Do I have trigger finger or just stiff joints if I experience stiff fingers every morning?

Given your short account of the problem, it would appear that your stiffness is caused by a tendon inflammation (tenosynovitis) - swelling and irritation of the flexor tendons that bend the fingers. At one end of the spectrum (in the acute or active phases) there is pain, swelling and stiffness of the fingers, while on the other end of the spectrum 'Triggering', locking or clicking occurs as the inflamed tendons have difficult passing through tunnel sheaths (called pulleys) that keep them in place. The pain is most tender in the palm around the first knuckle. In severe cases, you may have difficulty fully straightening the finger due to pain and tightness.

Trigger Finger is increasingly common with age, and with specific occupations and activities requiring repetitive hand use and prolonged gripping. People who have diabetes or rheumatoid arthritis are also at higher risk of developing trigger finger.

In your case, it is very likely due to overuse or over-exertion, and a review of your activities might reveal the cause of your tendon inflammation and finger stiffness. Heavy gripping activity is a likely cause, as your little and ring fingers are affected. A common clue that tendon inflammation is due to your occupation for example, is when the stiffness and swelling gets progressively worse from monday to friday, and then subsides over the weekend.

But as you pointed out, differentiating between small joint stiffness of the fingers and tendon inflammation can sometimes be difficult. In addition, there are many causes of inflammation or 'arthritis' of the small joints of the fingers, and these need to be considered and excluded; a visit to the doctor for a thorough examination and consultation is advised.

Best Regards,

Dr Jonathan Lee

The most common cause of the symptoms described is trigger finger. Trigger finger is a condition where the tendons controlling flexion of the digit become inflamed and swollen. As these tendons glide in and out within a fitting tunnel called a tendon sheath, any increase in girth of these tendons can disrupt the smooth gliding action. Trigger finger is categorized into 4 grades.

Grade 1 trigger finger:

Initially, the additional friction from the swelling of the tendons cause pain when moving the finger. This swelling is usually worse upon waking up in the morning as the swelling accumulates overnight. There is no demonstrable triggering or locking of the finger at this stage.

Grade 2 trigger finger:

As the condition progresses, the finger may start locking or getting stuck in flexion. This may be even more painful as the swollen tendon "clicks" in and out of the opening of the tight sheath.

Grade 3 trigger finger:

3A -

At this stage, the finger becomes locked when in a flexed position and can only be released with some force, usually by pulling it open with the other hand.

3B -

As the tendon swelling worsens, the finger can no longer be flexed fully as the tendon refuses to glide within its sheath. At this stage, the finger actually no longer locks, but the range of motion is significantly reduced and painful.

Grade 4 trigger finger:

This is the end stage of trigger finger where the finger is contractured, or stuck, in a flexed position. The finger looks bent and has minimal range of motion. The bent finger can no longer be straightened and this is called a fixed flexion deformity. At this stage, treatment is usually unsatisfactory as the proximal interphalageal joint (PIPJ) becomes stiff and non-pliable.

Treatment for trigger finger ranges from:

• simple splinting to rest,
• immobilize the inflamed tendon,
• taking non-steroidal anti-inflammatory drugs (NSAIDs),
• more invasive treatment such as corticosteroid injections and
• surgery.

A hand & wrist specialist will be able to advise on the appropriate form of treatment based on the grade of trigger finger one has.