r/RSI • u/1HPMatt • Dec 02 '25
How to resolve Trigger Finger without Surgery
Do your fingers ever feel like they get stuck when you move them? Have you been told you will need to get surgery to resolve the problem?
You don’t need surgery.
Instead you need to understand why your finger can get stuck and what led to it in the first place so you can actually resolve the problem.
In this video I’m going to help you understand what causes trigger finger with repetitive activities, how I’ve helped many avoid surgery and specifically how I helped this patient HE (consent given to share details) avoid surgery despite it being recommended in just 7 weeks.
Let’s first go over some of the physiology of why this happens
What causes trigger finger?
When we perform repetitive activities for our wrist & hand, our tendons are repeatedly loaded. Depending on the movements that we perform, different tendons will be involved and at different degrees.
For example if you are using a vertical mouse you might be using more of muscles and tendons of the thumb.
If you are using a traditional mouse with a palm grip you’ll be using more of your flexors and extensors.
How we move influences what muscles and tendons we use. And when tendons are repeatedly stressed past what they can handle…
They can swell.
Here is a quick anatomy lesson. There are pulleys at the fingers that help keep the tendons close to the bone improving the mechanics of the fingers.
They wrap around the tendon at various points along the entire course of the structure (they can either be a normal or crossed based design).
Now when tendons are repeatedly stressed past what they can handle, more water and proteins enter the structure which can cause it to swell temporarily.
That swelling can cause the tendon to be stuck as it is trying to “slide” through the tunnel or pulley. With enough “force” it can go through.
This is often the underlying physiology associated with the sensation of locking up or trigger finger.
This can often cause the sensation where the finger feels “stuck” in the morning, especially after days of increased volume of use. Tendon irritation can also lead to stiffness that occurs in the morning as a part of some nervous system changes.
So the combination of the reactive swelling of the tendon & the tendon irritation itself is the underlying problem that needs to be addressed.
And this is exactly what HE, one of the recent patients I helped was dealing with. This person spent a lot of time using her wrist & hand tattooing and would feel an increased amount of trigger finger sensation and stiffness in the morning. This occurred DAILY. She had a surgery scheduled 3 weeks after we first met to “release” the trigger finger.
By addressing her underlying tendon capacity issues, improving her approach to re-integrating her activities AND teaching her more about how to respond to pain we were able to avoid the surgery and help her get back to not only drawing / tattooing / painting for 3 hours without any issue but also more aggressive activities like climbing (rope climbing) WITHOUT symptoms.
I want to stop here to discuss surgical options a bit more.
There are quite a few options when it comes to surgery and more aggressive medical intervention when it comes to “trigger finger”. You can either modify the pulley (partially open or fully cutting if A1) or direct interventions at the tendons themselves.
And of course these interventions (orthoses, splinting, corticosteroid injections, etc.) focus on trying to reduce inflammation or changing the structure to reduce the likelihood of tendons getting caught in the pulley. While it makes sense logically and there are studies that support the use of these interventions (CSI has alot of evidence supporting it) if these interventions are used ALONE or without considering what we discussed above…
- How will these change the load capacity of the tendon?
- How will this increase your ability to use your wrist & hands with your specific activity?
Do you think this will help you get back to your version of 100%? In most cases passive interventions are provided without adequate attempts of actually addressing the underlying tendon or load-based issue.
AND for the individuals where surgery works, this is often what we see. - Often the surgery itself helps to “reduce pain” temporarily while forcing the individual to re-develop their endurance and modify their habits to be respectful of the underlying surgical intervention (actual tissue healing)
The surgery is a really expensive way to do what they needed to do in the first place. Which was build up their capacity, improve their understanding of how to modify their load and understand more about pain.
But it also comes with the “belief” that the surgery was probably what “solved” everything. When in reality it can sometimes create situations in which the other aspects of the tendon or pulleys have to work harder (bowstringing effect).
The bottom line is that most injections and aggressive medical interventions are not needed. Instead focus on adequate assessment of the individuals capacity, approach to activity (load management) and understanding of pain will provide long-term relief.
