 8].
• The radial digital nerve is at risk of iatrogenic injury during thumb trigger finger release given its superficial location [7, 8].
• Minor complications of open trigger finger release include wound dehiscence, scar tenderness, and decreased ROM [7, 8].
• Management of diabetic trigger finger with immediate surgical release in the clinic is the most cost-effective treatment strategy, assuming a corticosteroid injection failure rate of at least 34% [64].
• Procedure room-based treatment of trigger finger is less costly than release in the operating room [63].
• Comparing patients and hand surgeons, there were some differences in treatment preferences and perceived advantages and disadvantages regarding idiopathic trigger finger [36].
• In women with a trigger finger, the choice of treatment should take into account whether there are also one or more patient- or trigger-related factors that increase the risk of conversion to surgery [11].

Complications

Surgical Complications

• Approximately 1 in 20 fingers will experience a mild, transient adverse event after surgical release of the A1 pulley for idiopathic trigger finger [49].
• Approximately 1 in 200 patients have a second surgery after open A1 pulley release for idiopathic trigger finger [49].
• Minor complications of trigger finger release are relatively high and include wound dehiscence, scar tenderness, and decreased range of motion [7].
• Incomplete pulley release and damage to the flexor tendons and digital nerves remain of some concern, especially with limited exposure techniques [20].
• Preoperative hypoglycemia increases infection risk after trigger finger injection and release [5].
• There were no significant differences in scar quality or improvement in patient-reported disability with transverse or longitudinal incisions for trigger finger release [44].

Postoperative Outcomes and Recurrence

• Persistence of triggering is more common than recurrence after operative treatment [20].
• Subsequent release or injection in the same or another digit was common following an initial trigger finger release [51].
• Patients with more lifetime trigger fingers and/or prior trigger finger releases for other fingers are more likely to need ulnar superficialis slip resection [48].
• Proximal interphalangeal joint pain in trigger finger patients results from long symptom duration and consequent joint pathology, and is incompletely resolved after A1 pulley release, leading to worse surgical outcomes than expected [22].
• Physicians should consider the duration of preoperative symptoms and preoperative flexion contracture of the PIP joint when deciding timing of surgery for trigger finger patients [13].
• The incidence and treatment outcome of cases in which trigger finger occurred in conjunction with Dupuytren's disease appeared less predictable than that of ordinary trigger finger [47].

Non-Operative Complications and Risks

• Corticosteroid injections may elevate serum glucose levels for 5 days or more [20].

Recovery

Non-Operative

• Steroid injections are an effective first-line intervention for the treatment of trigger finger [27].
• Success beyond two years following a single corticosteroid injection is likely to predict lasting symptom relief [29].
• Long-term success rates for corticosteroid injections vary by sex and number of affected digits [29].
• Thirty-nine percent of second and third corticosteroid injections for trigger finger yield long-term relief [38].
• Splinting is an effective short-term conservative treatment for trigger finger [28].
• Splinting offers symptom relief and functional improvement comparable to corticosteroid injections [28].

Operative

• Open trigger finger release is generally a low-risk procedure [2].
• Open trigger finger release has potential for complications, some requiring reoperation [2].
• Percutaneous trigger finger release is an effective and safe procedure [15].
• There is no clinical advantage in using pre- or postoperative ultrasonography for percutaneous trigger finger release [15].
• Simultaneous steroid injection at the time of surgical release provides greater subjective improvement in the early period after percutaneous trigger finger release [89].
• Open surgery for trigger finger and trigger thumb yields excellent long-term results with no recurrence [30].
• Open surgery for trigger finger and trigger thumb yields excellent long-term results with no serious complications such as nerve transection or bowstringing [30].
• About 1 in 20 fingers will experience a mild, transient adverse event after surgical release of the A1 pulley for idiopathic trigger finger [49].
• About 1 in 200 fingers have a second surgery after surgical release of the A1 pulley for idiopathic trigger finger [49].
• There are no significant differences in scar quality between transverse or longitudinal incisions for trigger finger release [44].
• There are no significant differences in improvement in patient-reported disability between transverse or longitudinal incisions for trigger finger release [44].

