From the Guidelines
Non-surgical management of trigger finger should prioritize relative rest, icing, and eccentric strengthening exercises, as most patients with overuse tendinopathies fully recover within three to six months 1. When managing trigger finger non-surgically, the following steps can be taken:
- Activity modification and rest of the affected finger to reduce repetitive strain on the tendon
- Icing to reduce inflammation and pain
- Eccentric strengthening exercises to promote tendon healing and strengthening
- Topical or systemic nonsteroidal anti-inflammatory drugs (NSAIDs) can be used for acute pain relief, but with caution due to potential side effects 1
- Injected corticosteroids can relieve pain, but should be used with caution and reserved for more significant cases It is essential to note that surgery should be reserved for patients who have failed conservative therapy, as it is an effective treatment option for trigger finger 1. Key considerations in non-surgical management include:
- Avoiding repetitive gripping activities and using the affected finger when possible
- Using orthotics or splinting to support the finger and reduce strain on the tendon
- Modifying techniques to reduce repetitive strain on the tendon
- Considering ultrasonography, shock wave therapy, or massage as additional treatment options, although few data exist to support their use at this time 1
From the Research
Non-Surgical Management of Trigger Finger
- Non-surgical treatment options for trigger finger include activity modification, oral and topical non-steroidal anti-inflammatory drugs (NSAIDs), splinting, and local injections with anti-inflammatory drugs 2.
- Corticosteroid injection is a common non-surgical treatment for trigger finger, with studies suggesting that a 20-mg dose of triamcinolone acetonide may be more effective than lower doses 3, 4.
- The choice of corticosteroid solution may also affect outcomes, with triamcinolone requiring additional injections compared to methylprednisolone and dexamethasone, and methylprednisolone resulting in earlier and more frequent surgical intervention 5.
- NSAID injection may offer little to no benefit over glucocorticoid injection in the treatment of trigger finger, based on low- to very low-certainty evidence from two trials 2.
- Treatment effects for trigger finger may include resolution of symptoms, persistent moderate or severe symptoms, recurrence of symptoms, total active range of finger motion, residual pain, patient satisfaction, and adverse events 2.
Treatment Options
- Activity modification: modifying activities to avoid triggering or exacerbating the condition 6.
- Splinting: using a splint to immobilize the affected finger and reduce triggering 6.
- Corticosteroid injections: injecting corticosteroids into the affected area to reduce inflammation and relieve symptoms 6, 3, 4, 5.
- NSAID injections: injecting NSAIDs into the affected area to reduce inflammation and relieve symptoms 2.
Outcomes
- Resolution of symptoms: the percentage of patients who experience resolution of symptoms after treatment 2.
- Persistent moderate or severe symptoms: the percentage of patients who continue to experience moderate or severe symptoms after treatment 2.
- Recurrence of symptoms: the percentage of patients who experience recurrence of symptoms after treatment 2.
- Total active range of finger motion: the range of motion in the affected finger after treatment 2.
- Residual pain: the level of pain experienced by patients after treatment 2.
- Patient satisfaction: the level of satisfaction reported by patients after treatment 2.
- Adverse events: the number and type of adverse events experienced by patients after treatment 2.