'small-fingered' originates from Modern English as a compound of the adjective 'small' and the participial/adjectival element 'fingered' (from 'finger'), where 'small' ultimately comes from Old English 'smæl' (via Middle English 'smal') meaning 'thin, narrow' and 'finger' comes from Old English 'finger' (from Proto-Germanic *fingraz).

'small' changed from Old English 'smæl' to Middle English 'smal' and then to Modern English 'small'; 'finger' remained from Old English 'finger' (Proto-Germanic *fingraz). The adjectival compound 'small-fingered' is a transparent modern formation combining these elements.

Initially the elements meant 'thin/narrow' (for 'small') and 'finger' as the digit; the compound simply came to mean 'having small fingers' with no major semantic shift beyond the combination of the two parts.