Prognostic Factors and Complications

• Physicians should consider the duration of preoperative symptoms when deciding timing of surgery for trigger finger patients [13].
• Physicians should consider preoperative flexion contracture of the PIP joint when deciding timing of surgery for trigger finger patients [13].
• Proximal interphalangeal joint pain is incompletely resolved after A1 pulley release [22].
• Proximal interphalangeal joint pain leads to worse surgical outcomes than expected [22].
• The incidence and treatment outcome of trigger finger occurring in conjunction with Dupuytren's disease appear less predictable than that of ordinary trigger finger [47].
• Patients with more lifetime trigger fingers are more likely to need ulnar superficialis slip resection during trigger finger release [48].
• Patients with prior trigger finger releases for other fingers are more likely to need ulnar superficialis slip resection during trigger finger release [48].
• Patients requiring ulnar superficialis slip resection may benefit from hand therapy [48].

Key Evidence

• [L4] Female patients presenting with their first trigger finger have the highest rate of long-term treatment success after a single corticosteroid injection. [1] (10.2106/jbjs.n.00004)
• [L3] Open trigger finger release is generally a low-risk procedure, although there is potential for complications, some requiring reoperation. [2] (10.1007/s11552-014-9716-9)
• [L5] The manuscript aims to provide an updated practical guide for clinicians and surgeons reviewing the state-of-art of both the assessment and the treatments of patients with trigger finger to plan tailored rehabilitation management taking advantage of the matching of traditional and novel techniques. [3] (10.1186/s12891-024-08192-5)
• [Paper] Patients' preferences for trigger finger treatment often change after consulting with a hand surgeon and during treatment, but these choices do not affect treatment satisfaction. [4] (10.1007/s12593-015-0203-5)
• [L3] In women with a trigger finger, the choice of treatment should take into account whether there are also one or more patient- or trigger-related factors that increase the risk of conversion to surgery. [11] (10.1302/0301-620x.104b10.bjj-2022-0058.r3)
• [L1] Corticosteroid injections are effective in 57% of patients with trigger finger. [12] (10.5435/00124635-200703000-00006)
• [L4] Physicians should consider the duration of preoperative symptoms and preoperative flexion contracture of the PIP joint when deciding timing of surgery for trigger finger patients. [13] (10.1016/j.jhsa.2018.06.023)
• [L2] Management of trigger finger with 2 steroid injections before surgery is the least costly treatment strategy. [14] (10.1016/j.jhsa.2009.02.029)
• [L4] The study confirms the efficacy and safety of percutaneous trigger finger release but shows no clinical advantage in using pre- or postoperative ultrasonography. [15] (10.1177/1753193413517992)
• [L3] Percutaneous release is permanent, safe, and cost-effective and should be considered as first-line treatment for demonstrable trigger fingers. [18] (10.5435/jaaosglobal-d-25-00445)
• [L5] While the clinical significance of these findings is unclear, it raises questions regarding the safety and efficacy of percutaneous trigger finger release, even when adding ultrasound guidance. [21] (10.1007/s11552-008-9137-8)
• [L4] Proximal interphalangeal joint pain in trigger finger patients results from long symptom duration and consequent joint pathology, and is incompletely resolved after A1 pulley release, leading to worse surgical outcomes than expected. [22] (10.1177/1753193418809771)
• [L4] Observing the triggering of the digit guides the patient's treatment, and the outlined technique assists in diagnosing and treating one of the most common hand conditions seen in practice. [23] (10.1016/j.jhsa.2011.12.014)
• [L3] Trigger finger patients with metabolic syndrome are at risk of poorer functional outcomes and treatment failure after a single corticosteroid injection than age- and sex-matched controls. [24] (10.1016/j.jhsa.2016.07.091)
• [L4] Steroid injections were an effective first-line intervention for the treatment of trigger finger. [27] (10.1016/j.jhsa.2014.09.006)
• [L2] Splinting is an effective short-term conservative treatment for trigger finger, offering symptom relief and functional improvement comparable to corticosteroid injections. [28] (10.1016/j.jhsg.2025.100881)
• [L5] This commentary highlights that a single corticosteroid injection for trigger finger has a 45% long-term success rate, with success beyond two years likely predicting lasting symptom relief, though results vary by sex and number of affected digits. [29] (10.2106/jbjs.n.00832)
• [L4] The authors recommend open surgery for trigger finger and trigger thumb, citing excellent long-term results with no recurrence and no serious complications such as nerve transection or bowstringing. [30] (10.1007/s00402-008-0802-8)
• [L4] Pediatric trigger finger is a distinct ailment from adult trigger finger, and a secondary cause must be sought whenever long fingers are affected. [33] (10.1177/1558944715627634)
