What are the treatment options for trigger finger?

Treatment Options for Trigger Finger

The treatment of trigger finger should follow a stepwise approach, beginning with conservative measures and progressing to more invasive interventions when symptoms persist, with corticosteroid injections being the most effective first-line treatment for most patients. 1, 2

Non-Surgical Treatment Options

First-Line Treatments

• Corticosteroid injections:

  • Most effective non-surgical intervention with approximately 60-90% success rate 3
  • Can resolve symptoms in 61% of cases after a single injection 3
  • May require repeat injections for recurrent symptoms (effective in 27% of recurrent cases) 3
  • Consider as initial treatment unless patient presents with fixed flexion deformity 4

• Splinting:

  • Particularly effective for thumb-based trigger finger 1
  • Should be worn at night to maintain finger in extension
  • May be combined with other conservative measures

Additional Conservative Measures

• NSAIDs (topical or oral):

  • Recommended for pain management 1
  • Topical NSAIDs preferred due to better safety profile, especially in older adults 1
  • Oral NSAIDs should be used at lowest effective dose for shortest duration 5

• Physical Therapies:

  • External shock wave therapy (ESWT): Shows promise in reducing pain and improving function 6
  • Ultrasound therapy: May help prevent recurrence of symptoms 6
  • Local heat application: Can help relieve pain and stiffness before exercises 1

• Activity modification and joint protection techniques:

  • Avoid repetitive gripping activities
  • Rest the affected finger

Surgical Treatment Options

Indications for Surgery

• Failure of conservative treatment after 3 months 4
• Initial presentation with fixed flexion deformity 4
• Recurrent symptoms after multiple injections (approximately 12% of cases) 3

Surgical Approaches

1. Open surgery:

   • Traditional approach with high success rate
   • Lower recurrence rate compared to steroid injections (6.5% vs 38.5%) 7
   • May cause more pain in the first week post-procedure 7

2. Percutaneous release:

   • Less invasive alternative to open surgery
   • Similar effectiveness to open surgery with potentially faster recovery 7

3. Endoscopic release:

   • Newer technique with potential for smaller incision and faster recovery
   • Limited evidence compared to open and percutaneous approaches 7

Treatment Algorithm

1. Initial Presentation:

   • For mild to moderate symptoms: Start with splinting and NSAIDs for 2-4 weeks
   • For moderate to severe symptoms: Consider corticosteroid injection

2. After 4-6 weeks:

   • If symptoms resolve: Continue activity modification and monitor
   • If symptoms persist: Administer corticosteroid injection (if not done initially)

3. After 3 months of conservative treatment:

   • If symptoms persist or recur: Consider surgical referral
   • If symptoms are improving: Continue conservative management

4. Special Considerations:

   • Patients with diabetes: Higher recurrence rates after injections; may need earlier surgical consideration
   • Fixed flexion deformity: May benefit from earlier surgical intervention

Potential Complications

• Corticosteroid injections: Local pain, skin atrophy, fat necrosis (rare), infection (rare) 3
• Surgery: Neurovascular injury, infection, scarring, persistent pain, recurrence 7

Monitoring and Follow-up

• Schedule follow-up within 4-6 weeks after initial treatment to assess response 1
• Monitor for medication side effects, particularly with oral NSAIDs 1
• Consider occupational therapy referral for specialized hand therapy 1