From the Guidelines
Trigger finger management should begin with conservative approaches, prioritizing rest, activity modification, and non-pharmacological interventions to reduce symptoms and improve quality of life. The primary goal of managing trigger finger is to control symptoms, such as pain and stiffness, and to optimize hand function, in order to maximize activity, participation, and quality of life 1. Initially, patients should be encouraged to reduce activity to decrease repetitive loading of the damaged tendon, as recommended by the American Family Physician in 2005 1. However, more recent guidelines from the EULAR recommendations for the management of hand osteoarthritis in 2019 emphasize the importance of individualized management, taking into account the localization and severity of the condition, as well as comorbidities 1.
Some key considerations in trigger finger management include:
- Rest and activity modification to reduce repetitive gripping motions that aggravate the condition
- Over-the-counter NSAIDs like ibuprofen or naproxen to reduce inflammation and pain
- Splinting the affected finger in extension, particularly at night, to prevent locking
- Corticosteroid injections into the tendon sheath for more significant symptoms, with up to three injections spaced 4-6 weeks apart
- Surgical release of the A1 pulley through either open or percutaneous techniques if conservative measures fail after 3-6 months, with a high success rate of over 95%
It is essential to note that management of trigger finger should be based on a shared decision between the patient and the health professional, taking into account the patient's preferences, values, and individual circumstances 1. Additionally, optimal management of trigger finger usually requires a multidisciplinary approach, considering non-pharmacological modalities, pharmacological options, and surgery as needed 1.
From the Research
Trigger Finger Management Options
- Conservative management: includes NSAIDs, hand splints, corticosteroid injections, physical therapies such as external shock wave therapy (ESWT) and ultrasound therapy (UST) 2
- Surgical treatment options: percutaneous A1 pulley release and open A1 pulley release, excision of a slip of the flexor digitorum superficialis 3
Conservative Management
- Corticosteroid injection: a common nonoperative treatment, with optimal dosage still being researched 4
- Orthotic management: immobilizing a single joint of the affected digit for 6-10 weeks can be effective in reducing pain and triggering symptoms 5
- Physical therapies: ESWT and UST have been shown to be effective in reducing pain and trigger severity, and improving functional level and quality of life 2
Surgical Management
- Percutaneous A1 pulley release and open A1 pulley release: safe and effective options for trigger finger management 3, 6
- Excision of a slip of the flexor digitorum superficialis: reserved for patients with persistent triggering despite A1 release or patients with persistent flexion contracture 3