• [L4] Comparing patients and hand surgeons, there were some differences in treatment preferences and perceived advantages and disadvantages regarding idiopathic trigger finger—differences that might be addressed by a decision aid. [36] (10.1016/j.jhsa.2014.08.010)
• [L4] Thirty-nine percent of second and third corticosteroid injections for trigger finger yield long-term relief. [38] (10.1016/j.jhsa.2017.02.001)
• [L2] [40] (10.1016/j.jhsa.2024.05.016)
• [L4] The current evidence supports the use of corticosteroid injection as a first-line treatment for trigger finger. [41] (10.1177/175899830701200304)
• [L4] Patients who undergo open trigger finger release surgery in the clinic have complication rates similar to reported complication rates of surgery performed in the operating room. [43] (10.1016/j.jhsg.2022.01.008)
• [L2] There were no significant differences in scar quality or improvement in patient-reported disability with transverse or longitudinal incisions for trigger finger release. [44] (10.1177/1753193419859375)
• [Textbook] The incidence and treatment outcome of cases in which trigger finger occurred in conjunction with Dupuytren's disease appeared less predictable than that of ordinary trigger finger. [47] (10.1007/978-3-642-22697-7_31)
• [L3] Patients with more lifetime trigger fingers and/or prior TFRs for other fingers are more likely to need USSR, and these patients may benefit from hand therapy. [48] (10.1016/j.jhsa.2024.08.013)
• [L4] This large retrospective series suggests that about 1 in 20 fingers will experience a mild, transient adverse event after surgical release of the A1 pulley for idiopathic trigger finger and that about 1 in 200 have a second surgery. [49] (10.1016/j.jhsa.2012.05.014)
• [L1] [50] (10.1093/rheumatology/ker315)
• [L4] Subsequent release or injection in the same or another digit was common following an initial trigger finger release. [51] (10.1016/j.jhsa.2025.02.009)
• [L4] Thickening and hypervascularization of the A1 pulley are the hallmarks of trigger fingers on sonography. [52] (10.7863/jum.2008.27.10.1407)
• [L4] There is a predisposition for carpal tunnel syndrome and trigger finger to present in the same hand; however, patients can be counseled that CTR does not cause new incidence of trigger finger in the operative hand. [54] (10.1016/j.jhsa.2018.10.003)
• [L1] We recommend the use of an injection without lidocaine to treat trigger finger. [55] (10.1016/j.jhsa.2018.06.090)
• [L5] The author notes that the referenced trial found no differences in patient-reported outcomes for pain or function or in reduction of trigger finger severity at 52 weeks among splint alone, steroid alone, and combination treatments, leading the trial authors to recommend splinting alone as the least invasive option. [56] (10.1097/corr.0000000000002726)
• [L1] Initiating conservative treatment with the MCP joint blocking splint has value for patients with trigger finger and positive outcomes in 77% of subjects, whereas use of the DIP joint splint was effective in about half of subjects. [57] (10.1016/j.jhsa.2011.10.038)
• [L1] Orthoses are effective for non-surgical management of pediatric and adult trigger finger using various orthotic options. [58] (10.1016/j.jht.2023.05.016)
• [L2] Open release is an effective treatment for trigger finger with limited need for nonprescription drugs, since almost all patients reported full resolution of triggering within 6 weeks, and analgesic use was minimal. [61] (10.1016/j.jhsa.2025.12.006)
• [L4] The study demonstrates that procedure room-based treatment of trigger finger is less costly than release in the OR. [63] (10.1097/gox.0000000000002509)
• [L3] Management of diabetic trigger finger with immediate surgical release in the clinic is the most cost-effective treatment strategy, assuming a corticosteroid injection failure rate of at least 34%. [64] (10.1016/j.jhsa.2016.08.007)
• [L4] US can detect various lesions in clinical trigger fingers, and some US findings correlated with clinical findings. [66] (10.1007/s00296-009-1165-3)
• [L4] This is the first reported case of triggering pathology at the wrist to be treated with interventional radiological measures rather than open surgery and demonstrates the efficacy of the technique. [68] (10.1177/1753193412453699)
• [L4] This case supports the inclusion of metacarpal head osteochondroma in the differential diagnosis of a 'trigger finger.' Advanced imaging is critical for identifying bony prominences causing locking when common etiologies are absent. [71] (10.1016/j.jhsg.2023.03.010)
• [L4] [74] (10.4055/cios.2012.4.4.263)
• [L5] [77] (10.1007/s12178-007-9012-1)
• [L3] Patients with greater volar migration of the flexor tendons after CTR are at a higher risk of developing trigger finger. [88] (10.1177/1753193413479506)
• [L1] Simultaneous steroid injection at the time of surgical release provides greater subjective improvement in the early period after percutaneous trigger finger release. [89] (10.1177/1753193418813771)
• [L3] This study provides new conclusive evidence that the repetitive power grip and flexion involved in rowing increase the prevalence of trigger finger. [90] (10.1177/1558944720918321)
• [L4] In the thumb, the flexor tendon and A1 pulley thickened significantly only after patients exhibited triggering. [92] (10.1016/j.jhsa.2012.06.027)

