From the Guidelines
Toe finger lock management should prioritize conservative measures, including rest, ice application, and over-the-counter anti-inflammatory medications, as well as gentle stretching exercises and splinting, before considering corticosteroid injections or surgical release of the tendon sheath. The condition, also known as trigger finger or trigger toe, occurs when the tendon sheath becomes inflamed and narrows, preventing smooth gliding of the tendon through its sheath, causing the characteristic catching or locking sensation 1. According to the 2019 EULAR recommendations for the management of hand osteoarthritis, education and training in ergonomic principles, pacing of activity, and use of assistive devices should be offered to every patient, and exercises to improve function and muscle strength, as well as to reduce pain, should be considered for every patient 1. Some key points to consider in the management of toe finger lock include:
- Rest, ice application for 15-20 minutes several times daily, and over-the-counter anti-inflammatory medications like ibuprofen (400-600mg three times daily with food) or naproxen (220-440mg twice daily with food) for 1-2 weeks
- Gentle stretching exercises performed 3-5 times daily, holding each stretch for 30 seconds
- A splint worn at night to keep the digit in an extended position and prevent morning stiffness
- Consideration of corticosteroid injections administered by a healthcare provider if conservative measures fail after 4-6 weeks
- Surgical release of the tendon sheath (tenosynovectomy) may be necessary for persistent cases, as recommended by the American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee 1. Early intervention typically yields better outcomes, so seeking medical attention when symptoms first appear is advisable, and the management of toe finger lock should be individualized to the patient’s requirements, taking into account the localization of OA, risk factors, type of OA, presence of inflammation, severity of structural change, level of pain, disability, and restriction of quality of life, as well as comorbidity and co-medication 1.
From the Research
Toe Finger Lock Management
- The condition of toe finger lock, also known as trigger finger, is a sudden release or locking of a finger during flexion or extension 2.
- Treatments for trigger finger include conservative and surgical methods, such as NSAIDs, hand splints, corticosteroid injections, physical therapies, and percutaneous or open surgery 2.
- Physical therapies, including 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 in patients with trigger finger 2.
- Orthotic management, such as immobilizing a single joint of the affected digit, has also been recommended for the conservative management of trigger finger, with similar results regardless of the joint immobilized 3.
Comparison of Treatments
- A systematic review of conservative management of trigger finger found that orthotic management, including immobilizing a single joint of the affected digit, can be effective in reducing pain and improving function 3.
- Another study compared the effects of intra-articular methotrexate and corticosteroid injections in medium-sized joints of rheumatoid arthritis patients, and found that repeated intra-articular methotrexate resulted in a decrease in the degree of synovitis 4.
- A randomized controlled trial compared the effects of physiotherapy and physiotherapy plus corticosteroid injection on pain intensity, disability, quality of life, and treatment effectiveness in patients with Subacromial Pain Syndrome, and found that the combined approach may have more medium-term effects 5.
Treatment Effectiveness
- The effectiveness of different treatments for trigger finger and other conditions, such as Subacromial Pain Syndrome, can vary depending on the individual patient and the specific condition being treated 2, 3, 5.
- Further research is needed to fully understand the optimal treatment protocols for these conditions, and to determine the most effective treatments for individual patients 2, 3, 5.