Trigger Finger and Trigger Thumb

Trigger finger and trigger thumb are common conditions affecting the tendons in the fingers and thumb, causing pain, stiffness, and difficulty with movement. These conditions occur when the tendon sheath becomes inflamed and narrowed, restricting the smooth motion of the affected tendon. This article explores the pathophysiology, symptoms, diagnosis, treatment options, and prognosis for both trigger finger and trigger thumb.

How Common It Is and Who Gets It? (Epidemiology)

Trigger finger and trigger thumb can affect individuals of all ages, but they are more common in adults, particularly those aged 40 to 60. Women are more likely to develop these conditions, and certain medical conditions like diabetes and rheumatoid arthritis can increase the risk. Occupations that involve repetitive hand movements or excessive gripping also contribute to a higher incidence of these disorders.

Why It Happens – Causes (Etiology and Pathophysiology)

Trigger finger and trigger thumb occur due to inflammation and thickening of the tendon sheath, most commonly around the A1 pulley. This narrowing causes a restriction that prevents the tendon from sliding smoothly through the sheath, leading to pain and stiffness. Repetitive motion, gripping, and underlying conditions such as diabetes and rheumatoid arthritis can contribute to tendon irritation and inflammation. In many cases, the exact cause of the inflammation is unknown.

How the Body Part Normally Works? (Relevant Anatomy)

The tendons in the fingers and thumb are housed in sheaths that allow for smooth movement when the digits bend and straighten. The A1 pulley, a fibrous structure, helps guide the tendons in their movement. When inflammation causes the tendon to thicken, it cannot glide smoothly through the sheath, resulting in the “catching” or “locking” sensation typical of trigger finger and trigger thumb.

What You Might Feel – Symptoms (Clinical Presentation)

The primary symptom of trigger finger and trigger thumb is a “catching” or “locking” sensation during movement. This may start as a mild, intermittent issue but can progress to a point where the finger or thumb becomes locked in a flexed position. Additional symptoms include:

• Pain, particularly in the morning or with activities involving gripping

• A palpable nodule at the base of the affected finger or thumb

• Clicking or popping sounds when moving the affected digit

• In severe cases, permanent flexion of the finger or thumb

How Doctors Find the Problem? (Diagnosis and Imaging)

Trigger finger and thumb are usually diagnosed based on physical examination. The physician will assess the affected area for tenderness, swelling, and restricted movement. Special tests such as the “triggering” or “catching” of the finger, as well as ultrasound or MRI, may be used to rule out other conditions, although these imaging studies are not typically necessary. Most diagnoses are made through clinical presentation alone.

Classification

Trigger finger and thumb are classified based on severity. Early stages may involve intermittent symptoms, while more advanced stages can lead to persistent pain and stiffness, with the digit locking in a flexed position. The condition may be classified as mild, moderate, or severe, with severity often guiding treatment decisions.

Other Problems That Can Feel Similar (Differential Diagnosis)

Conditions such as rheumatoid arthritis, tenosynovitis, and other forms of arthritis can mimic the symptoms of trigger finger and thumb. It is also important to distinguish trigger finger from fractures, infections, or other musculoskeletal issues that may cause similar pain or stiffness in the hand and fingers.

Treatment Options

Non-Surgical Care

• Splinting: Splints are used to keep the affected finger or thumb in a neutral position, preventing movement that could aggravate the condition. Splints may be worn during the day or at night, depending on symptom severity.

• Corticosteroid Injections: For many patients, steroid injections into the tendon sheath can reduce inflammation and provide significant relief, especially in the early stages.

• Physical Therapy: Gentle exercises and stretches can improve the range of motion and reduce stiffness in the affected joint.

Surgical Care

If conservative treatments fail, surgery may be necessary. The two primary surgical options are:

• Percutaneous Release: A minimally invasive procedure that involves using a needle to cut the A1 pulley and relieve pressure on the tendon. While effective, this carries a risk of nerve damage and recurrence.

• Open Release Surgery: In more severe cases, or if percutaneous release is not suitable, open surgery may be performed. This involves removing or cutting the A1 pulley, allowing the tendon to move freely. It has a high success rate, though it carries a slightly higher risk of complications.

Recovery and What to Expect After Treatment

After surgery, patients typically wear a splint for two weeks to rest the wrist and prevent accidental injury. Stitches are removed after two weeks, and patients may continue to use the splint for a few more weeks during activities or at night. Most patients can return to work or light duties within a month, with full recovery occurring within 6 to 8 weeks.

Possible Risks or Side Effects (Complications)

Complications of treatment for trigger finger and thumb include infection, nerve injury, scarring, and recurrence of symptoms. Surgery, particularly the open release method, carries a higher risk of complications than conservative treatments, though most patients experience positive outcomes.

Long-Term Outlook (Prognosis)

With proper treatment, the prognosis for trigger finger and thumb is generally good. Many patients achieve full recovery with nonsurgical treatments such as splinting and corticosteroid injections. Surgical treatment has a high success rate, with most patients regaining full function. Recurrence of symptoms is rare, but it can happen, especially in more severe cases.

