Trigger finger (stenosing tenosynovitis) represents a common musculoskeletal condition that significantly impacts hand function and quality of life. Recent advances in diagnostic tools and therapeutic interventions have expanded the evidence base for clinical decision-making. This comprehensive review synthesizes the latest research, with particular focus on findings published in 2024-2025, regarding the pathophysiology, diagnostic approaches, and management strategies for trigger finger. Ultrasound-guided procedures, finger gliding exercises, and interdisciplinary care protocols have emerged as important areas of investigation. This review highlights the evolving understanding of trigger finger's complex pathophysiology, the refined role of ultrasound in diagnosis and intervention, and the evidence for conservative, interventional, and surgical approaches. The latest findings suggest that interdisciplinary care protocols incorporating both conservative and procedural interventions achieve optimal outcomes. Despite advances, there remain significant gaps in our understanding of the comparative effectiveness of various treatment modalities. This review provides clinicians with up-to-date evidence to inform their approach to patients with trigger finger.
Trigger finger, also known as stenosing tenosynovitis, is a prevalent condition characterized by painful catching or locking of the affected digit during flexion and extension. It significantly affects hand function and quality of life, with a lifetime risk of 2.6% and representing the fourth most common reason for referral to hand surgeons (Choi et al., 2025). The condition typically involves the A1 pulley at the metacarpophalangeal joint, though it can also occur at the A2 (proximal interphalangeal joint) or A3 (distal interphalangeal joint) pulleys (Jeanmonod et al., 2024).
The pathophysiology of trigger finger involves narrowing of the flexor pulley sheaths with hypertrophy and inflammation at the tendon-sheath interface, leading to nodule formation on the tendon. These changes impair the smooth gliding of the flexor tendons within their sheaths, resulting in the characteristic symptoms of pain, clicking, and locking (Donati et al., 2024).
Recent years have witnessed significant advances in our understanding of trigger finger's complex pathophysiology, refined diagnostic approaches, and innovative management strategies. Ultrasound has emerged as a valuable tool for both diagnosis and guided interventions, while novel therapeutic approaches such as extracorporeal shock wave therapy (ESWT) have joined traditional conservative treatments in the clinical armamentarium (Donati et al., 2024).
This review aims to provide a comprehensive synthesis of recent advances in trigger finger management, with particular focus on findings published in 2024-2025. It explores diagnostic approaches, conservative treatments, interventional procedures, surgical options, and interdisciplinary care protocols, while highlighting areas requiring further investigation.
Trigger finger exhibits a bimodal incidence pattern, with the first peak occurring in children under 8 years of age and the second peak between 40 and 50 years in adults. The overall prevalence is approximately 2% in the general population, with a higher incidence in women, particularly in the fifth and sixth decades of life (Jeanmonod et al., 2024). In adults, the condition more commonly affects the dominant hand, with the thumb and ring finger being the most frequently involved digits (Donati et al., 2024).
Several comorbid conditions increase the risk of developing trigger finger, including diabetes mellitus, rheumatoid arthritis, carpal tunnel syndrome, gout, thyroid disease, and amyloidosis (Jeanmonod et al., 2024). Occupational and recreational activities involving repetitive hand movements and prolonged grasping also appear to increase risk (Choi et al., 2025).
The pathophysiology of trigger finger is multifaceted and continues to be elucidated through histopathological studies. The condition arises from a combination of mechanical and biological factors affecting the flexor tendon-pulley system.
The smooth movement of the flexor tendons in the hand is facilitated by a stabilizing mechanism consisting of an inner synovial layer and an outer retinacular layer, known as the pulley system. This system includes five annular pulleys (A1-A5) and four cruciform pulleys (C1-C4) that prevent the tendons from bowstringing during finger flexion (Donati et al., 2024).
In trigger finger, the A1 pulley at the metacarpophalangeal joint is most commonly affected. The thickening and narrowing of this pulley, coupled with progressive degeneration of its inner fibrocartilaginous sliding surface, leads to excessive friction with the underlying tendons. This results in the development of nodular thickenings of the flexor tendons, particularly affecting the flexor digitorum superficialis (FDS) which lies just beneath the A1 pulley (Donati et al., 2024).
Recent histopathological studies have provided deeper insights into the tissue changes associated with trigger finger. Drossos described a three-layered structure of the A1 pulley: an outer vascularized areolar layer, an intermediate layer of chondrocyte-like cells and perpendicularly oriented collagen fibers, and a unicellular or bicellular deep layer in contact with the flexor tendon (Donati et al., 2024).
