From the Guidelines
The management of Stenosing Tenosynovitis (Trigger Finger) should prioritize relative rest and reduced activity to prevent further damage and promote healing and pain relief, as recommended by the American Family Physician 1. The goal of treatment is to reduce inflammation, relieve pain, and improve function.
- Relative rest and reduced activity are essential to prevent further damage and promote healing and pain relief, as stated in the American Family Physician guidelines 1.
- NSAIDs like ibuprofen (400-800mg three times daily) or naproxen (250-500mg twice daily) can help manage pain and inflammation, although they have no effect on long-term outcomes 1.
- Cryotherapy, eccentric strengthening, and locally injected corticosteroids may also be effective in managing trigger finger, as suggested by various studies 1.
- Surgical release of the A1 pulley should be considered if symptoms persist after conservative therapy, with a success rate exceeding 90% 1. It is crucial to note that the duration of rest and avoidance of activity is not clearly defined, and the use of orthotics and braces is guided by clinical experience and patient preference 1. The treatment approach should be individualized, taking into account the severity of symptoms, patient preferences, and response to initial treatment, with the ultimate goal of improving morbidity, mortality, and quality of life.
- A step-wise approach, starting with non-surgical methods and progressing to surgical options if necessary, is recommended to achieve the best outcomes for patients with trigger finger, as implied by the guidelines 1.
From the FDA Drug Label
Intra-Articular The intra-articular or soft tissue administration of triamcinolone acetonide injectable suspension is indicated as adjunctive therapy for short-term administration (to tide the patient over an acute episode or exacerbation) in acute gouty arthritis, acute and subacute bursitis, acute nonspecific tenosynovitis, epicondylitis, rheumatoid arthritis, synovitis of osteoarthritis. In treating acute nonspecific tenosynovitis, care should be taken to ensure that the injection of the corticosteroid is made into the tendon sheath rather than the tendon substance.
The recommended guidelines for the management of Stenosing Tenosynovitis (Trigger Finger) are not explicitly stated in the provided drug labels. However, acute nonspecific tenosynovitis is mentioned, which may be related to trigger finger.
- The injection of corticosteroid should be made into the tendon sheath rather than the tendon substance.
- The initial dose for intra-articular administration is 2.5 mg to 5 mg for smaller joints and 5 mg to 15 mg for larger joints.
- A single local injection of triamcinolone acetonide is frequently sufficient, but several injections may be needed for adequate relief of symptoms 2.
From the Research
Management of Stenosing Tenosynovitis (Trigger Finger)
The management of trigger finger involves various treatment options, including conservative management and surgical release. The following are some of the recommended guidelines for the management of trigger finger:
- Conservative management options include:
- Observation: This is often the first line of treatment, especially for mild cases of trigger finger 3.
- Splinting: This can help to rest the affected finger and reduce triggering 3, 4.
- Corticosteroid injections: These can be effective in reducing inflammation and relieving symptoms 5, 6.
- Physical therapies: Such as external shock wave therapy (ESWT) and ultrasound therapy (UST), which have been shown to be effective in reducing pain and improving functional level 7.
- Surgical release: This is usually reserved for more severe cases of trigger finger that do not respond to conservative management 4.
Treatment Preferences
Patient preference plays a significant role in the management of trigger finger. A study found that patients preferred less invasive treatment options, with observation and splinting being the most preferred options 3.
Effectiveness of Corticosteroid Injections
Corticosteroid injections have been shown to be effective in the treatment of trigger finger, with a significant reduction in symptoms and improvement in functional level 5, 6. However, the use of local anesthetic with corticosteroid injections may increase pain at the time of injection 6.
Physical Therapies
Physical therapies, such as ESWT and UST, have been shown to be effective in the conservative management of trigger finger, reducing pain and improving functional level 7.