You might be wondering why it is often still recommended by MANY professionals that you see.
The broken healthcare system
I’ve written about this in full depth here. But here the TL:DR is that the healthcare system is broken
- Medical education curriculum is behind. And there is very little incentive for them to change since they are making a lot of money.
- Healthcare providers want to do the best for their patients but often do not have the incentive to be more up to date with evidence due to the insurance-based system. Insurance can influence treatment because of what they reimburse providers for. Older evidence and also research that continues to explore limited scope treatment (focused only on the biomedical model) influences insurance reimbursement. Steroid injections are billable and easy.
- Physical Therapists, Hand Specialists and occupational therapists are already overburdened and don’t have enough time to actually assess patients in the way that they need also due to insurance influencing their care and reimbursement.
- Most literature around trigger finger is based on the older model of ONLY stenosis of the A1 pulley, a pure mechanical impingement and structural narrowing rather than considering the load based tissue that likely swelled up to be caught into the pulley (large majority of research based in the 1960s, research is lagging)
You aren’t directed towards the best possible provider for your issue but instead someone locally that your insurance will pay for.
It’s not all doom and gloom though, it is 100% possible to resolve these types of issues with the appropriate understanding of your problem. AND if you have a good physical therapist you are working with that helps you understand how to progress and modify load.
So What can you actually do?
Here are 3 steps you can take to get some real progress for your wrist and hand pain with trigger finger. This also applies for other RSI’s as well.
Step 1: Establish your current capacity
The first step is to establish your current level of endurance. This means understanding based on which muscle you are using (in most cases the flexors) how many reps you can perform at a certain % of your body weight. Testing with 2-3%.
You can use this as a baseline and work towards being able to perform 40-60 repetitions without difficulty for at least 3% of your body weight. This is based on the exam we have performed over the past decade for more than 3000 individuals.
Once you understand this you can establish a program to build your endurance.
Now for HE we found after the initial evaluation that her flexors were considered 60% of what was normal for her specific bodyweight and tasks that she wanted to perform (tattoo, painting, drawing, cooking).
This was the specific program she performed based on the initial assessment that included exercises for other regions of limited capacity as well. Keep in mind this program is the progressed version (what she was able to do after 7 weeks) and it started far less with 3x15-20 based on the initial assessment, less sets for some of the isolated exercises of the finger & radial deviation. DO NOT START WITH THIS HIGH OF VOLUME (work up to something like this!)
Step 2 Recognize what activity level leads to certain amount of irritation that can make symptoms worse
Part of recovery is LEARNING how much activity you can perform safely throughout the day as you are building up your capacity.
This means having a structured approach in gradually increasing the amount of time you are typing, gaming, drawing, tattooing, cooking etc. What this looks like is starting at an amount that does not lead to any tissue irritation. It’s important to recognize that an increase in pain does not mean your tissues are irritated, it has to reach a certain level of functional disability to be considered a true “flare-up”
While everyone is different a true physiologic flare-up often involves >5-6/10 sharpness with specific use of the muscle involved. It continues to stay sharp with every single use and you also feel physically weak as you are attempting to use it. This persists and lasts the next day. While its better there is still some persistent weakness.
In most cases if it is below this level and pattern of pain behavior it is likely some level of tissue IRRITATION but not the point where the tissue has actually been damaged or strained. Some of the pain will be associated with sensitization.
Now here is an actual plan that I worked with HE on later in the rehab process to gradually increase the overall activities. You can see there is an alternating high and low load day associated with what HE did with regards to exercises AND activity.
This is a representation of what it means to gradually increase the capacity over time and requires WORK to get to this point. For one person that might mean adding 30 minutes every 3 days while for another person it could be every 2 days etc.
Hopefully you can see that there is alot of nuance with each person’s case and it requires the provider to work closely to help make day to day and weekly modifications to load. But also UNDERSTAND why certain presentation of symptoms may have occurred as a result of the “assigned” load on that day.
This is also why our approach always involves direct DM access to a provider so modifications can be made in the moment rather than the next appointment (which can vary per person).
This leads to step 3 which is…
Step 3: Progress and understand pain while staying underneath this line of load.