In pathological trigger fingers, there is progressive thinning and fissuring of the avascular fibrocartilaginous gliding surface, replaced by vascular network hyperplasia that originates from the outer layer and invades the synovial space of the tendon sheath (Donati et al., 2024).
Molecular studies have identified upregulation of specific collagen fibers and downregulation of metalloprotease-3 variants in trigger finger tissue, though a hereditary link has not been established (Donati et al., 2024). Additional pathological changes include tendinosis with synovial reaction and inflammation, cartilaginous metaplasia of pulleys with increased fibrous thickening, edematous extracellular matrix, and increased hyaluronic acid synthesis (Choi et al., 2025).
Understanding these complex pathological changes has significant implications for treatment approaches, suggesting that interventions targeting different aspects of the pathology might be necessary for optimal management.
The clinical presentation of trigger finger typically includes pain and clicking at the metacarpophalangeal joint, causing functional limitations in grasping and holding objects. Patients often report experiencing digit locking during both flexion and extension, with extension typically presenting more pronounced challenges (Jeanmonod et al., 2024).
In some cases, a nodular thickening can be identified through careful palpation of the palmar aspect of the hand, and direct compression of the A1 pulley may reproduce the pain. In severe cases, the finger may lock in flexion, requiring painful passive manipulation to achieve extension. Chronic cases may develop capsular contracture at the metacarpophalangeal and/or proximal interphalangeal joints secondary to global hypomobility of the finger (Donati et al., 2024).
Several clinical grading systems and functional assessment tools have been developed to classify trigger finger severity and evaluate treatment outcomes:
These functional assessments are crucial for quantifying treatment efficacy and quality of rehabilitation strategies, providing outcomes that extend beyond simple symptom improvement (Donati et al., 2024).
Ultrasound has emerged as a valuable tool for the diagnosis and assessment of trigger finger, offering high-resolution imaging of the affected structures. The most common sonographic finding is hypoechoic thickening of the A1 pulley, which may involve the entire inverted U-shaped structure (global thickening) or only a part of it (nodular thickening) (Donati et al., 2024).
A diagnostic cut-off value of 0.62 mm for pulley thickness has been established to differentiate trigger finger from a healthy finger, with a sensitivity and specificity of 85%, independent of age, gender, height, and BMI (Donati et al., 2024).
Modern high-frequency ultrasound can detect hypervascularization of the thickened pulley, mainly involving its most superficial portion. This sonographic finding correlates with the histopathological observation of vascular network hyperplasia originating from the outer layer of the pulley. The presence of Doppler signals inside the thickened A1 pulley may suggest persisting with conservative therapies before considering surgical approaches (Donati et al., 2024).
Other common sonographic findings include:
Dynamic sonographic assessment can also confirm in real-time the snapping phenomena between tendons and the pulley system (Donati et al., 2024).
While ultrasound is the preferred imaging modality for trigger finger, plain radiographs may be useful to rule out other conditions such as occult fractures. Magnetic resonance imaging (MRI) and computed tomography (CT) scans are typically unnecessary for diagnosing trigger finger (Jeanmonod et al., 2024).
The management of trigger finger encompasses a spectrum of approaches, from conservative measures to surgical interventions. Recent research has focused on refining these approaches and developing evidence-based protocols for their implementation.
First-line conservative treatment includes modifications of daily activities involving the affected hand, particularly those requiring grasping, acute flexion, or repetitive stresses. Manual therapy with massages of the flexor tendons and forearm muscles, active exercises for tendon gliding, and passive stretching of the flexor tendons and joint capsules form the basic principles of rehabilitation management (Donati et al., 2024).
Specific exercises include:
A 2025 randomized clinical trial by Choi et al. evaluated the effectiveness of finger gliding exercises in patients who had received corticosteroid injections for trigger finger. The exercises included three basic fist positions: straight-fist (maximum FDS excursion), hook (maximum differential gliding), and full fist (maximum FDP excursion). Participants performed these exercises twice daily for 24 weeks. However, the study found no statistically significant differences in Numerical Pain Rating Scale scores, Quinnell grading, finger improvement rate, recurrence of triggering, need for repeated injection, or occurrence of new trigger finger sites compared to the control group. The exercise log response rate was 85.6%, and the compliance rate was 68.6%, suggesting good adherence to the exercise program (Choi et al., 2025).
