From the Guidelines
Trigger finger treatment should typically begin with conservative management, including rest, pain medications, and splinting, before considering surgical release of the A1 pulley, which has a success rate over 90%. The treatment aims to reduce inflammation and restore smooth tendon movement through the pulley system. According to the most recent evidence 1, ultrasound evaluation can be useful in diagnosing tendon abnormalities, including tendinopathy and tenosynovitis.
Conservative Management
- Rest and avoiding activities that cause pain
- Using over-the-counter pain medications like ibuprofen (400-800mg three times daily) or naproxen (220-500mg twice daily) to reduce inflammation
- Splinting the affected finger in a straight position, especially at night for 6-8 weeks, to prevent the finger from locking
- Physical therapy exercises that gently stretch and strengthen the hand can also be beneficial
Surgical Management
If conservative treatments fail after 3-6 months, surgical release of the A1 pulley (either open or percutaneous) is typically recommended 1. Surgery is a quick outpatient procedure with a recovery period of 2-4 weeks. The success rate of surgical release is over 90%, making it a highly effective treatment option for trigger finger.
Diagnosis and Evaluation
Ultrasound evaluation can be useful in diagnosing tendon abnormalities, including tendinopathy and tenosynovitis 1. However, the diagnosis of trigger finger is often clinical, based on history and physical examination. The treatment should be individualized, taking into account the patient's symptoms, medical history, and response to conservative management.
From the Research
Trigger Finger Treatment Options
- Conservative treatments for trigger finger include NSAIDs, hand splints, corticosteroid injections, physical therapies, and percutaneous or open surgery 2
- Physical therapies such as external shock wave therapy (ESWT) and ultrasound therapy (UST) have been shown to be effective in reducing pain and trigger severity, and improving functional level and quality of life 2
- ESWT is a safe and effective therapy for the conservative management of trigger finger, while UST has been proven to be useful in preventing the recurrence of TF symptoms 2
Comparison of Treatment Methods
- A randomized clinical trial comparing corticosteroid injection, percutaneous release, and open surgery found that percutaneous and open release methods were superior to conservative CS method in terms of trigger cure and relapse rates 3
- The trigger cure rate for patients in the injection method group was 57%, which increased to 86% with two injections 3
- A study comparing steroid injection and NSAID injection for trigger finger found that although steroids gave quicker relief, NSAID injections were equally effective at 3 months 4
Corticosteroid Injections
- The choice of corticosteroid solution can affect clinical outcomes, with triamcinolone requiring additional injections compared to methylprednisolone and dexamethasone 5
- Patients who underwent methylprednisolone injection had surgical release performed earlier and more frequently than the other two groups 5
Orthotic Management
- A systematic review of conservative management of trigger finger found that orthotic management can be effective in reducing pain and improving function, with a recommended immobilization period of 6-10 weeks 6
- The review suggested that future studies should use validated patient-reported outcomes to assess patient function and that more randomized controlled trials are needed 6