What is the diagnosis and treatment for trigger finger (stenosing tenosynovitis)?

From the Guidelines

Trigger finger should be initially managed with conservative treatments, and if symptoms persist, a corticosteroid injection or surgical evaluation may be warranted, as evidenced by the most recent and highest quality study 1. For mild cases, rest and avoiding repetitive gripping activities may help. Over-the-counter anti-inflammatory medications like ibuprofen (400-600mg three times daily with food) can reduce pain and swelling. Gentle stretching exercises and warm water soaks for 5-10 minutes several times daily may also provide relief. Some key points to consider in the management of trigger finger include:

• The use of ultrasound (US) evaluation to diagnose or confirm tendon abnormalities, including tendinopathy, tendon tear, and tenosynovitis, as noted in the 2024 study 1.
• The importance of early treatment to prevent the condition from becoming permanent, particularly in individuals with diabetes or rheumatoid arthritis who have a higher risk of developing trigger finger.
• The potential need for a minor surgical procedure called trigger finger release to widen the tendon sheath in severe or persistent cases, as discussed in the 2005 study 1. Key considerations in the management of trigger finger include:
• The location and severity of the condition
• The presence of underlying medical conditions, such as diabetes or rheumatoid arthritis
• The effectiveness of conservative treatments, such as rest, anti-inflammatory medications, and corticosteroid injections.

From the Research

Definition and Treatment of Trigger Finger

• Trigger finger is a sudden release or locking of a finger during flexion or extension, also known as stenosing flexor tenosynovitis of the fingers 2, 3.
• Treatments for trigger finger include conservative and surgical methods, such as NSAIDs, hand splints, corticosteroid injections, physical therapies, and percutaneous or open surgery 2, 3.

Conservative Treatment Options

• Physical therapies, including external shock wave therapy (ESWT) and ultrasound therapy (UST), have been shown to be effective in reducing pain and trigger severity, and improving functional level and quality of life 2.
• Corticosteroid injections are a common conservative treatment option, with triamcinolone, methylprednisolone, and dexamethasone being commonly used steroids 4, 5.
• The choice of corticosteroid solution can affect clinical outcomes, with triamcinolone demonstrating a higher rate of additional injections, and methylprednisolone resulting in earlier and more frequent surgical intervention 5.

Optimal Dosage of Corticosteroid Injection

• A study comparing the efficacy of different injection dosages of triamcinolone acetonide found that a 20-mg dose had a significantly higher rate of clinical effectiveness at 6-month follow-up compared to 5-mg and 10-mg doses 6.
• The optimal dosage of corticosteroid injection may depend on various factors, including the severity of the trigger finger and individual patient response 6.

Surgical Treatment Options

• Surgical treatment options for trigger finger include percutaneous A1 pulley release and open A1 pulley release, with excision of a slip of the flexor digitorum superficialis reserved for patients with persistent triggering or flexion contracture 3.
• Pediatric trigger thumb is typically treated with open A1 pulley release, while pediatric trigger finger may require release of the A1 pulley with excision of a slip or all of the flexor digitorum superficialis if triggering persists 3.