What is the treatment for a finger stuck in a locked position?

Treatment for Trigger Finger (Stenosing Flexor Tenosynovitis)

For a finger stuck in a locked position, begin with conservative management using splinting of the metacarpophalangeal joint at 10-15 degrees of flexion for 3-6 weeks, and if this fails, proceed to corticosteroid injection before considering surgical release. 1

Initial Diagnostic Approach

Trigger finger is a stenosing flexor tenosynovitis caused by inflammation and narrowing of the A1 pulley, resulting in clicking, catching, locking, and loss of motion. 2

• Standard radiographs should be obtained to rule out fractures or other bony abnormalities, though they are typically normal in trigger finger 3
• MRI without IV contrast can be helpful in complex cases to evaluate both the tendon and surrounding soft tissue abnormalities 3
• The diagnosis is usually straightforward based on clinical presentation, but other pathological processes such as fracture, tumor, or traumatic soft tissue injuries must be excluded 2

Treatment Algorithm

First-Line: Splinting (Success Rate 66%)

• Splint the metacarpophalangeal joint at 10-15 degrees of flexion for an average of 6 weeks (range 3-9 weeks) 1
• This approach is successful in 66% of cases overall, with 50% success in thumbs and 70% success in fingers 1
• Splinting offers an alternative for patients who have strong objections to corticosteroid injection 1
• Instruct patients to move the fingers regularly through a complete range of motion to prevent stiffness, which is one of the most functionally disabling adverse effects 4, 5

Second-Line: Corticosteroid Injection (Success Rate 84%)

• If splinting fails, inject 0.5 ml of betamethasone sodium phosphate and acetate suspension plus 0.5 ml of lidocaine 1
• This approach is successful in 84% of cases 1
• Of the 17 unsuccessfully treated digits in the splinted group, 15 were later cured with injections 1

Third-Line: Surgical Release

• Surgical options include percutaneous A1 pulley release or open A1 pulley release 6
• Surgery is indicated when conservative treatments fail 6
• All 7 unsuccessfully treated digits in the injected group were cured with surgery 1
• Excision of a slip of the flexor digitorum superficialis is reserved for patients with persistent triggering despite A1 release or patients with persistent flexion contracture 6

Prognostic Factors Predicting Treatment Failure

Patients with the following characteristics have higher failure rates with conservative treatment: 1

• Marked triggering (severe locking)
• Symptoms lasting more than 6 months
• Multiple involved digits

Alternative Physical Therapy Options

• External shock wave therapy (ESWT) is effective and safe for conservative management, reducing pain and trigger severity while improving functional level and quality of life 7
• Ultrasound therapy (UST) has proven useful to prevent recurrence of trigger finger symptoms 7

Special Consideration: Locked Finger (Metacarpophalangeal Subluxation)

If the presentation includes painful locking with inability to fully extend the metacarpophalangeal joint AND lateral displacement of the extensor tendon, this represents a different condition called "locked finger" (metacarpophalangeal subluxation) 8:

• This condition typically affects men aged 50 or older with history of repeated light manual effort 8
• Treatment consists of gentle manipulation under regional nerve block, which is successful in most cases 8
• Radiographs may show abnormal metacarpal head shape, free intra-articular bodies, sesamoid bones at the volar plate level, or degenerative changes 8

Common Pitfalls

• Failure to encourage early finger motion can lead to significant stiffness that is difficult to treat after resolution 4, 5
• Trigger finger is more common in diabetic patients and women in the fifth to sixth decade of life 2
• Unremitting pain during follow-up warrants reevaluation for complications 5