Trigger Finger Management

No matter how troublesome your trigger finger is NEVER get an A1 pulley release if you are a rock climber.

This can lead to later catastrophic failure of the flexor tendon sheath when you return to climbing and require pulley reconstruction + a year of rehabilitation!

Dealing with Trigger Finger

Trigger finger, when the finger gets stuck in a bent position and is painful to straighten out, is an inflammatory condition that is not uncommon. The tendon swells and gets stuck at the A1 pulley. While not a condition that climbers are predisposed to, it can occur in climbers. Initial treatment with rest (a four-letter word to climbers), anti-inflammatory medications and splinting may be effective. If not, an injection of corticosteroids into the tendon sheath is usually recommended which may resolve the issue. (A study in JBJS by Wojahn et al in 2014 showed 45% of patients responded to a single injection).

The treatment decision on what to do next, if non-operative methods have not worked is simple for most people. An A1 pulley release, done open or percutaneously with ultrasound guidance is highly effective for the average person. But the average person does not put the same stress through their flexor tendon pulleys that climbers do.

I know a very experienced climber that was treated with an A1 pulley release, who returned to climbing and sustained simultaneous ruptures of her adjacent A2, A3 and A4 pulleys and required a pulley reconstruction surgery, and a very lengthy rehabilitation process, and a year off the rock.

So if you are a rock climber with a trigger finger, work with your doctor or health care providers to find treatments to decrease your symptoms and avoid an A1 pulley release like the plague!

The simplest treatment for trigger finger, that is often overlooked is nighttime taping of the proximal interphalangeal joint (PIPJ). Any type of tape will do as long as it doesn’t irritate your skin. Apply it loosely before bed so the PIPJ cannot fully bend which prevents the finger from triggering. Remove the tape in the morning and use the finger normally. Resting the tendon overnight for several weeks usually will get the inflammation to settle down so the triggering stops. In some cases, if the finger triggers during the day, you may have to tape the finger similarly during the day as well for a few days until the swelling resolves.