What are the treatment options for trigger finger?

Trigger Finger Treatment

Begin with conservative management including activity modification, splinting, and oral analgesics, progressing to corticosteroid injection if symptoms persist, and reserve surgical release for refractory cases with marked pain or disability. 1

Initial Conservative Management (First-Line)

All patients with trigger finger should start with non-invasive interventions:

• Activity modification and education about avoiding repetitive gripping or forceful hand activities should be implemented immediately as the foundation of treatment 1
• Heat application (paraffin wax or hot packs) before exercise provides symptomatic relief and should be recommended 1
• Range of motion and strengthening exercises maintain finger mobility and prevent stiffness 1
• Splinting, particularly for trapeziometacarpal joint involvement, may provide benefit though evidence is limited 2, 1

Pharmacological Management (Second-Line)

When conservative measures alone are insufficient:

• Oral acetaminophen (up to 4g/day) is the first-choice analgesic due to its efficacy and safety profile 1
• Topical NSAIDs are effective for mild to moderate pain when only a few fingers are affected 1
• Oral NSAIDs should be used at the lowest effective dose and shortest duration in patients who respond inadequately to acetaminophen 1
• For patients with increased gastrointestinal risk, use non-selective NSAIDs plus gastroprotective agents or selective COX-2 inhibitors 1
• COX-2 inhibitors are contraindicated in patients with cardiovascular risk, and non-selective NSAIDs should be used cautiously 1

Important Caveat on NSAID Injections

NSAID injections (diclofenac or ketorolac) offer little to no benefit over glucocorticoid injections and should not be used as the injectable treatment of choice 3. Low-certainty evidence shows NSAID injections result in higher rates of persistent moderate to severe symptoms (28% vs 14%) compared to glucocorticoid injections 3.

Corticosteroid Injection (Third-Line)

Corticosteroid injection is effective for painful flares and should be considered when oral medications and conservative measures fail 1, 4:

• Corticosteroid combined with lidocaine is significantly more effective than lidocaine alone (number needed to treat = 3) 4
• Effects can last up to 4 months 4
• This represents silver-level evidence for superiority over lidocaine alone 4

Adjunctive Physical Therapy Modalities

For patients seeking additional conservative options:

• Extracorporeal shock wave therapy (ESWT) is effective and safe, reducing pain and trigger severity while improving functional level 5
• Ultrasound therapy (UST) may prevent recurrence of trigger finger symptoms 5

Surgical Release (Fourth-Line)

Surgery should be considered when conservative treatments have failed and the patient has marked pain and/or disability 1, 6:

• Indications include failure of activity modification, splinting, oral analgesics, exercise regimens, and corticosteroid injections 6
• Do not operate without exhausting conservative measures first, as the treatment algorithm requires stepwise progression 6
• Multiple surgical techniques are available including percutaneous or open release 5, 7

Common Pitfalls to Avoid

• Do not use NSAID injections instead of corticosteroid injections – they are inferior and result in worse outcomes 3
• Do not proceed directly to surgery without at least 3 months of conservative treatment, unless there is initial presentation with fixed flexion deformity or inability to flex the finger 8
• In diabetic patients, trigger finger is more common and may require earlier escalation of treatment 7
• Women in the fifth to sixth decade of life are at higher risk and may benefit from earlier intervention 7