Trigger Finger in Vienna
The finger catches as you bend it and springs on with a jerk; in the morning it can sometimes only be straightened with the other hand. Behind this lies a narrow point for the flexor tendon. At my practice in the Orthozentrum Döbling I assess the cause with ultrasound.
In short
In trigger finger (tendovaginitis stenosans) the flexor tendon and the annular ligament at the base joint of the finger no longer fit each other: the tendon is thickened or the ligament narrowed, so the tendon slips through with a jerk. Typical signs are snapping on bending, locking in the morning and tenderness in the palm; a related condition is tenosynovitis. I make the diagnosis from the consultation, the examination and ultrasound. Treatment is conservative at first, with a splint and an ultrasound-guided injection; if the snapping persists, I release the annular ligament in a small day-surgery procedure.
What is a trigger finger?
The flexor tendons run from the palm to the fingertip inside a tendon sheath, held in place by annular ligaments. The first of these, the A1 pulley, lies over the base joint of the finger — and that is exactly where the problem arises: if the tendon is thickened or the ligament narrowed by inflammation, the canal no longer fits the tendon.
On bending, the thickened part still squeezes through; on straightening it catches and springs out with a jerk, and the snapping can turn into a genuine block. The trigger is usually repeated forceful gripping; the condition also occurs more often with metabolic and rheumatic diseases. Above all, the thumb, the middle finger and the ring finger are affected.
Tenosynovitis of the hand
Tenosynovitis (tendovaginitis) is an irritation of the gliding tissue around the tendon, brought on by repeated loading; it shows itself as pulling pain, swelling and sometimes a grating sensation. If it affects the first extensor compartment on the thumb side (tendovaginitis de Quervain), the pain is easily mistaken for osteoarthritis of the thumb saddle joint.
A ganglion (ganglion cyst) feels similarly firm but has a different cause: it arises from the joint capsule, not from the gliding tissue of the tendon. Its location, assessment and treatment are covered on the separate page about the wrist ganglion.
Typical symptoms
- Snapping and jumping — the finger catches and releases with a jerk.
- Locking in the morning — the finger stays bent and has to be straightened out.
- Tenderness in the palm — often with a palpable nodule over the base joint.
- Pain in the middle joint — felt further forward than where the narrow point lies.
- Swelling along the tendon — a sign of the irritated tendon sheath.
- Loss of strength when gripping — the painful movement is avoided.
How I make the diagnosis
First I ask you to describe when and how the finger catches; then comes the clinical examination: I palpate the pulley region in the palm and check how the tendon glides and how well the finger joints move. Ultrasound in the practice takes it further: it shows the tendon in motion, makes fluid in the tendon sheath visible and distinguishes a ganglion. Where needed, I arrange an X-ray or an MRI. If the fingers go numb at night, I think of carpal tunnel syndrome; I place further causes under assessing hand pain.
Treatment: conservative first
I proceed step by step. First the load is adjusted: reduce forceful, repeated gripping, adapt your grips and avoid the movement that provokes it. A splint that rests the base joint at night takes pressure off the irritated site.
If that is not enough, I use ultrasound-guided injection: under direct vision I place the medication exactly where the tendon is caught in the annular ligament. The aim is to calm the inflammation.
For stubborn tenosynovitis, shockwave therapy can be added, and for persistent irritation of the tendon tissue also PRP therapy. For mobility and grip strength I work together with the physiotherapy in the building.
My practice is a private practice, in Austria a Wahlarztordination. I do not settle directly with any public health insurer; you receive an invoice and submit it to your insurer — on request I take care of the submission for you. I explain the process on the page about private practice and reimbursement.
When an operation is necessary
If the finger stays locked despite conservative treatment, or if the snapping returns, I raise the option of a procedure. In the pulley release I open the narrowed A1 annular ligament through a short incision in the palm, so that the flexor tendon runs freely through the canal again. I carry out necessary procedures at the ATOMOS Klinik Währing, the Privatklinik Döbling or the Rudolfinerhaus, and I accompany you from planning through the procedure to aftercare.
Afterwards the hand may and should be moved early, so that the tendon does not stick. I build up load and grip strength step by step. Whether an operation makes sense is not something I decide alone: we look at the findings together and agree on the next step jointly. All the options for the hand and wrist are set out in the overview of hand surgery in Vienna.
Frequently asked
Frequently asked questions about trigger finger
A typical sign is the finger catching as it bends and then releasing with a jerk. Many people notice it first in the morning: the finger stays bent and can only be straightened with the other hand. The spot in the palm is often tender to pressure.
A mild irritation can settle if the load that provokes it stops and the finger is rested in a splint at night. If the snapping persists or the finger locks regularly, the narrow point usually does not go away by itself. Whether waiting makes sense is something we decide together.
With an ultrasound-guided injection I place the medication under direct vision exactly at the irritated narrow point at the annular ligament. The aim is to calm the inflammation so that the tendon glides more freely again. Success cannot be guaranteed; if the snapping returns, I discuss the surgical route.
The procedure is small, performed as day surgery and usually under local anaesthetic. Through a short incision in the palm I release the narrowed annular ligament so that the flexor tendon can glide freely again. Afterwards the finger should be moved early; I take care of the aftercare myself.
Tenosynovitis is an irritation of the gliding tissue around the tendon, usually after unaccustomed loading; it shows itself as pulling pain and swelling. In trigger finger there is also a mechanical narrow point at the annular ligament, which is why the finger snaps as well. On ultrasound the two can be told apart.
Appointments are arranged by telephone on +43 1 2080145, Monday to Friday from 9:00 to 16:00, or by email; as a rule we find an appointment within a week. You do not need a referral. Please bring your e-card, previous findings and any images you have.
Dr. med. Martin Eigenschink
Specialist in Orthopaedics and Traumatology · Specialist in elbow, shoulder and hand surgery
Surgical and conservative treatment of the elbow, shoulder and hand, preferably minimally invasive. Practice at the Orthozentrum Döbling, 1190 Vienna. More about my background
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Medical notice: The contents of this page serve as general information. They do not replace a medical examination, diagnosis or individual advice. Medicine is a constantly evolving field — despite careful research, no guarantee can be given that the content is fully up to date.