Out-of-Pocket Costs

Medicare

CPT Code 26055 – Trigger Finger Release / Trigger Thumb Release: $136.75
CPT Code 20550 – Injection (Trigger Finger/Thumb): $13.39

Under Medicare, 80% of the approved amount for these procedures is covered once your annual deductible has been met. The remaining 20% is typically the patient’s responsibility. Supplemental insurance plans—such as Medigap, AARP, or Blue Cross Blue Shield—generally cover this 20%, leaving most patients with little to no out-of-pocket expenses for Medicare-approved procedures. These supplemental plans work directly with Medicare to ensure full coverage for treatments like trigger finger/thumb release and injections.

If you have secondary insurance—such as Employer-Based coverage, TRICARE, or Veterans Health Administration (VHA)—it functions as a secondary payer once Medicare processes the claim. After your deductible is satisfied, the secondary plan may cover any remaining balance, including coinsurance or any uncovered charges. Secondary plans typically have a modest deductible, ranging from $100 to $300, depending on the policy and network status.

Workers’ Compensation
If your trigger finger/thumb condition is work-related, Workers’ Compensation will fully cover all treatment-related costs, including surgery and rehabilitation. You will have no out-of-pocket expenses under an accepted Workers’ Compensation claim.

No-Fault Insurance
If your trigger finger/thumb condition is the result of a motor vehicle accident, No-Fault Insurance will cover the full cost of your surgery and any other medical treatments. The only possible out-of-pocket cost may be a small deductible depending on your individual policy terms.

Example
Jane, a 62-year-old patient with trigger thumb, underwent a trigger thumb release (CPT 26055) and received an injection (CPT 20550) for pain relief. Her estimated Medicare out-of-pocket cost was $136.75 for the surgery and $13.39 for the injection. Since Jane had supplemental insurance through Blue Cross Blue Shield, the 20% that Medicare did not cover was fully paid, leaving her with no out-of-pocket expenses for the procedures.

Frequently Asked Questions (FAQ)

Q. What is trigger finger and trigger thumb?
A. Trigger finger and trigger thumb are conditions where a finger or thumb locks in a flexed position due to inflammation and thickening of the tendon sheath, causing restricted movement.

Q. How is trigger finger diagnosed?
A. Diagnosis is typically made through physical examination, focusing on symptoms such as pain, tenderness, and restricted movement. Additional imaging tests may be used in certain cases.

Q. What are the treatment options for trigger finger?
A. Treatment options include conservative methods like splinting, corticosteroid injections, and physical therapy. In severe cases, surgery may be required to release the tendon sheath.

Q. How long does it take to recover from surgery for trigger finger?
A. Recovery can take 6 to 8 weeks, with most patients returning to light duties after about a month and resuming full activity within 6 to 8 weeks.

Summary and Takeaway

Trigger finger and trigger thumb are treatable conditions that cause pain, stiffness, and restricted movement due to tendon sheath inflammation. While nonsurgical treatments like splinting and corticosteroid injections are often effective, surgery may be necessary in more severe cases. With early intervention, the prognosis for both conditions is generally positive, and most patients regain full function after treatment.

Clinical Insight & Recent Findings

A recent study analyzed the epidemiology and management of pediatric trigger thumb using nationwide birth cohort data. The study revealed an incidence of 6 per 1,000 births for trigger thumb, with a significant prevalence of concurrent congenital malformations, such as renal agenesis and cleft palate, in children with trigger thumb.

Despite these associations, no developmental delays were observed in these children, with no significant differences in developmental milestones across key domains such as gross and fine motor skills. The study highlights the need for careful screening for congenital comorbidities in children with trigger thumb but reassures that developmental outcomes are typically unaffected by the condition (“Study on pediatric trigger thumb and congenital malformations – See PubMed“).

Who Performs This Treatment? (Specialists and Team Involved)

Orthopedic surgeons, hand surgeons, and physical therapists are typically involved in the diagnosis and treatment of trigger finger and thumb. Surgical intervention is often performed by orthopedic or hand surgeons specializing in upper extremity conditions.

When to See a Specialist?

If you experience persistent pain, stiffness, or locking in your finger or thumb, it is important to see a specialist for evaluation and treatment. Early intervention can help prevent the condition from worsening.

When to Go to the Emergency Room?

You should seek emergency care if you experience sudden, severe pain, loss of function, or signs of infection following surgery, such as increased redness, swelling, or fever.

What Recovery Really Looks Like?

After treatment, patients typically experience some discomfort during the recovery process, especially following surgery. Most people can return to light activities within a month, but full recovery may take several weeks, depending on the severity of the condition.

What Happens If You Ignore It?

If left untreated, trigger finger or thumb can result in permanent tendon damage, causing long-term dysfunction of the affected digit. In severe cases, the digit may remain locked in a flexed position, significantly impairing hand function.

How to Prevent It?

Preventive measures include avoiding repetitive hand motions, taking breaks during activities that involve excessive gripping, and performing exercises to maintain flexibility and strength in the fingers and thumbs.

Nutrition and Bone or Joint Health

Maintaining a balanced diet rich in nutrients like calcium and vitamin D is important for joint health. Regular exercise and maintaining a healthy weight can also reduce the risk of developing trigger finger or thumb.

Activity and Lifestyle Modifications

Modifying activities to reduce strain on the hands and wrists, such as using ergonomic tools or taking frequent breaks, can help prevent the onset or progression of trigger finger and thumb.