Treatment for trigger finger

Treatment

Treatment for trigger finger varies depending on its severity and duration.

Treatment of mild cases
For mild or infrequent symptoms, these approaches may be effective:

• Rest. You may notice improvement simply by resting the affected hand. To prevent the overuse of your affected finger, your doctor may also suggest you change or curtail work or personal activities that require repeated gripping actions.
• Splinting. Your doctor may have you wear a splint to keep the affected finger in an extended position for several weeks. The splint helps to rest the joint. Splinting also helps prevent you from curling your fingers into a fist while sleeping, which can make it painful to move your fingers in the morning.
• Finger exercises. Your doctor may also suggest that you perform gentle exercises with the affected finger. This can help you to maintain mobility in your finger.
• Soaking in water. Placing the affected hand in warm water for five to 10 minutes, especially in the morning, may reduce the severity of the catching sensation during the day. If this helps, it can be repeated several times throughout the day.
• Massage. Massaging your affected fingers may feel good and help relieve your pain, but it won't affect the inflammation.

Treatment of more serious cases
For more serious symptoms, your doctor may recommend other approaches, including:

• Nonsteroidal anti-inflammatory drugs (NSAIDs). Medications such as nonsteroidal anti-inflammatory drugs — ibuprofen (Advil, Motrin, others), for example — may relieve the inflammation and swelling that led to the constriction of the tendon sheath and trapping of the tendon, and can relieve the pain associated with trigger finger.
• Steroids. An injection of a steroid medication, such as cortisone, near or into the tendon sheath also can be used to reduce inflammation of the sheath. This treatment is most effective if given soon after signs and symptoms begin. Injections can be repeated if necessary, though repeated injections may not be as effective as the initial injection.
• Percutaneous trigger finger release. In this procedure, which is performed under local anesthesia, doctors use a needle to release the locked finger. Combining this procedure with a steroid injection may make it even more effective.
• Surgery. Though less common than other treatments, surgical release of the tendon may be necessary for troublesome locking that doesn't respond to other treatments.

 

 

 Treatment Options:  The main goals of treatment for trigger finger/thumb are to reduce the swelling present in the tendon and sheath and to restore the smooth gliding of the tendon in its sheath.

NONOPERATIVE
The main nonoperative treatment involves injecting the thickened tendon sheath with a combination of an anti-inflammatory drug (steroid) and local anesthetic.  The triggering may actually be worsened after the injection since there will be extra fluid within the sheath.  A recent study disputed the popular belief that the steroid needs to be injected directly into the sheath, which may be difficult for the physician to locate.  The study found a 70% response to the injection when placed in the vicinity of the sheath, and only 47% response with injections directly into the sheath.  Splinting the finger in extension after the injection is used by some physicians.  The patient is also instructed to restrict pinching and gripping with the affected digit. Approximately 2/3 of patients are relieved with one injection.   If there isn't relief from the injection, then it can be repeated a week later.  If  two injections fail to bring relief from the triggering, surgical management become appropriate.  However, a recent study suggested that surgical release may be more cost effective after failure of the first injection due to the effectiveness and permanency of the surgical release.

OPERATIVE
Surgical management involves making a skin incision over the involved flexor tendon sheath under local anesthesia.  The surgeon then identifies the tendon sheath and cuts the constricted area, avoiding any nerves in the area.  After the sheath is incised, there should be free movement (flexion and extension) of the previously triggering digit.  Complete recovery may take up to four weeks.  The procedure is very effective and has a low complication and recurrence rate (0-3% in recent studies).

 

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