What are the treatment options for trigger finger?

Treatment Options for Trigger Finger

The first-line treatment for trigger finger includes conservative measures such as orthoses (splinting), followed by corticosteroid injections, with surgical intervention reserved for cases that fail to respond to these treatments. 1

Conservative Management Options

Orthoses (Splinting)

• Custom-made neoprene or rigid rest orthosis worn at night can be effective 1
• Helps maintain the affected finger in extension and prevents triggering during sleep
• Should be used as initial treatment, especially in mild cases

Active Finger Motion Exercises

• Recommended to maintain mobility and prevent stiffness 1
• Should be performed regularly throughout the day
• Particularly important when using splints to prevent joint stiffness

Pain Management

• Paracetamol is recommended as the first oral analgesic for mild to moderate pain 1
• Topical NSAIDs can be used as first-line treatment for pain relief 1
• Oral NSAIDs may be considered as third-line treatment if other options fail 1

Corticosteroid Injections

Injection Technique and Dosage

• Triamcinolone acetonide is commonly used for trigger finger injections 2
• For smaller joints, 2.5 mg to 5 mg is typically sufficient 2
• For larger joints, 5 mg to 15 mg is recommended 2
• Strict aseptic technique is mandatory when administering injections 2

Efficacy and Considerations

• Corticosteroid injections have shown effectiveness in reducing recurrence rates compared to other conservative treatments 3
• May be used as second-line treatment after splinting fails or as first-line treatment in moderate cases 1, 4
• Multiple injections may be needed for adequate symptom relief 2
• Ultrasound guidance may improve accuracy of injection placement

Surgical Management

Surgical Options

• Open surgery: Traditional approach with direct visualization of the A1 pulley 3
• Percutaneous surgery: Less invasive approach using a needle to release the A1 pulley 3
• Endoscopic surgery: Minimally invasive approach using specialized equipment 3

Indications for Surgery

• Failure to respond to conservative treatments after approximately 3 months 5
• Initial presentation with fixed flexion deformity or inability to flex the finger 5
• Severe pain and functional disability 5
• Recurrent triggering after multiple corticosteroid injections 4

Outcomes and Considerations

• Low-quality evidence indicates that open surgery results in less recurrence compared to steroid injections (6-12 months follow-up) 3
• Surgery may cause more pain during the first week post-procedure compared to injections 3
• Risk of complications includes infection, tendon injury, and neurovascular injury 3

Treatment Algorithm Based on Severity and Duration

Mild Cases (Occasional triggering, minimal pain)

1. Orthoses/splinting (night use for 4-6 weeks)
2. Active finger motion exercises
3. Topical NSAIDs for pain relief

Moderate Cases (Regular triggering, moderate pain)

1. Corticosteroid injection (triamcinolone acetonide)
2. Continued splinting at night
3. Re-evaluation after 4-6 weeks 1
4. Second injection if partial improvement

Severe Cases (Locked finger, severe pain, functional disability)

1. Corticosteroid injection may be attempted first
2. If no improvement or locked finger persists, surgical release is indicated
3. Open surgical release is the standard approach, with percutaneous or endoscopic techniques as alternatives 6

Recurrent Cases

• After failed conservative treatment (splinting and 1-2 injections), surgical intervention is recommended 4
• For pediatric trigger thumb, open A1 pulley release is the standard treatment 6
• For pediatric trigger finger, release of A1 pulley with possible excision of flexor digitorum superficialis if triggering persists 6

Common Pitfalls and Caveats

• Failure to properly diagnose other conditions that may mimic trigger finger (fractures, tumors, other traumatic injuries) 7
• Inadequate injection technique leading to ineffective treatment
• Delay in surgical referral for cases that clearly require operative management
• Neglecting active finger motion exercises, which can lead to stiffness
• Not considering patient factors such as diabetes, which may affect treatment response

Approximately 80% of patients recover fully within 3-6 months with appropriate treatment 1, making the prognosis generally favorable when following this structured approach.