From the FDA Drug Label
In treating acute nonspecific tenosynovitis, care should be taken to ensure that the injection of the corticosteroid is made into the tendon sheath rather than the tendon substance. The treatment option for trigger finger, which is a type of tenosynovitis, is an injection of triamcinolone acetonide into the tendon sheath.
- The initial dose is not specified for trigger finger, but for smaller joints, the dose is 2.5 mg to 5 mg.
- It is essential to use strict aseptic technique and ensure the injection is made into the tendon sheath rather than the tendon substance 1.
From the Research
Trigger finger treatment should prioritize a collaborative interdisciplinary approach, starting with conservative management, including physical therapy, and reserving corticosteroid injections and surgical interventions for cases where initial management is insufficient, as evidenced by a recent study 2.
Treatment Options
- Conservative approaches:
- Rest and activity modification to reduce inflammation and pain
- Over-the-counter pain medications like ibuprofen (400-800mg three times daily) or naproxen (220-500mg twice daily)
- Splinting the affected finger in extension, particularly at night for 6-8 weeks
- Corticosteroid injections into the tendon sheath (typically methylprednisolone or triamcinolone) with a recommended dose of 20mg, as shown to be more effective than lower doses in a recent study 3
- Physical therapy exercises focusing on gentle stretching and strengthening to improve mobility
- Surgical release of the A1 pulley (trigger finger release) for severe or persistent cases, with success rates over 90% 4
Key Considerations
- Treatment choice depends on symptom severity, duration, and patient factors such as diabetes, which may reduce the effectiveness of steroid injections
- A collaborative interdisciplinary approach can facilitate timely access to evidence-based care, including corticosteroid injections and surgical management if necessary 2
- Physical therapy treatment provides self-management and education strategies to those requiring further interventions, potentially reducing recurrence rates 2