From the Guidelines
The best specialist to refer a patient with stenosing tenosynovitis (trigger finger) to is an orthopedic surgeon. This recommendation is based on the most recent and relevant evidence available, which suggests that orthopedic surgeons have the necessary expertise to effectively manage trigger finger, including surgical evaluation and treatment if conservative management fails 1.
When considering referral, it's essential to note that orthopedic surgeons are well-versed in the diagnosis and treatment of conditions affecting the musculoskeletal system, including the hand. They can provide a comprehensive evaluation and develop a personalized treatment plan, which may include conservative approaches such as rest, splinting, and anti-inflammatory medications, or surgical interventions like trigger finger release.
Key points to consider when referring a patient to an orthopedic surgeon for trigger finger include:
- The patient's condition has not improved with conservative management
- The patient is experiencing significant pain or functional impairment
- The patient has underlying conditions that may be contributing to the development of trigger finger, such as diabetes or rheumatoid arthritis
- The patient requires surgical evaluation and treatment, which is typically performed by an orthopedic surgeon
It's also worth noting that while other specialists, such as hand specialists or plastic surgeons with additional training in hand surgery, may also be qualified to manage trigger finger, the available evidence suggests that orthopedic surgeons are a suitable and effective choice for referral 1.
From the Research
Treatment Options for Stenosing Tenosynovitis (Trigger Finger)
The treatment approach for trigger finger may include non-surgical or surgical treatments. According to 2, the primary comparison was open surgery versus steroid injections, as open surgery is the oldest and most widely used treatment method, whereas steroid injection is the least invasive control treatment method.
Specialist Referral
When it comes to referring a patient with stenosing tenosynovitis (trigger finger), the choice of specialist depends on the treatment approach. The following are some options:
- Orthopedic hand surgeons: They may treat trigger finger with surgery, including percutaneous A1 pulley release and open A1 pulley release 3, 4.
- Hand surgeons: They are more likely to treat trigger finger with surgery 5.
- Family physicians: They may treat trigger finger with NSAIDs or refer patients to orthopedic hand surgeons or hand surgeons for further treatment 5.
Key Considerations
Some key considerations when referring a patient with trigger finger include:
- The patient's symptoms, such as pain and triggering of the finger
- The patient's medical history, including any previous treatments
- The patient's occupation and lifestyle
- The availability of specialists in the area
Treatment Effectiveness
The effectiveness of different treatment approaches for trigger finger is still being studied. According to 2, low-quality evidence indicates that open surgery may result in less recurrence of trigger finger, although it increases the incidence of pain during the first follow-up week. On the other hand, 6 found that most patients experience relief of pain and triggering at three weeks following corticosteroid injection.