What are the symptoms and treatment options for trigger finger?

Trigger Finger Symptoms and Treatment Options

Symptoms of Trigger Finger

Trigger finger is characterized by painful catching, snapping, or locking when flexing the affected finger, which occurs due to inflammation and subsequent narrowing of the A1 pulley, causing impaired tendon gliding. 1

• Pain, clicking, catching, and loss of motion of the affected finger are the primary symptoms 1
• Patients typically complain of clicking or locking of the finger during flexion 1
• The condition can progress to different severity levels, often classified using the Quinnell Grading System 2
• Symptoms may include:
  • Painful popping or snapping sensation when moving the finger 1, 3
  • Finger catching or locking in a bent position 1, 4
  • Morning stiffness in the affected finger 3
  • Tenderness or a nodule at the base of the finger in the palm 2
  • Difficulty straightening the finger after it locks 1, 4

Diagnosis

• Diagnosis is usually straightforward based on clinical presentation and physical examination 1
• Ultrasound can identify characteristic findings including hypoechoic A1 pulley thickening (>0.62 mm) and tendon snapping 2
• Other pathological processes such as fracture, tumor, or traumatic soft tissue injuries must be excluded 1
• MRI may be used in equivocal cases to evaluate the pulley system, particularly the A2 and A4 pulleys 5

Treatment Options

Non-Surgical Management

The first-line treatment for trigger finger should be conservative management, including activity modification, splinting, and/or corticosteroid injections. 4, 3

• Education and training in ergonomic principles, pacing of activity, and use of assistive devices should be offered to every patient 5, 6
• Exercises to improve function and muscle strength should be considered for pain reduction and functional improvement 5, 6
  • Tendon gliding exercises can reduce pain by up to 70% within weeks 2
• Splinting (orthoses) is an effective conservative treatment option 3
  • Splints should be worn to maintain the metacarpophalangeal joint in slight flexion 3

Pharmacological Treatment

• Topical NSAIDs are preferred over systemic treatments due to safety considerations 5, 6
• Corticosteroid injection into the flexor tendon sheath is considered the most effective non-surgical treatment 4, 3
  • Success rates are high with minimal reported adverse effects 7
  • Potential side effects include subcutaneous atrophy at the injection site 7
• Ultrasound-guided corticosteroid injections can improve accuracy and outcomes 2

Surgical Management

• Surgical treatment should be considered when conservative measures fail to provide adequate relief 5, 4
• Surgical options include:
  • Percutaneous A1 pulley release 4, 2
  • Open A1 pulley release 4
  • Excision of a slip of the flexor digitorum superficialis (reserved for patients with persistent triggering despite A1 release) 4

Treatment Algorithm

1. Initial treatment: Activity modification, splinting, and exercises 4, 3
2. If symptoms persist: Corticosteroid injection into the tendon sheath 4, 3
3. For recurrent or persistent symptoms: Consider a second corticosteroid injection or surgical release 4, 3
4. For severe cases or after failed injections: Surgical A1 pulley release 4

Special Considerations

• Trigger finger occurs more frequently in diabetic patients and in women, typically in the fifth to sixth decade of life 1
• Pediatric trigger finger and thumb require different treatment approaches than adult cases 4
• The severity and duration of symptoms should guide treatment selection 3
• Treatment effectiveness should be regularly monitored using functional assessment tools like the Jamar Dynamometer 2

Common Pitfalls and Caveats

• Avoid prolonged use of oral NSAIDs due to potential complications 6
• Be aware that corticosteroid injections can cause subcutaneous atrophy at the injection site 7
• Recognize that multiple corticosteroid injections may be needed for complete resolution 3
• Surgical intervention should be considered when conservative treatments fail rather than continuing ineffective treatments indefinitely 6