From the Guidelines
Trigger finger recurrence after surgical release is a recognized complication, with recurrence rates ranging from 1-20%, and management typically involves conservative measures first, followed by revision surgery if necessary. The literature discussing revision or recurrent trigger finger after a trigger finger release is limited, but it is acknowledged that common causes of recurrence include incomplete release of the A1 pulley, scarring, or development of trigger finger in adjacent digits 1. Risk factors for recurrence include diabetes, rheumatoid arthritis, multiple trigger fingers, and carpal tunnel syndrome.
Management of Recurrent Trigger Finger
Management of recurrent trigger finger typically involves:
- Conservative measures first, including NSAIDs, splinting, and corticosteroid injections
- Revision surgery if conservative measures fail, which often involves complete release of the A1 pulley and sometimes partial release of the A2 pulley, with careful attention to avoid bowstringing of the tendon
- Post-operative physical therapy focusing on tendon gliding exercises and scar management to prevent re-adhesion.
Important Considerations
Some key points to consider when managing recurrent trigger finger include:
- The importance of addressing any scarring or adhesions that may have formed during revision surgery
- The need for careful patient counseling regarding the potential outcomes of revision procedures, which generally have good outcomes but slightly lower success rates than primary releases
- The limited high-quality evidence available to guide management decisions, with most studies having very low to low quality GRADE evidence 1.
From the Research
Revision Trigger Finger or Reoccurring Trigger Finger
- There are several studies that discuss revision trigger finger or reoccurring trigger finger after a trigger finger release 2, 3, 4, 5, 6.
- A study published in 2023 found that the recurrence rate after trigger finger release was 2.39% and that more than 3 steroid injections before surgery and manual labor were independent predictors of recurrent trigger finger 3.
- Another study published in 2008 found that 56% of digits had a recurrence of symptoms at a median of 5.6 months after corticosteroid injection, and that insulin-dependent diabetes mellitus was a strong predictor of symptom recurrence 5.
- A review published in 2021 discussed the management of advanced trigger finger, which is more refractory to complete symptom resolution from corticosteroid injection, and may require specific attention to incomplete improvement of flexion contractures 6.
- The study published in 2020 found that ultrasound therapy (UST) has proven to be useful to prevent the recurrence of TF symptoms 2.
- A study published in 2015 discussed the treatment strategies for trigger finger, including surgical treatment options such as percutaneous A1 pulley release and open A1 pulley release, and excision of a slip of the flexor digitorum superficialis for patients with persistent triggering despite A1 release or patients with persistent flexion contracture 4.