What is the treatment for trigger finger?

Treatment for Trigger Finger

The treatment of trigger finger should follow a stepwise approach, beginning with conservative measures and progressing to more invasive interventions if symptoms persist, with corticosteroid injection being the most effective first-line treatment for most patients.

Definition and Pathophysiology

Trigger finger (stenosing tenosynovitis) is a condition characterized by:

• Catching, clicking, or locking of a finger during flexion or extension
• Caused by inflammation and narrowing of the A1 pulley
• Results in pain, restricted movement, and functional limitation

Treatment Algorithm

First-Line Treatment Options:

1. Corticosteroid Injection

   • Most effective first-line treatment
   • Success rates of 60-70% with a single injection
   • May require repeat injection after 4-6 weeks if symptoms persist
   • Caution: Higher recurrence rates compared to surgical release

2. Conservative Measures

   • Splinting

     • Particularly effective for thumb base (trapeziometacarpal) involvement
     • Should be worn at night and during activities that trigger symptoms
     • Recommended duration: 4-6 weeks

   • Activity Modification

     • Avoid repetitive gripping or activities that exacerbate symptoms
     • Joint protection techniques to reduce mechanical stress

   • NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)

     • May provide symptomatic relief
     • Low-certainty evidence suggests they are less effective than corticosteroid injections 1
     • Consider topical NSAIDs for patients ≥75 years to minimize systemic effects

Second-Line Treatment Options:

1. Physical Therapies

   • External shock wave therapy (ESWT) may reduce pain and improve function 2
   • Ultrasound therapy may help prevent recurrence 2
   • Thermal modalities (heat application) before exercise may provide relief 3

2. Repeat Corticosteroid Injection

   • Consider if partial response to first injection
   • Maximum of 3 injections recommended within a 12-month period

Third-Line Treatment (Surgical Options):

1. Surgical Release
   • Indicated when conservative treatments fail after 3-6 months
   • Open A1 pulley release (standard approach)
   • Percutaneous release (alternative with faster recovery but higher risk of digital nerve injury)
   • Success rates >90% with low recurrence rates

Special Considerations

Diabetic Patients

• Higher incidence of trigger finger
• Often less responsive to conservative measures
• May require earlier surgical intervention

Pediatric Trigger Finger

• Pediatric trigger thumb is treated with open A1 pulley release
• Other pediatric trigger fingers may require more extensive surgery 4

Rheumatoid Arthritis

• May require tenosynovectomy instead of simple A1 pulley release 5

Complications to Monitor

• Post-injection: temporary pain, skin discoloration, fat atrophy
• Post-surgical: digital nerve injury, bowstringing, continued triggering, infection
• Untreated: progressive flexion contracture, functional limitation

Treatment Effectiveness

The evidence suggests that corticosteroid injection provides better outcomes than NSAIDs in terms of symptom resolution and reduction of persistent moderate to severe symptoms 1. Surgical release has the highest long-term success rate but carries more risks and should be reserved for cases that fail conservative management.

Common Pitfalls to Avoid

1. Delaying treatment, which may lead to fixed contractures
2. Multiple (>3) corticosteroid injections, which can damage tendons
3. Failure to identify and address comorbid conditions that may affect treatment response
4. Inadequate patient education about the condition and expected outcomes

By following this stepwise approach and considering individual patient factors, most cases of trigger finger can be effectively managed with good functional outcomes and quality of life.