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Trigger Finger


Referrals for USS guided steroid injections to RCHT Clinical Imaging have restarted.  Please note there is limited capacity so referrals should be reserved for patients with significant disabling and persistent symptoms.  Please click here for full details



Covid-19 Update: Corticosteroid Injections During The Coronavirus Pandemic  

Please ensure and document that a discussion has happened that the patient is aware corticosteroid injections pose a possible and quantifiably unknown increased risk of, and complications from, Covid and the possible risk of reduced Covid vaccine efficacy prior to performing.  Secondary care referrals for steroid injection, including image guided injections, require the patient to be counselled and risk assessed prior to referral and this documented in the referral.  Please see guidance available here for detailed information. 



Conservative management options prior to surgery:

  1. Activity modification/NSAIDs
  2. Hand Therapy
  3. Splinting
  4. Steroid injection relieves the pain and triggering in about 70% of cases, but the success rate is lower in people with diabetes. A second injection is sometimes helpful, but surgery may be needed if triggering persists.

 

When to Refer for Surgery:

  • Uncomplicated trigger finger failing to respond to conservative measures (following a trial of up to 2 steroid injections if the first injection gives some benefit)
  • Trigger finger in a patient with Diabetes – Following a trial of 1 steroid injection
  • Locked trigger finger (in either flexion or extension)

AND· Patient wishes to undergo surgery

If symptoms fail to resolve, or there are extenuating circumstance that lead to a patient deciding against injection, then the next line of treatment may be either an open or percutaneous release of the constricted pulley (high evidence).

Recurrence of triggering after surgery is uncommon.

http://policies.kernowccg.nhs.uk/DocumentsLibrary/KernowCCG/IndividualFundingRequests/Policies/MusculoskeletalCorticosteroidInj

 

References:

  1. British Society Surgery of the Hand – Evidence for Surgical Treatment (BEST) Evidence based management of adult trigger digits, October 2016.  

 

 

Date reviewed                     10/12/2021

Next review due                  10/12/2022

Sifter name                          Dr Rebecca Hopkins

 

Version No. 2.1