Trigger Points that refer pain to the Hand and Fingers
⬇️
Pain Referred to the Palm
Central palm, especially when gripping or during wrist flexion,
Flexor Digitorum Superficialis:
Palm and base of the fingers, especially the middle and ring fingers,
Deep in the palm, often described as an “aching grip”,
Deep pain in the web space between thumb and index finger,
Referral into the palm via neurovascular entrapment,
Thenar Muscles (e.g., Opponens Pollicis, Abductor Pollicis Brevis): Base of the thumb and medial palm.
Pain Referred to the Dorsum of the Hand
➡️ Extensor Indicis: Localized to the back of the hand and index finger.
➡️ Extensor Digiti Minimi: Dorsum of the hand and fifth finger.
➡️ Dorsal Interossei: Pain between the metacarpals, spreading toward the dorsal fingers.
➡️ Extensor Carpi Ulnaris: Dorsomedial hand pain, base of the 5th metacarpal.
➡️ Extensor Carpi Radialis Longus: Dorsal hand near thumb and index finger.
➡️ Extensor Carpi Radialis Brevis: Dorsal hand near thumb and index finger.
➡️ Infraspinatus: Diffuse dorsal hand and finger pain, especially lateral side.
➡️ Teres Minor: Less common but may refer pain to dorsal wrist and hand.
➡️ Latissimus Dorsi: Dorsal hand, ulnar side.
➡️ Triceps Brachii (long head): Posterior hand and 4th/5th fingers.
➡️ Subscapularis: Dorsum of the hand, particularly the 3rd and 4th fingers.
➡️ Rhomboids: Can contribute to dorsal hand pain when combined with nerve involvement.
⬇️
Pain Referred to the Thumb
Volar aspect of the thumb into the pad,
Lateral wrist and base of the thumb,
Dorsal thumb and lateral wrist,
Dorsal thumb and lateral wrist,
Deep aching in the thumb web space,
Scalenes (especially anterior):
Can refer to the thumb and index finger,
Occasionally refers pain to the thumb (radial pattern),
May contribute to radial hand/thumb discomfort,
Thenar pain through median nerve involvement,
Via brachial plexus compression, can mimic carpal tunnel symptoms,
Thenar Muscles:
Base of the thumb, especially during pinching or grasping.
Pain Referred to the Fingers
Index Finger
➡️ Scalenes: Via brachial plexus (C5–C7) - common referral.
➡️ Infraspinatus: Lateral arm to radial hand and index finger.
➡️ Pronator Teres: Through median nerve, affecting 1st–3rd digits.
➡️ Flexor Digitorum Superficialis: Directly into the finger.
➡️ Flexor Digitorum Profundus: Directly into the finger.
➡️ Extensor Digitorum: Dorsal referral.
➡️ Extensor Indicis: Dorsal referral.
➡️ Cervical Spine (C6): commonly overlooked source.
Middle Finger
Infraspinatus: Lateral forearm to middle finger.
Scalenes: Via brachial plexus (C5–C7) — common referral.
Pronator Teres: Via nerve compression.
Extensor Digitorum: Dorsal middle finger.
Flexor Digitorum Superficialis: Volar referral.
Flexor Digitorum Profundus: Volar referral.
Cervical Spine (C7): Often presents in middle finger.
Ring Finger
Flexor Digitorum Profundus: Palmar side.
Extensor Digitorum: Dorsal side.
Subscapularis: Dorsal ring finger and hand.
Teres Minor: May contribute as part of ulnar distribution.
Latissimus Dorsi: Can refer to ring/pinky fingers.
Infraspinatus: May contribute as part of ulnar distribution.
Triceps (long head): Posterior arm to ring finger.
Cervical Spine (C8): Possible referral.
Little Finger (Pinky)
Flexor Digitorum Profundus (ulnar portion): Palmar pinky.
Extensor Digiti Minimi: Dorsal pinky.
Triceps Brachii (long head): Ulnar arm and pinky.
Scalenes: through lower trunk involvement.
Latissimus Dorsi: Posterior shoulder to pinky.
Subscapularis: Dorsal 4th/5th fingers.
Teres Major: May contribute in posterior pinky referral.
Pectoralis Minor: Neurovascular compression to pinky.
Cervical Spine (T1): Pinky and medial hand.
⬇️
Pain Referred to the Web Spaces
Web space between thumb and index finger,
Can produce deep aching in the thumb/index web,
Radial nerve irritation presenting in web areas,
First Dorsal Interosseous:
Web space tension and pain.