What is the treatment for trigger finger?

Treatment for Trigger Finger

The treatment for trigger finger should follow a stepwise approach, beginning with conservative management including custom-made neoprene or rigid rest orthosis worn at night, active finger motion exercises, and paracetamol as first-line oral analgesic, progressing to corticosteroid injections if symptoms persist, and ultimately surgical release for refractory cases. 1

Etiology and Diagnosis

Trigger finger is a common condition characterized by:

• Inflammation and narrowing of the A1 pulley
• Pain, clicking, catching, and restricted motion of the affected finger
• Higher prevalence in diabetic patients and women in their 50s-60s 2

Diagnosis is primarily clinical, based on:

• Finger locking during active bending movement 3
• Radiographs are not routinely needed but may be used to exclude other pathologies 1

Treatment Algorithm

First-Line: Conservative Management (0-3 months)

• Custom-made neoprene or rigid rest orthosis worn at night 1
• Active finger motion exercises to maintain mobility 1
• Paracetamol as first-line oral analgesic for pain management 1
• Topical NSAIDs as first-line treatment 1
• Apply local cold therapy (ice) for 20 minutes with periodic interruptions 1
• Apply local heat (e.g., paraffin wax, hot packs) before exercise to relieve pain and stiffness 1

Second-Line: Corticosteroid Injections

• If symptoms persist after 3 months of conservative treatment
• Highly effective: resolution in approximately 61% of cases after a single injection 4
• Recurrent episodes (27%) can be effectively re-treated with additional injections 4
• Corticosteroid injections are more effective than NSAID injections for symptom resolution 5

Third-Line: Surgical Management

• Indicated when:

  • Conservative treatments and injections have failed (approximately 12% of cases) 4
  • Patient presents with flexion deformity or inability to flex the finger 3
  • Severe functional disability 3

• Surgical options include:

  • Open A1 pulley release (standard approach) 6
  • Percutaneous A1 pulley release (less invasive alternative) 6
  • Excision of flexor digitorum superficialis slip (for persistent triggering despite A1 release) 6

Special Considerations

Pediatric Trigger Finger

• Pediatric trigger thumb: treated with open A1 pulley release
• Pediatric trigger finger: A1 pulley release with possible excision of flexor digitorum superficialis if triggering persists 6

Post-Treatment Follow-up

• Follow-up in 4-6 weeks to evaluate response to treatment 1
• Monitor for medication side effects, particularly with oral NSAIDs 1
• Approximately 80% of patients recover fully within 3-6 months with appropriate treatment 1

Common Pitfalls and Caveats

• Avoid delaying surgical intervention in patients with fixed deformities or severe functional limitations
• Be aware of potential complications after surgery, including recurrence of deformity and stiffness 1
• Corticosteroid injections may cause local adverse reactions (pain, stiffness, ecchymosis, subcutaneous fat atrophy), but these are typically self-limited 4
• NSAID injections may result in higher rates of persistent moderate to severe symptoms compared to corticosteroid injections 5