What are non-injection therapeutics for stenosing tenosynovitis (trigger finger)?

From the Guidelines

Non-injection treatments for trigger finger include rest, activity modification, splinting, and oral medications, with splinting being a highly recommended option, as it can prevent the flexed position that exacerbates symptoms and allow the inflamed tendon sheath to heal 1.

Non-Pharmacological Treatments

• Rest and activity modification involve avoiding activities that aggravate symptoms and reducing repetitive gripping or grasping motions.
• Splinting the affected finger in extension, particularly at night for 6-8 weeks, can be effective by preventing the flexed position that exacerbates symptoms and allowing the inflamed tendon sheath to heal.
• Commercially available or custom-made splints can be used.
• Gentle stretching and strengthening exercises can maintain mobility and prevent stiffness.

Pharmacological Treatments

• Oral non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (400-800mg three times daily) or naproxen (250-500mg twice daily) can help reduce inflammation and pain, as they inhibit prostaglandin synthesis, thereby decreasing inflammation in the tendon sheath 1.
• Topical NSAIDs and capsaicin are also effective and safe treatments for hand OA, and can be used for trigger finger treatment 1.

Additional Treatments

• Heat or ice therapy may provide temporary symptom relief.
• Education concerning joint protection and an exercise regimen involving both range of motion and strengthening exercises are recommended for all patients with hand OA, and can be applied to trigger finger treatment 1.
• Local application of heat, especially before exercise, and ultrasound are beneficial treatments, although the evidence for ultrasound is limited 1. It is essential to note that these conservative measures are most effective for mild to moderate cases and when implemented early, and if symptoms persist beyond 6-8 weeks of consistent non-injection therapy, other interventions like corticosteroid injections or surgery may be necessary 1.

From the FDA Drug Label

Diclofenac has analgesic, anti-inflammatory, and antipyretic properties. The mechanism of action of diclofenac sodium topical solution, like that of other NSAIDs, is not completely understood but involves inhibition of cyclooxygenase (COX-1 and COX-2).

Non-injection therapeutics for trigger finger may include:

• Topical diclofenac sodium solution 2, which has anti-inflammatory properties that may help reduce inflammation and pain associated with trigger finger. Note that the label does not explicitly mention trigger finger as an indication, but its mechanism of action and pharmacokinetics suggest it may be useful in treating inflammatory conditions.

From the Research

Non-Injection Therapeutics for Trigger Finger

• Non-injection therapeutics for trigger finger include:
  • Activity modification 3
  • Splinting 3, 4
  • External shock wave therapy (ESWT) 5
  • Ultrasound therapy (UST) 5
  • Finger gliding exercises 6
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) 5, 7
  • Physical therapies 5
• These treatments aim to reduce pain and trigger severity, improve functional level and quality of life, and prevent the recurrence of trigger finger symptoms.

Effectiveness of Non-Injection Therapeutics

• ESWT has been shown to be an effective and safe therapy for the conservative management of trigger finger, reducing pain and trigger severity and improving functional level and quality of life 5.
• UST has been found to be useful in preventing the recurrence of trigger finger symptoms 5.
• Finger gliding exercises have not been shown to have a significant effect on trigger finger symptoms when used in conjunction with steroid injections 6.
• Surgical treatment has been found to have the best efficacy among treatments for trigger finger, with significantly better success rates than steroid injection at all follow-ups 7.