What is the treatment for trigger finger?

Treatment of Trigger Finger

The first-line treatment for trigger finger is a corticosteroid injection into the affected tendon sheath, which provides effective short-term relief with resolution of symptoms in many patients. 1

Treatment Algorithm

Conservative Management

1. Initial Non-Surgical Approaches

   • Activity modification to reduce repetitive finger movements
   • Splinting to maintain extension, particularly at night 2
   • Topical NSAIDs as first-line pharmacological therapy for pain relief 2
   • Oral analgesics (paracetamol/acetaminophen) for mild to moderate pain 2

2. Corticosteroid Injections

   • Highly effective first-line interventional treatment
   • Success rate significantly higher than lidocaine alone (NNT = 3) 1
   • Effects may last up to 4 months 1
   • May require repeat injections for recurrent symptoms

Physical Therapies

• External shock wave therapy (ESWT) may reduce pain and trigger severity 3
• Ultrasound therapy may help prevent recurrence of symptoms 3
• Local heat application (e.g., paraffin wax, hot packs) before exercise can relieve pain and stiffness 2

Surgical Management

Indicated when conservative treatments fail:

• Percutaneous A1 pulley release - less invasive option 4
• Open A1 pulley release - standard surgical approach 4
• Flexor digitorum superficialis slip excision - reserved for persistent triggering despite A1 release 4

Special Considerations

Adult vs. Pediatric Treatment

• Adult trigger finger: Start with conservative measures before considering surgery
• Pediatric trigger thumb: Typically treated with open A1 pulley release 4
• Pediatric trigger finger: May require release of A1 pulley with possible flexor digitorum superficialis slip excision 4

Diabetic Patients

• Higher incidence of trigger finger 5
• May have poorer response to conservative treatment
• May require earlier surgical intervention

Treatment Efficacy and Pitfalls

Corticosteroid Injections

• Efficacy: Silver-level evidence supports superiority of corticosteroid with lidocaine over lidocaine alone 1
• Pitfall: Multiple injections may cause tendon weakening or rupture

NSAIDs

• Efficacy: NSAID injections appear less effective than corticosteroid injections for trigger finger 6
• Pitfall: Higher rate of persistent moderate to severe symptoms with NSAID injections compared to corticosteroid injections (28% vs 14%) 6

Surgical Treatment

• Efficacy: Highly effective for severe cases unresponsive to conservative management 2
• Pitfall: Potential complications include digital nerve injury, infection, and stiffness

Follow-up Care

• Schedule follow-up within 4-6 weeks to assess response to initial therapy 2
• Monitor for recurrence of symptoms
• Consider progression to next treatment tier if inadequate response

Remember that early intervention typically leads to better outcomes, and treatment should progress from conservative to more invasive options as needed based on symptom persistence and severity.