What are the treatment options for trigger finger?

Treatment Options for Trigger Finger

The optimal management of trigger finger requires a combination of non-pharmacological and pharmacological treatment modalities individualized to the patient's specific needs, with a stepwise approach from conservative to more invasive interventions. 1

Conservative Management Options

• Activity modification and education about avoiding adverse mechanical factors should be recommended as first-line treatment for all patients with trigger finger 1

• Splinting is a preferred initial non-invasive treatment option with approximately 27% of patients choosing this as their first treatment choice 2

• Heat application (such as paraffin wax or hot packs) may provide symptomatic relief, especially when applied before exercise 1

• Exercise regimens involving both range of motion and strengthening exercises are recommended to maintain finger mobility and function 1

Pharmacological Options

• Topical NSAIDs are effective and safe treatments, especially for mild to moderate pain when only a few fingers are affected 1

• Oral analgesics: Paracetamol (up to 4g/day) is the oral analgesic of first choice due to its efficacy and safety profile 1

• Oral NSAIDs should be used at the lowest effective dose and for the shortest duration in patients who respond inadequately to paracetamol 1

  • In patients with increased gastrointestinal risk, use non-selective NSAIDs plus a gastroprotective agent or a selective COX-2 inhibitor
  • In patients with increased cardiovascular risk, COX-2 inhibitors are contraindicated and non-selective NSAIDs should be used with caution

Invasive Treatment Options

• Corticosteroid injection is effective for painful flares, with 19% of patients preferring this as their first treatment choice 2

  • Particularly effective for trapeziometacarpal joint involvement 1
  • May provide better short-term pain relief (at 3-6 weeks) compared to percutaneous release, but with higher recurrence rates by 6 months 3

• Percutaneous release of the A1 pulley may provide greater long-term recovery, higher satisfaction levels, lower recurrence rates, and less pain at 6 months compared to corticosteroid injection 3

• Surgical release (16% of patients choose this as first-line treatment) 2 should be considered when:

  • Conservative treatments have failed
  • Patient has marked pain and/or disability
  • Options include open A1 pulley release, percutaneous release, or in persistent cases, excision of a slip of the flexor digitorum superficialis 4

Treatment Algorithm

1. Initial presentation: Begin with activity modification, splinting, and heat application 1

2. If symptoms persist: Add topical NSAIDs and/or oral analgesics (paracetamol first, then NSAIDs if needed) 1

3. For moderate to severe symptoms or inadequate response: Consider corticosteroid injection 1

4. For recurrent or persistent symptoms after injection: Consider percutaneous release or surgical intervention 3, 4

Important Considerations

• Patient preferences should be taken into account - studies show many patients (37%) prefer observation as first-line treatment, followed by splinting (27%), corticosteroid injection (19%), and surgery (16%) 2

• Surgical approaches have higher success rates but also carry risks of complications including tendon rupture/adhesion, scar tenderness, sensory changes, and complex regional pain syndrome 1

• Pediatric trigger finger/thumb may require different management approaches than adult cases, with open A1 pulley release being the primary treatment for pediatric trigger thumb 4