Orthoses aim to reduce movement of finger flexor tendons and their repetitive impingement with the overlying pulley. Different types of orthoses can be used to selectively block various joints of the affected finger:
The optimal duration of orthotic treatment is generally 6-10 weeks, with the choice of orthosis based on patient-specific factors and the degree of symptom relief provided (Donati et al., 2024).
ESWT has emerged as a novel therapeutic approach for trigger finger. This modality uses sound waves to maximize pressure in the target tissue over a few nanoseconds, stimulating healing processes, soft tissue neovascularization, and neural modulation of local nociceptors (Donati et al., 2024).
A randomized controlled study demonstrated that pain relief and functional improvement after ESWT are dose-dependent, with higher energy flux density (0.01 mJ/mm², 5.8 bar, 1500 impulses, once per week for 4 weeks) producing better outcomes than lower energy (0.006 mJ/mm², 3 bar, 1500 impulses, once per week for 4 weeks) or sham therapy (Donati et al., 2024).
When compared to corticosteroid injection, ESWT has shown similar efficacy in terms of cure rates, pain reduction, and functional improvement, making it a viable non-invasive option, particularly for patients wishing to avoid injections (Donati et al., 2024).
ESWT appears to be most effective in patients with sonographic findings of tendinosis of flexor tendons rather than those with effusion and hypertrophy of the synovial tissue (tenosynovitis) (Donati et al., 2024).
Several other biophysical modalities have been employed in trigger finger management:
Corticosteroid injection remains a first-line treatment for trigger finger, particularly for patients whose symptoms have not resolved after 4-6 weeks of conservative therapy. The success rate ranges from 67% to 90% after the first injection (Choi et al., 2025).
Triamcinolone acetonide appears to be more effective than dexamethasone at 6 weeks, though this advantage is lost by 3 months (Donati et al., 2024). Potential complications include subcutaneous tissue atrophy, bleeding, skin hypopigmentation, and rarely, tendon and pulley ruptures or deep-site infections (Donati et al., 2024).
Compared to other injectable agents such as low-molecular-weight hyaluronic acid or diclofenac sodium, corticosteroids typically provide faster improvement (within 3 weeks), though long-term outcomes may be similar (Donati et al., 2024).
The recurrence rate after corticosteroid injection ranges from 11% to 56%, with most recurrences occurring within the first year (Choi et al., 2025). Risk factors for recurrence include diabetes, carpal tunnel syndrome, multiple trigger fingers, and symptoms persisting over 6 months (Choi et al., 2025).
Ultrasound guidance has increasingly been employed for trigger finger injections and release procedures. For injections, ultrasound guidance allows targeting specific anatomical structures:
A cadaveric study comparing blind versus ultrasound-guided injections found that the dye was observed only in the synovial sheath (optimal outcome) in 70% of sonographically guided injections compared to 15% of blind injections. Moreover, the dye was observed inside the tendon tissue (unsafe outcome) in 30% of blind injections and 0% of sonographically guided injections (Donati et al., 2024).
However, some studies have found no difference in the rate of trigger finger resolution between intra-sheath and extra-sheath ultrasound-guided injections, suggesting that local absorption of corticosteroid by surrounding tissues may be sufficient for clinical efficacy (Donati et al., 2024).
Ultrasound-guided release of the A1 pulley has also shown promising results. A systematic review of 34 studies involving 2114 procedures reported a total success rate of 94% for percutaneous release, with sonographic guidance yielding significantly higher success rates than non-sonographic guidance (Donati et al., 2024).
Another systematic review focused solely on ultrasound-guided release of the A1 pulley reported an overall success rate of 97% among 749 procedures. Minor complications such as hematoma, persistent pain, and transient numbness occurred in 23 cases, with no major complications reported (Donati et al., 2024).
Open surgical release of the A1 pulley is considered the gold standard for trigger finger cases that fail to respond to conservative and injection therapies. The procedure has a high success rate and is recommended in the following circumstances:
Alternative surgical approaches include percutaneous release of the A1 pulley and, for advanced or recurrent cases, division of one or more slips of the flexor digitorum superficialis tendon. The latter approach is particularly recommended for patients with diabetes or rheumatoid arthritis, as well as those with fixed flexion deformities (Jeanmonod et al., 2024).
A 12-year retrospective observational study identified factors associated with recurrence after open surgical release in adult trigger fingers. Receiving more than three steroid injections before surgery and engaging in manual labor increased the risk of recurrence following open A1 pulley release (Jeanmonod et al., 2024).
