How is trigger finger managed in pregnancy?

Management of Trigger Finger in Pregnancy

Conservative management with splinting is the recommended first-line treatment for trigger finger during pregnancy, as corticosteroid injections and surgical interventions should be deferred until after delivery when possible.

Initial Conservative Approach

Splinting should be initiated as the primary treatment modality for pregnant patients with trigger finger. The affected metacarpophalangeal joint should be immobilized in a neutral position for at least 8 hours per day for 6 consecutive weeks 1. This approach avoids potential fetal exposure to medications and surgical risks while providing effective symptom relief 1.

• Activity modification and avoidance of repetitive gripping motions should be implemented alongside splinting 2
• Pain management can be achieved with acetaminophen, which is considered safe throughout pregnancy 2
• Splinting alone has demonstrated comparable pain reduction and functional improvement to steroid injection at 6,12, and 52 weeks in non-pregnant populations 1

Considerations for Corticosteroid Injection

If conservative measures fail and symptoms significantly impact quality of life, corticosteroid injection may be considered after the first trimester, though this requires careful risk-benefit discussion. While corticosteroids cross the placenta, with approximately 10% of the maternal dose reaching the developing fetus, more recent studies have not supported earlier concerns about cleft lip/palate abnormalities when used in the first trimester 3.

• High-dose or prolonged corticosteroid use (>5 mg prednisolone per day for >3 weeks) is associated with gestational diabetes and potential adrenal suppression 3
• Local corticosteroid injection for trigger finger involves lower systemic exposure than oral corticosteroids 4
• The injection technique involves 1 mL of 1% lidocaine without epinephrine and 1 mL of triamcinolone acetonide (10 mg/mL) into the flexor tendon sheath 1

Surgical Management

Surgical release of the A1 pulley should be deferred until after delivery except in rare cases of severe functional impairment or locked finger that cannot be passively extended. Open A1 pulley release has cure rates near 100% but carries surgical and anesthetic risks during pregnancy 5.

• If surgery is absolutely necessary during pregnancy, it should ideally be performed in the second trimester to minimize risks of spontaneous abortion (first trimester) and preterm labor (third trimester) 3
• Regional anesthesia with lidocaine or bupivacaine is preferred over general anesthesia when surgery cannot be avoided 3
• Elective procedures should be postponed until the postpartum period 3

Common Pitfalls to Avoid

• Do not withhold appropriate pain management due to pregnancy concerns, as inadequately controlled pain can negatively impact maternal and fetal well-being 3
• Avoid multiple corticosteroid injections during pregnancy, as repeated injections increase systemic exposure and potential complications 3
• Do not delay treatment of a locked finger that cannot be passively extended, as this may lead to permanent flexion contracture requiring more extensive surgical intervention 6

Clinical Algorithm

1. First-line: Initiate splinting for 6 weeks with activity modification 1
2. If inadequate response after 6 weeks and beyond first trimester: Consider single corticosteroid injection after discussing risks/benefits 3, 1
3. If persistent symptoms: Continue conservative management until postpartum period when definitive surgical treatment can be performed 5
4. Exception: Locked finger with inability to passively extend warrants earlier surgical consideration regardless of trimester 6