Integrative Management of Trigger Finger Using Traditional Chinese Medicine and Biomedical Approaches: A Case Report
NAO¹, CBL²
¹Intern Student, BTCM
²Clinical Supervisor, Department of Traditional & Integrative Medicine
Abstract
Background: Trigger finger (stenosing tenosynovitis) is a common degenerative condition characterized by pain, stiffness, and mechanical locking during finger movement, particularly in elderly populations. Conventional treatments include splinting, corticosteroid injection, and surgery, though these may not be suitable for all patients.
Case Presentation: A 72-year-old female presented with chronic trigger finger of the middle finger on the right hand, associated with pain and impaired finger flexion and extension. TCM assessment revealed a normal pulse and a light-red tongue with yellow coating. An integrative acupuncture approach grounded in TCM and biomedical principles was applied, incorporating primary distal points (LI4 and SJ4), supporting channel points, and adjunct therapies including cupping and moxibustion.
Intervention: Treatment used LI4 (Hegu) and SJ4 (Wangu) only with 40 mm filiform needles, following Guangxi University technique, and supporting points along the Lung, Conception Vessel, Pericardium, and Sanjiao channels with 0.25 mm needles. Adjunct therapies promoted systemic circulation, tendon nourishment, and musculoskeletal balance.
Outcome: Immediate resolution of pain and mechanical locking was observed following a single treatment session, with restoration of smooth finger movement. A transient superficial linear skin change was noted post-treatment without adverse effects.
Conclusion: Integrative acupuncture with targeted distal points and supporting points may provide rapid symptomatic relief for trigger finger through combined neuromodulatory, myofascial, and circulatory mechanisms. Future studies are warranted to evaluate reproducibility and long-term outcomes.
Keywords: Trigger finger, acupuncture, LI4, SJ4, Traditional Chinese Medicine, biomedical mechanism, integrative therapy
Introduction
Trigger finger, or stenosing tenosynovitis, results from thickening of the flexor tendon sheath, most commonly at the A1 pulley, which impedes tendon glide and produces mechanical locking during finger movement. Elderly patients are particularly susceptible due to age-related connective tissue degeneration, reduced circulation, and chronic low-grade inflammation.
While conventional management—splinting, corticosteroid injections, and surgical release—is effective, these interventions carry risks such as tendon injury, recurrence, and postoperative stiffness. Acupuncture has been proposed as a conservative, low-risk alternative; however, literature describing both the mechanistic rationale and clinical outcomes remains limited. This report presents a case of trigger finger of the right-hand middle finger, successfully treated with distal acupuncture at LI4 and SJ4, supplemented with supporting points and adjunct therapies, and explained through TCM, biomedical, and kinesiological perspectives.
Case Presentation and Methods
A 72-year-old female presented with chronic trigger finger of the middle finger on the right hand, characterized by pain, stiffness, and mechanical catching during flexion and extension. TCM assessment revealed a normal pulse and a light-red tongue with yellow coating, indicating mild heat and slight Qi and Blood stagnation. The patient had no history of trauma or infection and exhibited no neurological deficits or systemic inflammatory signs.
Acupuncture Intervention: Primary distal points LI4 (Hegu) and SJ4 (Wangu) were selected for their analgesic properties, ability to relax tendons, and capacity to restore smooth finger movement. Needling was performed using 40 mm filiform needles, 0.25 mm in diameter, following Guangxi University technique, with moderate depth, gentle manual stimulation, and standard retention time appropriate for elderly tissue.
Supporting points along the Lung, Conception Vessel, Pericardium, and Sanjiao channels were included to enhance circulation, nourish tendons, tonify Yin, reduce inflammation, and promote systemic balance. Supporting points were needled with 0.25 mm filiform needles.
Adjunct Therapies: Cupping therapy was applied to the upper back and paraspinal region to improve systemic circulation, reduce muscular tension, and support autonomic and immune regulation. Moxibustion was applied to the lower arm to warm the channels, improve Qi and Blood flow, and support patients with cold or deficiency patterns, particularly beneficial in elderly populations.
Rationale: The combined approach aimed to address both local tendon pathology and channel-level imbalance, guided by TCM assessment (pulse and tongue) and informed by biomedical understanding of tendon inflammation and restricted glide.
Results
Immediately following the session, the patient reported complete resolution of pain in the right-hand middle finger, with full, smooth flexion and extension. Mechanical locking and catching were absent. A transient superficial linear skin mark appeared near the needle sites, likely due to local vasodilation and fascial release, but was asymptomatic and self-limiting. No adverse effects were observed.
Discussion
From a TCM perspective, trigger finger arises from Qi and Blood stagnation in the hand channels, often compounded by age-related deficiency of Liver Blood and Kidney Essence. The distal points LI4 (Hegu) and SJ4 (Wangu), needled with 40 mm filiform needles, directly relieve obstruction, relax tendons, and restore smooth finger movement. Supporting points along the Lung, Conception Vessel, Pericardium, and Sanjiao channels, needled with 0.25 mm needles, enhance circulation, nourish tendons, tonify Yin, and maintain systemic balance. Pulse and tongue findings—normal pulse and light-red tongue with yellow coating—indicated mild heat and slight stagnation, guiding selection of points to balance local and systemic dysfunction.
From a biomedical perspective, needling LI4 and SJ4 may modulate peripheral and central pain pathways, reduce inflammatory mediators, and improve microcirculation around the flexor tendon sheath, facilitating tendon glide. Supporting points and adjunct therapies optimize tissue perfusion, reduce myofascial tension, and enhance connective tissue elasticity.
From a kinesiological perspective, distal needling and supporting stimulation restore proprioceptive input, relax peri-tendinous fascia, and normalize tendon mechanics, explaining the immediate functional recovery observed in the right-hand middle finger. The combination of distal primary points with supporting points demonstrates a synergistic integrative effect, where TCM channel theory, biomedical principles, and musculoskeletal mechanics converge to restore pain-free movement.
This case highlights that using only LI4 and SJ4 with 40 mm needles can be highly effective, with supporting points using finer 0.25 mm needles to optimize systemic balance without complicating treatment, providing a practical, low-risk approach suitable for elderly patients.
Conclusion
This case demonstrates that an integrative acupuncture approach utilizing LI4 and SJ4 with 40 mm needles, supported by fine-needle points along relevant channels, guided by pulse and tongue diagnosis, can provide rapid and safe relief of trigger finger of the right-hand middle finger in elderly patients. Integrating TCM theory, biomedical mechanisms, and kinesiology principles clarifies the treatment rationale for scholars and clinicians. Further studies are warranted to evaluate reproducibility, long-term outcomes, and mechanistic pathways for distal acupuncture interventions in tendon disorders.
