What is the treatment for traumatic trigger finger?

Treatment of Traumatic Trigger Finger

For traumatic trigger finger, begin with corticosteroid injection as first-line treatment, reserving open surgical release for cases with persistent symptoms after 3 months of conservative management, significant displacement (>3mm), or when more than one-third of the articular surface is involved. 1, 2, 3

Initial Diagnostic Workup

• Obtain at least 3-view radiographs of the affected digit to assess for fracture fragments, displacement, and articular involvement that would necessitate surgical intervention 1, 4
• MRI without IV contrast or ultrasound of the hand is indicated when tendon avulsion is suspected, as MRI has 92-100% sensitivity and 100% specificity for detecting flexor tendon injuries and determining the level of retraction 5, 1
• Look specifically for displacement >3mm, interfragmentary gaps >3mm, or involvement of more than one-third of the articular surface—these findings mandate surgical referral 1

Conservative Treatment Approach

Corticosteroid injection alone (without local anesthetic) is the preferred first-line treatment for traumatic trigger finger without significant structural damage. 2, 6

• Use triamcinolone 40mg (1 mL) without lidocaine, as adding local anesthetic significantly increases injection pain (VAS 3.5 vs 2.0) without improving outcomes 6
• Corticosteroid injection provides initial symptom relief but has a recurrence rate of 385 per 1000 patients at 6-12 months compared to 65 per 1000 with open surgery 2
• Institute conservative treatment for at least 3 months before considering surgical intervention, unless there is flexion deformity, inability to flex the finger, or severe pain causing functional disability 3
• Splinting can be used as an adjunct conservative measure, though evidence is limited specifically for traumatic cases 7, 8

Surgical Indications

Proceed directly to open surgical release when any of the following are present: 1, 2, 3

• Displacement >3mm on radiographs 1
• More than one-third of articular surface involvement 1
• Interfragmentary gap >3mm 1
• Persistent triggering after 3 months of conservative treatment 3
• Initial presentation with fixed flexion deformity or inability to actively flex the finger 3

Surgical Approach

• Open surgical release is the standard approach, providing 83% improvement in recurrence rates compared to steroid injection (RR 0.17,95% CI 0.09 to 0.33) at 6-12 months 2
• The main disadvantage of open surgery is increased pain during the first postoperative week (678 per 1000 vs 184 per 1000 with injection), though this is temporary 2
• Percutaneous release is an alternative to open surgery, though comparative effectiveness data are limited 2

Post-Operative Management

Following surgical release, implement rigid immobilization for 3-6 weeks, then immediately begin aggressive active range of motion exercises to prevent stiffness. 1

• Splinting protects the surgical repair during initial healing 1
• Active finger motion exercises must begin immediately after the immobilization period, as stiffness is the most functionally disabling complication 1
• Home exercise programs moving fingers through complete range of motion are effective and minimize stiffness risk 1

Follow-Up Red Flags

• Unremitting pain during follow-up warrants immediate reevaluation for inadequate fixation, pulley system injury, tendon adhesions, or re-rupture 1
• Monitor for adverse events including infection, tendon injury, neurovascular injury (though rates are similar between surgical and injection approaches at approximately 1-2%) 2

Key Clinical Pitfalls

• Do not add local anesthetic to corticosteroid injections—this increases injection pain without benefit and adds unnecessary complexity 6
• Do not delay surgical referral when radiographic criteria for surgery are met (displacement >3mm, >1/3 articular involvement), as early definitive treatment prevents complications 1
• Do not skip the immobilization phase after surgery, as premature mobilization can lead to repair failure 1
• Do not delay active mobilization beyond 6 weeks post-surgery, as this is the critical window to prevent permanent stiffness 1