What are the treatment options for finger pain?

Treatment Options for Finger Pain

The optimal management of finger pain requires a combination of non-pharmacological and pharmacological treatment modalities tailored to the specific cause of the pain, with topical NSAIDs being the first-line pharmacological treatment for most cases. 1

Diagnostic Considerations

Before initiating treatment, it's important to identify the underlying cause of finger pain:

• Osteoarthritis: Common in older adults, especially postmenopausal women (40% prevalence in women over 75) 1
• Trigger finger: Affects up to 20% of adults with diabetes and 2% of the general population 2
• De Quervain tenosynovitis: More common in women, particularly those with frequent mobile phone use 2
• Post-fracture pain: May require specific interventions based on fracture healing status 3
• Carpal tunnel syndrome: Characterized by numbness and tingling in the thumb and fingers 2

Non-Pharmacological Treatment Options

1. Exercise Therapy

• Active finger motion exercises are essential for maintaining mobility 3, 1
• Range of motion and strengthening exercises should be performed regularly 1
• For post-fracture patients, a home exercise program is recommended after adequate stabilization 3

2. Orthoses and Splinting

• Hand orthoses/splints are recommended as initial management for first CMC joint degenerative changes 1
• Custom-made neoprene or rigid rest orthoses worn at night can be effective 1
• For thumb base osteoarthritis, splints are recommended to prevent/correct lateral angulation and flexion deformity 3

3. Physical Modalities

• Local application of heat (paraffin wax, hot packs) before exercise can be beneficial 3
• Cryotherapy (ice) may help decrease pain in acute soft tissue injuries 4
• Ultrasound has limited evidence for effectiveness in hand pain 3

4. Joint Protection and Education

• Patient education about joint protection techniques and ergonomic principles is essential 1
• Avoiding adverse mechanical factors can help prevent worsening of symptoms 1
• Pacing of activities to minimize stress on affected joints 1

Pharmacological Treatment Options

1. Topical Treatments

• Topical NSAIDs: First-line pharmacological treatment due to effectiveness and safety profile 1
• Capsaicin: Effective and safe alternative for hand pain 3

2. Oral Medications

• Paracetamol (Acetaminophen): Second-line oral analgesic for mild to moderate pain, up to 4g/day 3, 1
• Oral NSAIDs (like naproxen): Third-line treatment when topical treatments and paracetamol are ineffective 1, 5
  • Should be used at the lowest effective dose for the shortest duration 3, 5
  • Monitor for gastrointestinal, cardiovascular, and renal side effects 5
  • Contraindicated in patients with history of asthma attacks, hives, or allergic reactions to aspirin or other NSAIDs 5

3. Injections

• Corticosteroid injections: Effective for specific conditions:
  • Trigger finger: First-line therapy (less effective in insulin-dependent diabetes) 2
  • De Quervain tenosynovitis: Relieves symptoms in approximately 72% of patients 2

Surgical Options

Consider surgical intervention only when non-pharmacological and pharmacological treatments have failed 1:

• Trigger finger: Surgical release for recurrent symptoms or in diabetic patients 2
• De Quervain tenosynovitis: Surgical release of the first dorsal extensor compartment for recurrent symptoms 2
• Thumb CMC arthritis: Trapeziectomy, arthroplasty, or arthrodesis for severe cases unresponsive to conservative treatment 1, 2
• Distal radius fractures: Surgical intervention may be needed for unremitting pain during follow-up 3

Treatment Algorithm

1. Initial approach:

   • Active finger motion exercises
   • Joint protection education
   • Topical NSAIDs

2. If inadequate response:

   • Add orthoses/splinting
   • Consider paracetamol (up to 4g/day)

3. For persistent symptoms:

   • Short-term oral NSAIDs at lowest effective dose
   • Condition-specific interventions (e.g., corticosteroid injections for trigger finger)

4. For refractory cases:

   • Referral for surgical evaluation

Common Pitfalls and Caveats

• NSAIDs risks: Can cause ulcers and bleeding in the stomach and intestines without warning; risk increases with age, longer use, and concomitant corticosteroids 5
• Post-fracture management: Unremitting pain during follow-up requires reevaluation 3
• Diabetic patients: Higher prevalence of trigger finger with lower response rates to conservative treatment 2
• Elderly patients: Higher risk of adverse effects from oral NSAIDs; prefer topical treatments 1, 5
• Diagnostic challenges: Ensure proper diagnosis before treatment; finger pain may be the first manifestation of systemic conditions like rheumatoid arthritis 6

By following this structured approach to treating finger pain, clinicians can effectively manage symptoms while minimizing risks associated with treatments.