Trigger Thumb: How to Heal It and How to Prevent It

©2025 Timothy Agnew

When musician Peter Frampton was at the height of his career in the 1970s, he, like many musicians, suffered with bouts of thumb and finger dysfunctions. Doctors later diagnosed Frampton with inclusion body myositis (IBM) in 2015, a neuromuscular disease that causes weakness and dysfunction in the muscles and tendons. While it affects the hands, it can also wreak havoc on the arms and legs.

The human hand is one of the most sensitive tools on the body. Your fingertips can feel objects thinner than a fraction of a human hair — about 13 nanometers high.

Yet, the real genius is in our thumbs. Unlike the other fingers, it moves independently, arcs across the palm, and locks onto objects with surprising strength.

That opposable movement — the ability to pinch, grip, and press — powers nearly half of everything your hand does. And unlike our fingers that operate with three bones, the thumb uses two.

Frampton’s hands, especially, became nearly unusable as he lost the dexterity of playing the guitar. Although Frampton learned to compensate by playing multiple chords with one finger, for many, stenosing tenosynovitis (ST), also known as trigger finger, can be debilitating. ST impairs hand use and can make simple, everyday hand movements nearly impossible.

Most people don’t understand what ST is, or how to treat it. Like many muscular-skeletal disorders, it can quickly rage into a chronic situation, with many turning to cortisone injections or surgery.

In this piece, I’ll discuss ST and share my years of treating it — and show you how to heal it quickly.

Stenosing Tenosynovitis Explained

ST is a condition where the flexor tendon sheath becomes thickened and inflamed, producing a catching or snapping sensation when flexing or extending the thumb. Imagine the tendons as an A-1 pulley, gently sliding into the sheath as we flex and extend the thumb. Located on the second knuckle of the thumb, this sheath can eventually cause the thumb to seize into a bent position.

While autoimmune pathologies can cause ST development, it’s mostly encouraged by overuse — grasping (excessive flexion) and repetitive movements such as texting on a phone.

Traditional Treatments, Little Relief

Treatment for ST is a mixed bag (see my video below of Broadway composer Steven Orich’s experience before I treated him).

Doctors use braces after ACL knee surgery or a ruptured Achilles tendon, for example, when they must mobilize the joint to prevent further injury. In the case of ST, this is moot.

Many orthopedists recommend braces and splints to minimize movement in the hand, but this is nonsense. I’ve never been a fan of braces or splints. Hindering movement is counterproductive unless that movement causes severe pain. Splinting causes stiffness and the tendon could freeze in the sheath because of lack of mobility.

The best approach is to allow full sliding of the tendon in the sheath, even while it’s inflamed. Our tissues create the chemicals we need to help injuries heal, and these include hyaluronic acid produced when fascia moves and slides against each other. This “acid” helps lubricate tissues and keeps joints moving.

Cortisone injections at the metacarpophalangeal (MP) joint are a band aid treatment. While one or two injections might help, multiple treatments damage the bone and soft tissues by weakening them — think of cortisone as an acid that corrodes the batteries.

How to Treat ST

I once treated a young high school student who presented with a severe case of trigger thumb. The tendon in her right hand froze into a bent position because the sheath was so swollen. As I palpated the MP joint in the fleshy area of her lower thumb, I felt a nodule that was larger than normal. Pressing on it caused pain.

I determined the cause of her ST was from excessive texting, much to the chagrin of her mother’s “I told you so.” After we got the ST under control, I instructed her to use other fingers to text instead of relying on the thumb.

The first step in treatment is to minimize the size of the tendon sheath and enable the tendon to slide as the A-1 pulley it was designed to be.

Cold laser treatments are one of the most effective (and proven) adjunct therapies for ST. It’s non-invasive and painless, and applications are simple (when I practiced, I had two smart lasers that I used extensively with noteworthy results).

Cold laser helps reduce the inflammation of the sheath and helps the body produce the healing compounds it needs. While acupuncture is another valid option, it takes many sessions to get results, and it’s expensive.

I highly recommend icing. I always suggested that my patients use pure ice on the skin instead of ice packs (the packs have a barrier between the skin and cold). Freezing a Dixie cup and using it as an ice massager works well.

Increasing circulation is paramount for any injury, so active range of motion (ROM) of the thumb is prudent if it does not produce pain. I usually manually moved the digits, then showed them how to do it on their own.

Deep pressure massage over the tendon sheath has many benefits, if you can stand the discomfort. Find a provider that is skilled in deep tissue therapy. It’s easy to do on your own as well. Clasping the MP joint with the index finger and thumb and gently (but deeply) rolling the bone in rotation, gliding the thumb over the sheath nodule, helps immensely.

How to Prevent ST

The last bit of treatment is prevention. Changing habits such as texting positions or excessive clasping helps, but strengthening the hands is powerful. How? You should only do the next two exercises when the nodule swelling has almost disappeared and the digit isn't frozen or clicking. Doing these exercises can otherwise irritate the tendon more.

Using a tennis or a toy ball, squeeze the ball in flexion with your arm extended completely (this pulls the fascia taught and makes the exercise more effective). Then, work each digit separately, actively squeezing the ball with each digit (you will cry when you get to the pinky finger). You should do at least three sets of 10 reps with each exercise, repeated 3–4 times per week.

Next, focus on extension exercises—always perform these after flexion movements (again, with an extended arm). You can use a rubber band or purchase an extensor band. Wrap the band around the fingers and open the hand into full extension. As with the ball exercise, you can work each digit separately, especially the thumb.

While you can perform these exercises with active ST, you might experience some discomfort, but push forward. Your goal is to restore the A-1 pulley so it glides naturally in the sheath with no clicking.

To Sum It Up

ST can be a debilitating condition that affects hand movement and can occur in the fingers and thumb. It’s easily treatable with common-sense — ice, cold laser, massage, and active ROM and strengthening.

Prevention is key. Flexion and extension of all the digits keeps the synovial sheath lubricated and strengthens the hand and fingers. Changing poor movement patterns and positions is prudent.