From the Guidelines
Trigger finger treatment should prioritize conservative management, including rest, pain medications, and splinting, before considering surgical intervention, as supported by the most recent evidence 1. Treatment for trigger finger typically starts with rest and avoiding activities that cause pain. Over-the-counter pain medications like ibuprofen (400-800mg three times daily) or naproxen (220-500mg twice daily) can reduce inflammation and discomfort. A splint worn at night for 3-6 weeks may help by keeping the affected finger extended.
- Key considerations in managing trigger finger include:
- Avoiding repetitive gripping activities
- Using ultrasound (US) evaluation to diagnose or confirm tendon abnormalities, as it is well-suited for assessing superficial tendon injuries in the hand and wrist 1
- Considering corticosteroid injections into the tendon sheath for more persistent cases, with about 70% of patients finding relief after one injection
- If conservative treatments fail after 6-8 weeks, surgical release of the constricted tendon sheath (trigger finger release) may be necessary, which is a minor outpatient procedure with high success rates, as noted in earlier studies 1. The condition occurs when inflammation narrows the space within the tendon sheath, causing the tendon to catch and release suddenly. People with diabetes, rheumatoid arthritis, or those who perform repetitive gripping activities are at higher risk for developing trigger finger.
From the Research
Definition and Symptoms of Trigger Finger
- Trigger finger is a common hand condition that occurs when movement of a finger flexor tendon through the first annular (A1) pulley is impaired by degeneration, inflammation, and swelling, causing pain and restricted movement of the affected finger 2.
- It is characterized by a sudden release or locking of a finger during flexion or extension 3.
Treatment Options for Trigger Finger
- Conservative treatments include NSAIDs, hand splints, corticosteroid injections, physical therapies, and activity modification 3, 2, 4.
- Surgical treatment options include percutaneous A1 pulley release and open A1 pulley release 4.
- 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 3.
Effectiveness of Corticosteroid Injections
- Triamcinolone acetonide injection has been shown to be effective in treating trigger finger, with a dose-related pattern of success rates 5.
- The choice of corticosteroid solution can affect clinical outcomes, with triamcinolone demonstrating a higher rate of additional injections, and methylprednisolone resulting in earlier and more frequent surgical intervention 6.
- 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.
Pediatric Treatment Strategies
- Pediatric trigger thumb is treated with open A1 pulley release, while pediatric trigger finger is treated with release of the A1 pulley with excision of a slip or all of the flexor digitorum superficialis if triggering persists 4.