What is Trigger Finger?

a hand showing a pistol grip

A trigger finger can be a painful injury that requires a reduction in climbing intensity if not a period of rest. Still, the more proactive you deal with the pain in your finger, the less this time you’ll need to take off from rock climbing.

In this article, I explain what a trigger finger is, what the symptoms are, how you can treat it, and most importantly, how you can prevent it.

Let’s dive right in!

1. What is Trigger Finger?

Trigger finger or (stenosing) tenosynovitis is an inflammation of the tendon sheath right after the pulley tendon. A tendon sheath is a canal through which a tendon can slide freely without the obstruction of surrounding structures. A trigger finger is characterized by a thickening of the tendon which can’t move freely through the pulley sheath. As a result, your finger might get stuck when bent. The noise you hear when you (forcefully) manage to extend your finger is a “pop”. For this reason, a stenosing tenosynovitis is called a “trigger finger”. A trigger finger mostly occurs at the A1 pulley because that one is the tightest of all the pulley ligaments.

location of trigger finger (stenosing tenosynovitis)
Trigger Finger; inflammation of the flexor tendon behind the A1 pulley. [Image adapted from: THIEME Atlas of Anatomy [Gen. Anat., Musculoskel. Sys.] – M. Schuenke, et. al., (Thieme, 2010)]

As I described above, the main symptom of a trigger finger is a locking of the finger in a bent (flexed) position whereafter extending the finger causes a popping noise. You might be able to do this activity or you might need to help with your other hand. However, it could also be that your trigger finger isn’t locking yet. Here are other symptoms to look for:

  • Stiffness and/or swelling, are usually more pronounced after prolonged inactivity. Like when you wake up in the morning.
  • Loss of mobility in either direction, flexion, and extension.
  • A painful nodule that is palpable near the A1 pulley ligament
  • Thickening of the base of the affected digit

And these are the 6 stages in the development of the trigger finger:

  1. Normal
  2. A painful palpable nodule
  3. Triggering
  4. The proximal interphalangeal (PIP) joint locks into flexion and is unlocked with active PIP joint extension
  5. The PIP joint locks and is unlocked with passive PIP joint extension
  6. The PIP joint remains locked in a flexed position1

The best way to confirm a trigger finger is by using Ultrasound Imaging.

2. Trigger Finger in Rock Climbers

Tenosynovitis of the flexor tendon is one of the most common finger injuries in rock climbers.2 When looking into the prevalence of stenosing tenosynovitis of the finger though, I couldn’t find any data. In the general population, a trigger finger occurs more often in women than in men and mostly between the ages of 40 and 60.

In rock climbers, stenosing tenosynovitis is the result of overload. The grabbing of tiny holds frequently requires a high amount of tension in the flexor tendon which makes it prone to injury.

3. How Does Trigger Finger Occur?

The overload I mentioned above, in the case of a trigger finger, occurs from repeated friction between the flexor tendon and the pulley ligament. This induces inflammation which increases the size of the flexor tendon which in turn causes even more friction.

Normal tenosynovitis is just that. With a stenosing tenosynovitis, however, a nodule develops above the pulley ligament which increases the chance of locking.

The initial overload of these structures can occur acutely after an intense climbing session or build-up over time. Continuous loading of the forearm muscles without proper rest can increases tension. The more tension there is in the forearm flexors the more the tendons get pressed to the bone. This mechanism too can increase the friction between the tendon sheath and the tendon.

4. Conservative Treatment for Trigger Finger

In most cases trigger can be treated conservatively with a combination of anti-inflammatory medication (talk to your doctor about this), splinting, rest, and a variety of physiotherapy modalities which can in part be done at home.

4.1 Rest

Each time you glide the nodule on the flexor tendon through the tendon sheath (which happens when you bend your finger) you increase the irritation. Giving your injured finger time to recover is a great starting point for your healing.

Since your fingers are not only essential for rock climbing but also for your everyday life, splinting might be a good idea to give your finger extra protection.

4.2 Splinting

A splint helps to increase the stretch on the flexor tendon and limits movement so that the inflammation of the tendon sheath has time to heal. Besides, a splint allows you to use your hands without overthinking if what you’re doing might increase irritation of your injury.

Splints can block the metacarpophalangeal joint at 0 to 15 degrees. The best way to go is to use a splint that blocks the MCP joint at 10-15 degrees allowing your finger to make harmless movements in everyday life.1

4.3 Stretching

Stretching of the forearm and the finger flexors helps to build resilience to stretch and can reduce tension in the muscles. But there’s more to it, as things go, when you stretch your forearm muscles you stretch other structures too. Pulling your wrist and fingers back also stretches the connective tissue in between the muscles, the wrist, and the finger joints.

Single Finger Stretch. If you want more stretch extend the wrist as well.

4.4 Releasing Muscles/Connective Tissue of the Forearm

Earlier I mentioned that a trigger finger can be a direct or indirect consequence of hypertension in your forearm flexors. More tension in the muscles means tighter tendons which cause more friction in the pulley ligaments.

