Where should a patient with stenosing tenosynovitis (trigger finger) be referred for treatment?

From the Guidelines

For trigger finger, you should be referred to an orthopedic surgeon or a hand specialist. These medical professionals specialize in conditions affecting the hand and can provide comprehensive evaluation and treatment options. Initially, your primary care physician may recommend conservative treatments like rest, splinting, or anti-inflammatory medications. If these measures don't provide relief, they should refer you to a specialist. The specialist may offer steroid injections into the tendon sheath, which can reduce inflammation and resolve symptoms in many cases. For persistent or severe cases, a minor surgical procedure called trigger finger release may be necessary to widen the tendon sheath and allow smooth tendon movement. Early specialist referral is particularly important if you experience severe pain, complete locking of the finger, or if the condition affects multiple fingers or interferes with daily activities. Trigger finger occurs when inflammation narrows the space within the tendon sheath, causing the tendon to catch or "trigger" when the finger bends and straightens, so specialized care is often needed for proper resolution, as supported by the American College of Rheumatology 1.

Some key points to consider when referring a patient with trigger finger include:

• The use of musculoskeletal US to identify synovitis, joint effusion, tenosynovitis, tendinopathy and tendon injury, CTS, and retained foreign body 1
• The importance of early specialist referral for severe or persistent cases, as surgery may be necessary to promote healing and prevent further complications, as noted in a study on common overuse tendon problems 1
• The potential benefits of steroid injections into the tendon sheath to reduce inflammation and resolve symptoms, which can be evaluated and performed by an orthopedic surgeon or hand specialist.

Overall, referral to an orthopedic surgeon or hand specialist is the most appropriate course of action for trigger finger, as they can provide comprehensive evaluation and treatment options to improve morbidity, mortality, and quality of life outcomes.

From the Research

Referral for Trigger Finger

For a trigger finger, you should be referred to a hand surgeon or an orthopedic specialist.

• The decision for referral may depend on the severity of the condition and the effectiveness of non-surgical treatments such as corticosteroid injections 2, 3, 4.
• If non-surgical treatments fail, surgical options such as percutaneous A1 pulley release or open A1 pulley release may be considered 5.
• In some cases, excision of a slip of the flexor digitorum superficialis may be necessary for patients with persistent triggering or flexion contracture 5.

Treatment Options

Treatment options for trigger finger include:

• Corticosteroid injections, which can be effective in reducing symptoms and improving function 2, 3, 4
• Orthotic management, such as immobilizing a single joint of the affected digit for 6-10 weeks 6
• Surgical treatment, including percutaneous A1 pulley release, open A1 pulley release, or excision of a slip of the flexor digitorum superficialis 5

Specialist Referral

Referral to a specialist, such as a hand surgeon or orthopedic specialist, may be necessary for:

• Persistent or severe symptoms that do not respond to non-surgical treatments 5
• Surgical treatment options, such as percutaneous A1 pulley release or open A1 pulley release 5
• Complex cases, such as those with multiple trigger fingers or underlying medical conditions 2, 3, 4