When Does Trigger Finger Need Surgery?

Baytide Health
5 days ago
3 min read

Trigger finger often improves with conservative care. Learn when splinting, hand therapy, dry needling, or cortisone injections are appropriate—and how to know when surgery is truly necessary.

Trigger finger (stenosing tenosynovitis) is a common hand condition that causes pain, clicking, catching, or locking of a finger or thumb. While the word surgery often comes up early in conversations, the reality is that many cases can be successfully managed without it—if addressed early and treated appropriately.

As a certified hand therapist, I want to walk you through how to decide when surgery is necessary, what conservative care should look like first, and why timing matters.

What Is Trigger Finger?

Trigger finger occurs when inflammation and thickening develop around the flexor tendon and its pulley system (most commonly the A1 pulley). As the tendon glides back and forth, swelling, a nodule or tendon fraying can prevent smooth motion, causing the finger to catch or lock.

If left untreated, this repeated friction can damage the tendon over time, leading to fraying, thickening, and long-term stiffness or weakness.

Step 1: Splinting and Hand Therapy (First-Line Treatment)

The first and most important step in treating trigger finger is conservative care.

Overnight Splinting

A night splint keeps the finger in a neutral or extended position, allowing the tendon to rest and reducing repetitive irritation during sleep. This alone can significantly reduce morning locking and pain.

Hand Therapy

Working with a hand therapist is critical. Therapy focuses on:

Mobilizing surrounding joints (finger, hand, and wrist)
Reducing stiffness and swelling
Improving tendon excursion through guided tendon-gliding exercises
Addressing contributing factors such as grip habits, overuse, or poor biomechanics

The goal is to restore smooth tendon movement before structural damage progresses.

Step 2: Dry Needling to Promote Self-Healing

If symptoms persist, dry needling can be an effective next step.

Dry needling targets tight or irritated tissue within the flexor musculature and along the tendon pathway. Benefits include:

Improved local blood flow
Reduction in muscle tension that contributes to tendon overload
Stimulation of the body’s natural healing response
Decreased pain and inflammation

For many patients, dry needling helps reduce mechanical stress on the tendon and pulley system, allowing continued progress with therapy and exercises.

Step 3: Cortisone Injection

Cortisone injections are often recommended when conservative therapy alone has not fully resolved symptoms.

How Effective Are Cortisone Injections?

Research shows that cortisone injections are effective in approximately 50–70% of cases after one injection, with success rates reported as high as up to 90% in early or mild cases. Effectiveness tends to be lower in:

Long-standing trigger finger
Diabetic patients
Fingers that are already locking frequently

It is important to understand that cortisone does not “repair” the tendon—it reduces inflammation. For some patients, this creates enough space for normal tendon gliding to resume. For others, symptoms may temporarily improve and then return.

Hand therapy before and after injection significantly improves outcomes by addressing the underlying mechanics of the problem.

When Is Surgery Necessary?

Surgery is typically considered when:

The finger becomes fully locked and cannot be actively opened
Conservative care fails after approximately 6 months
Symptoms persist or worsen despite splinting, therapy, dry needling, and/or injection

Timing Matters

If trigger finger remains problematic, surgery is generally recommended within one year of onset. Waiting too long increases the risk of:

Tendon fraying or degeneration
Persistent stiffness
Incomplete recovery of motion or strength

Why Early Treatment Is Critical

Trigger finger is not just an inconvenience. Ongoing catching and locking can damage the tendon, leading to long-term limitations even after surgery. Early intervention improves the likelihood of avoiding surgery altogether—and if surgery is needed, it improves post-operative outcomes.

How a Hand Therapist Can Help

A hand therapist plays a key role at every stage of trigger finger care:

Early diagnosis and education
Customized splinting
Targeted manual therapy and tendon gliding
Adjunct treatments such as dry needling
Pre- and post-injection rehabilitation
Post-surgical recovery and scar management

If you are experiencing finger pain, clicking, or locking, do not wait until it becomes severe. Conservative care is most effective when started early.

Try conservative care for approximately 6 months. If symptoms persist or the finger becomes locked, surgery may be the appropriate next step—ideally within one year to prevent permanent tendon damage.

If you suspect trigger finger, consulting a hand therapist early can make all the difference in your outcome.