Treatment

The treatment of trigger finger can be divided into medical and surgical. Surgical release tends to provide a definitive cure but for mild disease, steroid injection may provide a more simple solution.

• diagnosis is made clinically
  • the joints and tendons should be examined to exclude synovitis or tenosynovitis
  • ultrasound can confirm the diagnosis
• medical therapy
  • conservative therapy using splints may allow the condition to resolve naturally. Resistant cases often respond dramatically to localised corticosteroid and lignocaine injections placed within the tendon sheath around the painful nodule. Cases resistant to corticosteroid injections can be referred for surgical release
  • a systematic review concluded that show compared to glucocorticoid injection, NSAID injection offered little to no benefit in the treatment of trigger finger. Specifically, there was no difference in resolution, symptoms, recurrence, total active motion, residual pain, participant-reported treatment success, or adverse events (2)
• surgical therapy
  • irreducibly locked trigger fingers should be referred urgently to a hand or orthopaedic surgeon to prevent permanent contracture of the finger
    • surgical treatment of trigger finger entails release of the A1 pulley but the surgeon should clinically ascertain the level of obstruction as more distal release may be required. This can be carried out as a local anaesthetic procedure
    • after exsanguination and tourniquet application, an incision is made either longitudinally from the distal palmar crease to the base of the digit, or transversely at a level just distal to the palmar crease. The latter incision can be extended with Brunner-type flaps to the base of the digit if exposure is problematical
    • carefully dissecting, the flexor tendon sheath is exposed. It is prudent to identify and preserve the neurovascular digital bundles. Identifying the proximal thickened edge of the sheath that corresponds to the A1 pulley, a longitudinal incision is made from this point distally. There may be a palpable 'give' as release is obtained. The operator should ensure that the digit is the freely mobile
    • care must be exercised in rheumatoid arthritis. The A1 pulley reinforces the volar connection between the head of the metacarpal and the proximal phalanx. Release may increase the tendency to subluxation.

Reference:

• 1) Arthritis Research UK (April 2013). The upper limb in primary care. Part 2: Wrist, hand. Hands On 2(7).
• 2) Leow MQ, Zheng Q, Shi L, Tay SC, Chan ESY. Non-steroidal anti-inflammatory drugs (NSAIDs) for trigger finger. Cochrane Database of Systematic Reviews 2021, Issue 4. Art. No.: CD012789. DOI: 10.1002/14651858.CD012789.pub2. Accessed 28 August 2021.