What is the treatment for trigger finger?

Treatment for Trigger Finger

The treatment for trigger finger should follow a stepwise approach, beginning with conservative measures such as splinting, NSAIDs, and corticosteroid injections, progressing to surgical release of the A1 pulley if conservative measures fail to provide relief.

Conservative Management Options

First-line Treatments

• Splinting/Orthoses

  • Custom-made orthoses are preferred over prefabricated ones for better compliance 1
  • Splints should be fitted by an occupational therapist who can provide proper instruction 1
  • Splinting helps prevent locking and reduces inflammation

• Activity Modification

  • Joint protection education and ergonomic adjustments
  • Pacing of activities to reduce strain on the affected finger 1
  • Avoidance of repetitive gripping or activities that worsen symptoms

Second-line Treatments

• Topical and Oral Medications

  • Topical NSAIDs (particularly diclofenac gel) as first-line medication 1
  • Oral paracetamol (up to 4g/day) as second-line medication 1
  • Oral NSAIDs at lowest effective dose and shortest duration if inadequate response to paracetamol 1

• Corticosteroid Injections

  • Highly effective for pain relief in trigger finger 2
  • A single injection is recommended initially, with a second injection if symptoms recur 3
  • Research shows that a single injection is as effective as planned staged injections, with lower surgery rates (27% vs 47%) 3
  • Patients with diabetes may have higher failure rates and increased need for surgical intervention 3

• Physical Therapy Modalities

  • External shock wave therapy (ESWT) may reduce pain and trigger severity while improving function 4
  • Ultrasound therapy may help prevent recurrence of symptoms 4
  • Range of motion exercises and strengthening of intrinsic and extrinsic finger muscles 1

Surgical Management

• Indications for Surgery

  • Persistent symptoms after 3 months of conservative treatment 5
  • Initial presentation with fixed flexion deformity or inability to flex the finger 5
  • High baseline disability scores (DASH >40) predict earlier treatment failure and need for surgery 3

• Surgical Options

  • Open A1 pulley release - standard surgical approach 2
  • Percutaneous A1 pulley release - less invasive alternative 2
  • For advanced trigger finger with persistent flexion contracture after A1 release, partial or complete excision of the flexor digitorum superficialis may be necessary 6, 2

Treatment Algorithm

1. Initial Presentation

   • Begin with splinting and activity modification
   • Consider topical NSAIDs or oral pain medications

2. After 4-6 weeks if symptoms persist

   • Corticosteroid injection
   • Continue splinting and exercises

3. After 3 months if symptoms persist

   • Consider second corticosteroid injection if first provided partial relief
   • Evaluate for surgical intervention if minimal or no improvement

4. Advanced Cases

   • For fixed flexion contractures or severe functional limitation, consider earlier surgical referral
   • Post-surgical rehabilitation with hand therapy to restore function

Special Considerations

• Patients with diabetes may have higher failure rates with conservative treatment and may require surgical intervention sooner 3
• Advanced trigger finger (with loss of active or passive range of motion) is more refractory to complete symptom resolution from corticosteroid injection 6
• Regular assessment of range of motion, pain levels, and functional improvement should guide progression through the treatment algorithm 1

Common Pitfalls

• Delaying surgical intervention when conservative measures clearly fail can lead to prolonged disability
• Overlooking flexor tendon pathology in advanced cases, where the problem extends beyond just the A1 pulley
• Failing to address persistent flexion contractures after A1 pulley release, which may require additional interventions
• Not considering diabetes as a risk factor for treatment failure and need for earlier surgical intervention

By following this structured approach to trigger finger management, most patients will achieve satisfactory outcomes with improved function and quality of life.