Trigger Thumb Causes, Symptoms & Treatment Options

Trigger thumb, or stenosing tenosynovitis of the thumb, is a painful condition that creates a locking or catching feeling when you straighten or bend your thumb. In severe cases, your thumb  gets stuck in a bent position, a clear sign of thumb locking or trigger thumb.

Flexor tendons, long fibrous cords, connect the forearm muscles to the bones that make up the fingers. These tendons normally glide through a sheath when your muscles contract, allowing your fingers to bend. When the tendon nodules become inflamed and swollen, they can’t move easily through the sheath, creating irritation, pain, and painful clicking.

VIDEO: “Trigger Digit” from Viewmedica.com

While the exact cause of trigger thumb is unknown, the condition is more common among athletes who play sports involving repeated and forceful gripping with their fingers and thumbs. People with chronic conditions, such as rheumatoid arthritis, gout, and diabetes are at greater risk. Suffering an acute trauma to the hand may also cause this condition.

Trigger Thumb is most common in these sports:

• Racket sports (tennis, racket ball, squash)
• Golf

Symptoms of trigger thumb typically emerge after chronic, heavy use of the hands rather than a single injury. Symptoms may start with mild discomfort and get progressively worse. Common symptoms include:

• Pain and swelling at the base of  the thumb
• Tenderness or a tendon nodule where the thumb and palm meet
• Stiffness, especially in the morning
• Pain, clicking, or snapping sensations when you bend your thumb
• Thumb locked in a bent position

If you have symptoms of trigger thumb that do not go away or get worse with time, make an appointment to see your doctor. He or she will ask questions about your medical history and physical activity. Your doctor will examine your hand, looking for areas of tenderness, swelling, or signs of triggering, including thumb locking or limited motion at the A1 pulley. Diagnostic imaging may not always be necessary, but can help rule out related conditions like de Quervain’s tendonitis..

Trigger Thumb  is commonly treated without surgery. Conservative treatments include:

• Rest: Avoid activities that involve heavy use of the hands and gripping movements, like racket sports.
• Splinting: A splint, especially when worn at night, may help rest the tendon by keeping it extended.
• Medication: Nonsteroidal anti-inflammatory (NSAID) medication like ibuprofen can be helpful for relieving pain.
• Steroid Injections: Corticosteroid (anti-inflammatory medicine) injections can reduce swelling of the tendons and resolve the triggering sensation.
• Physical Therapy: Gentle exercises can help reduce stiffness and increase mobility in your finger.

Try these exercises to help address your condition:

Below is a PDF of the exercise program.

Trigger Thumb

Your doctor may suggest surgery if your symptoms do not resolve with non-operative treatments. Surgery would involve cutting the tendon sheath at the base of your finger or thumb to make more room for the inflamed flexor tendons to glide. Pain and triggering relief can usually be expected after the operation, although the area may be sore for a few months.

Typically, patients can move their thumb right after surgery, though pain and swelling take several months to fully resolve. Hand therapy may be needed as part of the athlete’s recovery to maximize the thumb’s range of motion.