Is it always the case that trigger finger requires surgery? We have a three-year-old with this condition (middle finger on the left hand). We would just as soon adopt a wait-and-see approach and let nature take its course. But we are worried that he will be permanently stuck with his finger bent. What do you advise?

Triggering is usually the result of a thickening in the tendon that forms a nodule, or knob. The tendons that move the fingers are held in place on the bones by a series of ligaments called pulleys.

The pulley ligament may thicken as well. The constant irritation from the tendon repeatedly sliding through the pulley causes the tendon to swell in this area and create the nodule.

Treatment is usually surgical release. Normally, to keep the tendons moving smoothly under the ligaments, the tendons are wrapped in a slippery coating called tenosynovium. The tenosynovium reduces the friction and allows the flexor tendons to glide through the tunnel formed by the pulleys as the hand is used to grasp objects.

But when thickening and fibrosis (scarring) develop in the synovial lining, it doesn’t go away on its own or even with conservative (nonoperative) care. One exception to that is in the case of trigger finger caused by viral infection. In the rare cases reported, trigger finger in these children went away after a period of time (one to four months).

Your pediatrician and surgeon may agree to a wait-and-see approach for a few weeks up to several months. But an extended period of time (many months to years) is not advised. If there is evidence that the trigger finger was caused by a recent infection (e.g., elevated sed rate), a trial period of waiting is acceptable as well.