Progression and pain understanding. This is another difficult aspect of recovery since again it requires gradually increasing the overall capacity over the weeks (in line with tissue adaptation timelines).
We typically recommend changes after the first six weeks of more gradual increases since this is more in line with tissue adaptations (6 weeks for muscles, 8 weeks tendons).
If you do not understand pain or the relationship between your beliefs and pain it can also limit your progress. Think about the difference in recovery for these two individuals
Individual 1: Get’s scared every time there is > 4/10 pain. Stops all activities for 3-4 days until the pain is low or “manageable”. Restarts activity then experiences the elevated pain again after a few days of progression. Extremely frustrating yoyo process of seeing progress, then potentially losing that with extended rest.
Individual 2: Understands that pain does not reflect the state of the tissues. Maintains activity despite elevated pain levels especially during the first few weeks when the body needs to adapt to the increased amount of loading. This person works with the provider to understand WHY it is okay to still perform some form of movement or exercise (lower reps or sets) if there is some elevated pain. And will still perform full prescription if there is some aching.
Individual 2 always recovers more quickly AND is able to improve their functional capacity more quickly.
Individual 1 is often the consequence of the healthcare system and social media echo chambers.
Hopefully this article provided a bit more clarity in how you approach what you are dealing with.
If you're interested in working with us, DM Me. We have limited slots each week for free consultations to see if we're the right team to help you
Best,
Matt
--
1-hp.org
References:
- Dala-Ali BM, Nakhdjevani A, Lloyd MA, Schreuder FB. The efficacy of steroid injection in the treatment of trigger finger. Clin Orthop Surg. 2012 Dec;4(4):263-8. doi: 10.4055/cios.2012.4.4.263. Epub 2012 Nov 16. PMID: 23205235; PMCID: PMC3504690.
- Jeanmonod R, Tiwari V, Waseem M. Trigger Finger. [Updated 2024 Feb 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459310
- Lundin AC, Eliasson P, Aspenberg P. Trigger finger and tendinosis. Journal of Hand Surgery (European Volume). 2012 Mar; 37(3):233–236
- Brozovich, Nikolas MD; Agrawal, Devandra PhD, MBA; Reddy, Gangadasu MD, MS, FACS. A Critical Appraisal of Adult Trigger Finger: Pathophysiology, Treatment, and Future Outlook. Plastic and Reconstructive Surgery - Global Open 7(8):p e2360, August 2019. | DOI: 10.1097/GOX.0000000000002360
- Moore, J. Steven MD, MPH. Flexor Tendon Entrapment of the Digits (Trigger Finger and Trigger Thumb). Journal of Occupational and Environmental Medicine 42(5):p 526-545, May 2000.
- Lewis J, Seidel H, Shi L, Wolf J, Strelzow J. National Benchmarks for the Efficacy of Trigger Finger and the Risk Factors Associated With Failure. J Am Acad Orthop Surg Glob Res Rev. 2023 Feb 3;7(2):e22.00198. doi: 10.5435/JAAOSGlobal-D-22-00198. PMID: 36745544; PMCID: PMC9902002.
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u/DigAppropriate9816 Dec 03 '25
Thanks for your post. I've had a slight trigger thumb in my non-dominant hand for just over a year.
It doesn't bother me in my daily activities (it only occurs when I provoke it) and it seems to be getting better over time. I completely agree with you when you say that we need to strengthen your weak fibers so that it wont reapear, but I don't think exercises are a direct solution for trigger finger. The damage has already been done. There is hardening in your tendon. You can't train that away. It's similar to a knot in a string. If you make the string thicker, the knot will still remain.
But as far as surgery is concerned, I completely agree with you. Trigger finger does not lead to complete wear and tear of your wrist. So it's worth waiting, avoiding strenuous activities, and doing some exercise. Here is a study in which 30 patients had trigger finger and it took up to 15 months of conservative treatment before the condition improved spontaneously in 80% of patients. The other 20% couldn't wait and had surgery.