References

[1] Long-Term Outcomes Following a Single Corticosteroid Injection for Trigger Finger. Journal of Bone and Joint Surgery. 2014. DOI: 10.2106/jbjs.n.00004

[2] Risk Factors for Complications of Open Trigger Finger Release. HAND. 2014. DOI: 10.1007/s11552-014-9716-9

[3] From diagnosis to rehabilitation of trigger finger: a narrative review. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-024-08192-5

[4] Early Patient Satisfaction with Different Treatment Pathways for Trigger Finger and Thumb. Journal of Hand and Microsurgery. 2015. DOI: 10.1007/s12593-015-0203-5

[5] Campbell S Operative Orthopaedics 4 Volume Set. EXCISION OF NECROTIC MUSCLES COMBINED WITH NEUROLYSIS OF MEDIAN AND ULNAR NERVES FOR SEVERE CONTRACTURE > REFERENCES > TRIGGER THUMB AND TRIGGER FINGER.

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[13] Factors Causing Prolonged Postoperative Symptoms Despite Absence of Complications After A1 Pulley Release for Trigger Finger. The Journal of Hand Surgery. 2019. DOI: 10.1016/j.jhsa.2018.06.023

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[33] Pediatric Trigger Finger due to Osteochondroma. HAND. 2016. DOI: 10.1177/1558944715627634

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[43] Office-Based Open Trigger Finger Release Has a Low Complication Rate. Journal of Hand Surgery Global Online. 2022. DOI: 10.1016/j.jhsg.2022.01.008

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[49] Adverse Events of Open A1 Pulley Release for Idiopathic Trigger Finger. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2012.05.014

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[51] Incidence and Predictors of Subsequent Triggering Requiring Treatment After Trigger Finger Release. The Journal of Hand Surgery. 2026. DOI: 10.1016/j.jhsa.2025.02.009

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[54] Relationship of Carpal Tunnel Release and New Onset Trigger Finger. The Journal of Hand Surgery. 2019. DOI: 10.1016/j.jhsa.2018.10.003

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[58] Orthotic intervention options to non-surgically manage adult and pediatric trigger finger: A systematic review. Journal of Hand Therapy. 2023. DOI: 10.1016/j.jht.2023.05.016

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[64] Cost of Immediate Surgery Versus Non-operative Treatment for Trigger Finger in Diabetic Patients. The Journal of Hand Surgery. 2016. DOI: 10.1016/j.jhsa.2016.08.007

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[71] Metacarpal Neck Osteochondroma: An Atypical Cause of “Trigger Finger”. Journal of Hand Surgery Global Online. 2023. DOI: 10.1016/j.jhsg.2023.03.010

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[89] Effects of simultaneous steroid injection after percutaneous trigger finger release: a randomized controlled trial. Journal of Hand Surgery (European Volume). 2018. DOI: 10.1177/1753193418813771

[90] Trigger Finger From Ocean Rowing: An Observational Study. HAND. 2020. DOI: 10.1177/1558944720918321

[92] Sonographic Appearance of the Flexor Tendon, Volar Plate, and A1 Pulley With Respect to the Severity of Trigger Finger. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2012.06.027