For patients with advanced trigger finger, characterized by limitations in active or passive range of digit movements, achieving a full range of motion may require reduction flexor tenoplasty and partial or complete resection of the flexor digitorum superficialis tendon, followed by hand physiotherapy and splinting (Jeanmonod et al., 2024).
Recent research has highlighted the value of interdisciplinary care protocols in the management of trigger finger. Yanko et al. (2025) outlined a trigger finger management protocol that redirects referrals for surgical consultations to conservative management first, demonstrating significant benefits in patient outcomes and resource utilization.
In their study, patients initially received a physical therapy assessment and three treatment sessions, with further management determined based on patient presentation. Among 72 patients referred for surgical consultation who were redirected to physical therapy first, 22% resolved with physical therapy alone, 48.5% resolved with 1-2 corticosteroid injections following initial physical therapy, and only 12.5% were ultimately referred back for surgical consultation (Yanko et al., 2025).
This approach facilitated timely access to evidence-based care while providing self-management and education strategies to those requiring further interventions, potentially reducing recurrence rates. The collaborative interdisciplinary protocol demonstrated that conservative management was successful in a majority of cases (Yanko et al., 2025).
Similarly, Donati et al. (2024) emphasized the importance of integrating traditional and novel techniques in a comprehensive rehabilitation approach. They recommended tailoring the rehabilitation strategy based on sonographic findings, with different interventions targeted for patients with tenosynovitis versus those with pulley thickening or tendinosis.
Patients with diabetes mellitus present special challenges in trigger finger management. They typically exhibit a less favorable response to corticosteroid injections and often require surgical intervention (Jeanmonod et al., 2024). Additionally, diabetic patients may experience significant transient elevation in glycemic levels following corticosteroid injections, necessitating close monitoring (Donati et al., 2024).
Trigger finger in children differs from the adult presentation in several important ways. While trigger thumb is more common than trigger finger in pediatric populations, the etiology is believed to be developmental, arising from a mismatch in size between the flexor tendon and its tendon sheath due to fibroblast proliferation (Jeanmonod et al., 2024).
Most cases in childhood are idiopathic, though they may also be associated with congenital metabolic conditions (e.g., Hurler syndrome) or inflammatory conditions (e.g., juvenile rheumatoid arthritis). Conservative approaches with passive exercises have shown success in pediatric trigger finger management, though bilateral cases and those with initial grade 3 severity tend to have less favorable outcomes (Donati et al., 2024).
For infants with trigger thumb, surgical release is often recommended to prevent the development of fixed flexion deformity of the interphalangeal joint (Jeanmonod et al., 2024).
Despite significant advances in the understanding and management of trigger finger, several areas warrant further investigation:
Trigger finger management has evolved significantly in recent years, with advances in diagnostic imaging, conservative therapies, interventional procedures, and surgical techniques. Ultrasound has emerged as a valuable tool for both diagnosis and guided interventions, while novel therapeutic approaches such as ESWT have expanded the treatment armamentarium.
Recent evidence suggests that interdisciplinary care protocols incorporating physical therapy, patient education, corticosteroid injections, and surgical referral when necessary achieve optimal outcomes while minimizing resource utilization. The integration of traditional and novel techniques, tailored to individual patient characteristics and sonographic findings, represents a promising approach to trigger finger management.
Despite these advances, questions remain regarding the comparative effectiveness of different treatment modalities, optimal timing of interventions, and predictive factors for treatment response. Future research addressing these gaps will further refine our approach to this common and potentially disabling condition.
Choi, Y. K., Sit, R. W., Wang, B., Cheuk, C., Lee, M. K., & Leung, K. W. (2025). Clinical effectiveness of Finger gliding Exercise for patients with trigger fingers receiving steroid injection: a Randomized Clinical Trial. Scientific Reports, 15, 5141. https://doi.org/10.1038/s41598-025-89436-9
Donati, D., Ricci, V., Boccolari, P., Origlio, F., Vita, F., Naňka, O., Catani, F., & Tarallo, L. (2024). From diagnosis to rehabilitation of trigger finger: a narrative review. BMC Musculoskeletal Disorders, 25, 1061. https://doi.org/10.1186/s12891-024-08192-5
Jeanmonod, R., Harberger, S., Tiwari, V., & Waseem, M. (2024). Trigger Finger. In StatPearls. StatPearls Publishing.
Yanko, E., Thomson, C., Bourassa, R., Gasmo, C., Le, T., & Crockett, K. (2025). A collaborative interdisciplinary approach for trigger finger management. Journal of Hand Therapy, (Ahead of print). https://doi.org/10.1016/j.jht.2024.12.003