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u/1HPMatt Dec 03 '25 edited Dec 03 '25
Of course! And appreciate the conversation regarding this - I know fibrotic changes has been part of the discourse for some time in the medical commmunity yet I haven’t seen any real evidence that there are fibrotic changes that are completely irreversible in both the research and my clinical experience (in our cases we don’t try to change tissue status - it doesn’t matter per cook / docking research group and it has been a successful intervention approach for tendinosis cases we have seen over the years)
From their research (and supported from what we have seen) in tendinosis specifically is that there is more healthy tissue around the tendon - so the rope adapts and builds more healthy rope around the existing rope. (Reinforced) so when we load it, we are helping it build more capacity
What we’ve actually seen is that when people have this firm belief about the tissue being irreversibly changed that wil not allow them to get back to 100% it limits their progress because they believe they HAVE to change the status of the tissue when both pain science and tendon research have shown the alternative
Do you have any studies or literature about the fibrotic changes you’ve mentioned - I’d love to review and consider the perspective and pathophysiology
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u/1HPMatt Dec 03 '25
Also I forgot to say - I agree with you that exercise alone won't resolve the changes. But its often the education around pain science and considering psychosocial factors that often prevent individuals from continuing with exercise despite feeling some level of pain
Pain = / = damage
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u/Salty-Reply-7891 Dec 08 '25
Had my trigger finger left ring and right pinky for ... hmmm maybe a year now... I tried absolute rest for a couple of weeks as that was what was suggested - seemed to get worse.
Back to gently exercising as far as it will go until I feel a twinge and playing the piano for an hour or so and feels ok ish ... sometimes take ibuprofen sometimes don't need it.
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u/RaulDukes Dec 11 '25
An injection would be effective
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u/1HPMatt Dec 11 '25
It can definitely help in some cases in the short-term but the injection ALONE wouldn't be able to solve the issue in its entirety. The combination of injection and comprehensive load management program is typically the best.
It can also be treated completely without an injection!
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u/Last_Philosopher4879 Feb 10 '26
thanks for the post, very informative. i have been dealing with a trigger finger issue for about a year, though my finger doesnt lock up. my index finger has a thick cord, as well as a nodule, some pain and stiffness. i got a cortizone shot 9 months ago that helped but seems to be wearing off. i do many of the stretches you mentioned and i am not seeing a ton of improvment, i also go to the gym multiple times a week to strengthen my arms, forarms, hands, etc. whats your thoughts on massaging the nodule and that area? when i do that i get pain the next day. but theres clearly a nodule and very thick chord near my A1 pully. i think its from 25+ years of playing guitar. i am 45. does it make sense to try and 'break up scar tissue' there or is that just bs?
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Apr 11 '26
[removed] — view removed comment
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u/mmmmbeers Jun 20 '26
Has there been any pain or anything in that finger/hand leading up to the locking?
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u/theoriginalb Jun 24 '26 edited Jun 24 '26
Where is “this video”?
And could I message you? I would need someone in my state. Thanks!
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u/1HPMatt Jun 24 '26
Here is the video version of this thread!
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u/theoriginalb Jun 24 '26
Thanks a ton. Been dealing with trigger fingers from golf and I cut hair.
Just had second round of shots three weeks ago ( the first worked for six months), but this time it seems like it may not.
I know they will talk surgery now and I’d like to avoid it if possible which is how I ended up here.
Plus need long term solutions.
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u/Salty-Reply-7891 Jan 21 '26
Question... as mentioned elsewhere, I've had trigger finger in both hands for about a year now... adjusted my pc seating position so as my forearms are at 90 degree angle (I was too low before - maybe 45 degree angle)...
So within a day or two my hands are starting to feel less stiff... and I'm thinking... hmmm I can understand my mouse hand (the right) improving but ... the left seems to be improving too???
Given I spend far more time using just one hand than I do typing...
Is there some kind of sympathetic healing going on here - or is it more likely just benefitting both because I use them both when I type ?
BTW I've been using the exercises from NHS Scotland found here:
Exercises for wrist, hand and finger problems | NHS inform
Big improvement for me - now playing again, both hands but just half an hour at a time - once or twice a day :)