Evidence in treatment of trigger finger: a review

Authors

DOI:

https://doi.org/10.18203/2349-2902.isj20232872

Keywords:

Finger, Occupational hand injuries, Hand surgery, Tendon sheath

Abstract

Sclerosing flexor tenosynovitis (commonly known as “trigger finger”) is one of the main causes of pain and disability in the hand for which patients attend reconstructive and orthopedic surgery. The pathophysiology of this affectation is based on the presence of repetitive trauma that generates an inflammatory process in the sheath of the flexor tendon of the fingers, which eventually generates an alteration in the hand pulley system and produces all the manifestations characteristics of this disease. First and second author independently searched databases using the following databases: Medline, Cinhal, Pubmed, Cochrane Library, and Clinicaltrials.gov, using the keywords: trigger finger conservative and surgical management. Publications that evaluated the effectiveness and provided comparative and conclusive information on the results of surgical and conservative management for carrying out this work were reviewed and considered. The usefulness of 3 therapeutic methods for managing trigger finger was reviewed, identifying a success rate of 56% with isolated steroid injection and up to 79.6% when used serially; in the use of orthoses, a reduction in the symptom score was identified in all cases, although there is no conclusive evidence on long-term results and complete resolution of the condition; Regarding surgical treatment, it was determined that it represents the best alternative for long-term symptom resolution, with a higher rate of sequelae such as pain within the first week or nerve injury. Intrafascial steroid-based injection represents the initial technique of choice in the management of trigger finger. The use of orthoses may represent an alternative in patients who have no impediment for their use for a fairly long time. Open surgical treatment continues being the therapeutic measure to be overcome, with a high symptom resolution rate 1 year after the procedure.  

References

AAOS. Trigger finger. AAOS Essentials of Musculoskeletal Care. 6th ed. Burlington, MA: Jones and Bartlett Learning; 2022.

Finnoff JT, Johnson W. Upper limb pain and dysfunction. Cifu DX, Eapen BC, Johns JS, Kowalske KJ, Lew HL, Miller MA, et al, eds. Braddom's Physical Medicine and Rehabilitation. 6th ed. Philadelphia: Elsevier; 2021: 715-26.

Kim HR, Lee SH. Ultrasonographic assessment of clinically diagnosed trigger fingers. Rheumatol Int. 2010;30(11):1455-8.

Kloeters O, Ulrich DJ, Bloemsma G, Houdt CI. Comparison of three different incision techniques in A1 pulley release on scar tissue formation and postoperative rehabilitation. Arch Orthop Trauma Surg. 2016;136(5):731-7.

Zyluk A, Jagielski G. Percutaneous A1 pulley release vs steroid injection for trigger digit: the results of a prospective, randomized trial. J Hand Surg Eur Vol. 2011;36(1):53-6.

Makkouk AH, Oetgen ME, Swigart CR, Dodds SD. Trigger finger: etiology, evaluation, and treatment. Curr Rev Musculoskelet Med. 2008;1(2):92-6.

Cardoso R, Szabo RM. Wrist anatomy and surgical approaches. Orthop Clin North Am. 2007;38(2):127-48.

Turowski GA, Zdankiewicz PD, Thomson JG. The results of surgical treatment of trigger finger. J Hand Surg Am. 1997;22(1):145-9.

Doyle JR. Anatomy of the finger flexor tendon sheath and pulley system. J Hand Surg Am. 1988;13(4):473-84.

Huisstede BM, Hoogvliet P, Coert JH, Fridén J; European HANDGUIDE Group. Multidisciplinary consensus guideline for managing trigger finger: results from the European HANDGUIDE Study. Phys Ther. 2014;94(10):1421-33.

Lewis J, Seidel H, Shi L, Wolf J, Strelzow J. National Benchmarks for the Efficacy of Trigger Finger and the Risk Factors Associated With Failure. J Am Acad Orthop Surg Glob Res Rev. 2023;7(2):e22.00198.

Kerrigan CL, Stanwix MG. Using evidence to minimize the cost of trigger finger care. J Hand Surg Am. 2009;34(6):997-1005.

Fleisch SB, Spindler KP, Lee DH. Corticosteroid injections in the treatment of trigger finger: a level I and II systematic review. J Am Acad Orthop Surg. 2007;15(3):166-71.

Stahl S, Kanter Y, Karnielli E. Outcome of trigger finger treatment in diabetes. J Diabetes Complications. 1997;11(5):287-90.

Dala-Ali BM, Nakhdjevani A, Lloyd MA, Schreuder FB. The efficacy of steroid injection in the treatment of trigger finger. Clin Orthop Surg. 2012;4(4):263-8.

Marshall S, Tardif G, Ashworth N. Local corticosteroid injection for carpal tunnel syndrome. Cochrane Database Syst Rev. 2002;(4):CD001554.

Rozental TD, Zurakowski D, Blazar PE. Trigger finger: prognostic indicators of recurrence following corticosteroid injection. J Bone Joint Surg Am. 2008;90(8):1665-72.

Baumgarten KM, Gerlach D, Boyer MI. Corticosteroid injection in diabetic patients with trigger finger. A prospective, randomized, controlled double-blinded study. J Bone Joint Surg Am. 2007;89(12):2604-11.

Lunsford D, Valdes K, Hengy S. Conservative management of trigger finger: A systematic review. J Hand Ther. 2019;32(2):212-21.

Froimson AI. Tenosynovitis and tennis elbow. 4th ed. Philadelphia: Churchill Livingston; 1999.

Fiorini HJ, Tamaoki MJ, Lenza M, Gomes Dos Santos JB, Faloppa F, Belloti JC. Surgery for trigger finger. Cochrane Database Syst Rev. 2018;2(2):CD009860.

Anuntaseree S. The percutaneous trigger finger release scalpel - the A knife. BMC Proc. 2015;9(3):A78.

Downloads

Published

2023-09-22

Issue

Section

Review Articles