Management for trigger finger
Currie, 2022Brozovich, 2019Amirfeyz, 2017
Refer people with trigger finger to a hand therapist. Nonsurgical treatments include:
- activity modification—for example, avoid repetitive gripping or pinching movements, such as playing guitar or rock-climbing
- splinting—evidence for the effectiveness of splinting is limited; for symptomatic relief, a trial of splinting in either metacarpophalangeal-joint extension or distal-interphalangeal joint extension is a reasonable option
- local corticosteroid injection.
Splinting can be combined with application of ice, and use of oral nonsteroidal anti-inflammatory drugs (NSAIDs). Topical, oral and injectable NSAIDs have been trialled for trigger finger, but no studies have evaluated their efficacy against placeboLeow, 2021. Injectable NSAIDs have not demonstrated benefit over local corticosteroid injection and may be less effectiveLeow, 2021. NSAIDs are therefore not recommended.
Local corticosteroid injection in the region around the first annular ligament (A1) pulley is a highly effective treatment, with reported success rates of 50 to 70% in randomised controlled trialsBrozovich, 2019. Injection may be particularly effective if a well-defined nodule is palpable, or if symptoms have been present for less than 6 monthsBrozovich, 2019. A clinician experienced with soft-tissue injections is usually required. Alternatively, the injection can be performed under ultrasound-guidance. Recurrence or persistence of symptoms is more likely to occur after local corticosteroid injection than after surgeryFiorini, 2018. For principles of use and example doses of local corticosteroid injections, see Principles of using local corticosteroid injections for musculoskeletal pain.
If a digit is locked in flexion, gentle passive manipulation may be attempted to release the digit into extension.
Surgery may be considered for people with persistent symptoms despite nonsurgical management. A 2018 Cochrane review1 concluded there was insufficient evidence to recommend open surgery over local corticosteroid injection, or if one type of surgery was better than anotherFiorini, 2018. Refer to a hand surgeon if necessary.