That’s why reducing the tension in the forearm flexors can help you reduce the symptoms from a trigger finger. There are plenty of ways to release tight tissues in your forearm, here are some you can consider:

  • Mini massage roll
  • Use your opposite elbow or hand
  • Massage, tennis, or lacrosse ball
  • A “trigger wood”
  • Dry Needling
  • Classical Massage (ask your partner)

4.5 Antagonist Training

If your forearm flexors are tight, it’s great to use any of the aforementioned strategies to reduce the tension. Still, the question remains: why are they tense in the first place?

An obvious reason would be an overload due to little rest between your climbing sessions. Another one that’s a bit harder to figure out though, is if there’s a disbalance between the strength of your forearm and finger flexors and extensors.

How do you know whether this is the case?

Just answer this simple question: do you ever train your forearm extensors? If the answer is anything but a super-confident YES, then I’m sure you’ll benefit plenty from doing antagonist training for your forearm and finger extensors.

Exercises to consider are:

  • Dumbbell Wrist Extension
  • Dumbbell Front Raise
  • Finger Extension into a Theraband
  • Rope Roll-Up’s

4.6 Upstream Postural & Joint Issues

Upstream postural and joint problems mean reduced mobility in all the joints before the trigger finger. These include the:

  • Metacarpal joints
  • Carpal joints
  • Wrist
  • Elbow
  • Shoulder
  • Shoulder blade
  • Thoracic Spine
  • Cervical Spine

Yes, that’s quite a list.

Don’t underestimate though, how limitations in joints alter movement in the joint before and after. A limitation in your shoulder, as an example, can cause inefficient use and therefore hypertension in the forearms.

Still, this doesn’t mean that finger fixing your shoulder will fix your finger. On rare occasions, it might but in general, I know from experience that it’s smart to look at the entire situation surrounding your injury.

4.7 Extracorporeal Shockwave Therapy

Extracorporeal Shockwave Therapy (ESWT) is done by using a machine that generates mechanical pressure waves that are directed through a head at a specific body part. This is called radial shockwave therapy, as opposed to focused shockwave therapy, which creates a tiny heat field in the body part it’s directed at.

At the clinic where I work, we only have Radial ESWT and my results are mixed. The supposed benefits of ESWT have increased blood circulation, increased inflammation (and therefore triggering more healing), increased collagen production, and pain reduction. The scientific evidence for ESWT is there, but it’s little and non-conclusive. My recommendation, therefore, is that if ESWT is available to you, try it for 3-5 sessions. If you notice no effects, let it be. If you notice improvements. Awesome!

5. How to Prevent Trigger Finger?

If you want to prevent trigger finger you have to manage the underlying mechanisms that cause it:

  • Hypertension of the forearm flexors
  • Training overload
  • Inefficient recovery

And mechanisms that might influence it but are out of my area of expertise:

  • High inflammatory diets
  • Hormonal changes

Here’s how to manage the first 3 mechanisms.

5.1 Hypertension of the Forearms

Use the treatment options I mentioned and do antagonist training regularly. I think 1-2x/week if you climb 2-4x times. If you have a part of the year where you climb less, you can increase the number of antagonist training sessions to 3x/week.

The most important way to reduce tension in your forearms though is by managing your training load well.

5.2 Training Overload

The effect of your training is defined by the quantity and the quality of your rest. So, more training doesn’t mean more effectiveness. Even if it seems so, more training is never better if you can’t recover properly. You’re prone to injury, overtraining syndrome, and a reduction of climbing performance instead of your wished-for improvements.

Thus:

  • Take rest days when you don’t feel tired yet
  • Don’t always climb at your limit
  • Focus on technique before strength

And if you go for a more professional approach, periodize your training plan. This helps you to think about your training intensity and rest periods before you start a training phase.

5.3 Inefficiënt Recovery

Even if you take enough rest days from rock climbing, they could be inefficient.

Things to consider when trying to rest well is to:

  • Eat well and plenty full
  • Sleep 7-9 hours (don’t tell me you only need 4-6 hours; I won’t believe you)
  • Drink plenty of water; you know if you drink enough by looking at your pee, it should be light yellow to colorless and you should rarely feel thirsty

6. Takeaway Message

I started this article with the specifics of the trigger finger and finished with the generals on recovery and training.

Like with all overload injuries, and trigger finger is no different, the best way to prevent it is by managing training load and recovery.

7. Citations

1.          Colbourn J, Heath N, Manary S, Pacifico D. Effectiveness of Splinting for the Treatment of Trigger Finger. J Hand Ther. 2008;21(4):336-343. doi:10.1197/j.jht.2008.05.001

2.          Schöffl V, Simon M, Lutter C. Finger and shoulder injuries in rock climbing. Orthopade. 2019;48(12):1005-1012. doi:10.1007/s00132-019-03825-3

Joël Broersma

Hey, I'm Joël, a Dutch Physical Therapist living & working in Switzerland. I'm an avid rock climber and sports & movement lover in general.

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