What are the treatment options for trigger finger symptoms?

Trigger Finger: Symptoms and Treatment Options

Conservative management with night splinting, activity modification, and NSAIDs should be the first-line treatment for trigger finger, with corticosteroid injections recommended if these fail, and surgery reserved for persistent cases. 1

Symptoms of Trigger Finger

Trigger finger (stenosing flexor tenosynovitis) presents with the following characteristic symptoms:

• Painful clicking or catching sensation during finger movement
• Locking of the affected finger in a bent position
• Stiffness, especially in the morning
• Tenderness or a nodule at the base of the affected finger
• Difficulty straightening the finger after it locks

Treatment Algorithm

First-Line Conservative Management

1. Custom-made orthosis/splinting:

   • Night splinting with neoprene or rigid rest orthosis 1
   • Helps maintain the finger in extension and reduces inflammation

2. Activity modification:

   • Avoid repetitive gripping or activities that aggravate symptoms 1
   • Implement joint protection techniques to minimize stress on affected joints 1

3. Pain management:

   • Topical NSAIDs as first-line medication 1
   • Oral paracetamol for mild to moderate pain as second-line 1
   • Oral NSAIDs as third-line option 1

4. Physical therapy:

   • Range of motion exercises to maintain mobility 1
   • Local heat application (e.g., paraffin wax, hot packs) before exercise to relieve pain and stiffness 1
   • Local cold application for acute pain (20 minutes with periodic interruptions) 1

Second-Line Treatment

If symptoms persist after 4-6 weeks of conservative management:

Corticosteroid injection:

• Highly effective with approximately 61% of patients experiencing resolution after a single injection 2
• Recurrent episodes (27%) can be effectively re-treated with additional injections 2
• Only 12% of cases fail injection therapy or have early recurrence requiring surgical release 2

Third-Line Treatment (Surgical Options)

Consider surgery if conservative treatments and injections fail:

1. Percutaneous A1 pulley release:

   • Less invasive option with quicker recovery 3

2. Open A1 pulley release:

   • Standard surgical approach with high success rates 3
   • Considered first-line surgical treatment for flexible deformities 1

3. Flexor digitorum superficialis slip excision:

   • Reserved for patients with persistent triggering despite A1 release 3
   • Or for patients with persistent flexion contracture 3

Special Considerations

Pediatric Trigger Finger

• Pediatric trigger thumb is treated with open A1 pulley release 3
• Pediatric trigger finger may require release of the A1 pulley with excision of part or all of the flexor digitorum superficialis if triggering persists 3

Emerging Therapies

• External shock wave therapy (ESWT) shows promise in reducing pain and trigger severity while improving functional level and quality of life 4
• Ultrasound therapy (UST) may be useful in preventing recurrence of trigger finger symptoms 4

Follow-up and Rehabilitation

• Schedule follow-up in 4-6 weeks to evaluate response to treatment 1
• Implement self-management programs to improve outcomes 1
• Evaluate ability to perform activities of daily living and provide assistive devices as needed 1
• Early mobilization after surgery is crucial to prevent stiffness 1

Treatment Outcomes

Approximately 80% of patients recover fully within 3-6 months with appropriate treatment 1. When corticosteroid injections are used, nearly 90% of cases resolve without requiring surgery 2.

Common Pitfalls and Caveats

1. Diagnostic confusion: Ensure proper diagnosis by ruling out other conditions like fractures or tumors 5

2. Injection complications: While generally safe, corticosteroid injections can cause temporary pain, stiffness, ecchymosis, or atrophy of subcutaneous fat 2

3. Surgical complications: Be aware of potential complications including recurrence of deformity, transfer lesions to adjacent fingers, and stiffness 1

4. NSAIDs limitations: NSAIDs injections offer little to no benefit over glucocorticoid injections for trigger finger treatment 6

5. Diabetic patients: Trigger finger occurs more frequently in diabetic populations and may require more aggressive treatment 5