What Is Trigger Finger?

Trigger finger (stenosing tenosynovitis) occurs when inflammation narrows the tendon sheath surrounding the finger flexor tendons, creating a constriction that catches on the A1 pulley at the base of the finger. This causes the finger to lock in a flexed position, then suddenly 'trigger' (snap) into extension. It is common in diabetics, patients with rheumatoid arthritis, and people performing repetitive gripping activities.

Grades of Trigger Finger

Grade 1 (Pre-triggering): Tenderness and stiffness at base of finger, no locking. Grade 2 (Active triggering): Catching or snapping during movement, patient can actively unlock. Grade 3 (Passive triggering): Locked finger requires passive manipulation to unlock. Grade 4 (Fixed contracture): Permanently locked in flexion — likely requires surgery.

Conservative Physiotherapy Treatment (Grades 1-3)

Splinting

A finger extension splint holding the MCP joint at 0° (preventing the triggering position) for 6 weeks reduces inflammation and allows the tendon sheath to recover. Evidence supports splinting as effective in approximately 50-60% of grade 1-2 trigger fingers.

Tendon Gliding Exercises

Specific exercises that glide the flexor tendons through the A1 pulley independently maintain tendon mobility and reduce adhesion formation.

Activity Modification

Avoiding repetitive gripping, using larger grip tools, and padding tool handles reduces ongoing irritation of the tendon sheath.

Ultrasound Therapy

Therapeutic ultrasound applied to the A1 pulley area reduces tendon sheath inflammation and may improve outcomes when combined with splinting.