Current Concepts in the Management of Trigger Finger in Adults

J Am Acad Orthop Surg. 2020 Aug 1;28(15):e642-e650. doi: 10.5435/JAAOS-D-19-00614.

Abstract

Trigger finger (TF) is one of the most common causes of hand disability. Immobilization of TF with a joint-blocking orthosis has been demonstrated to effectively relieve pain and improve function. The efficacy of steroid injections for TF varies based on the number of affected digits and the clinical severity of the condition. Up to three repeat steroid injections are effective in most patients. When conservative interventions are unsuccessful, open surgical release of the A1 pulley effectively alleviates the subjective and objective manifestations of TF and currently remains the benchmark procedure for addressing TF. Although several studies have emerged suggesting that a percutaneous approach may result in improved outcomes, this technique demands a learning curve that may predispose patients to higher risk of procedure-related complications. There is no role for preoperative antibiotics in patients who undergo elective soft-tissue procedures of the hand. WALANT anesthesia has gained popularity because it has been associated with improved patient outcomes and a clear cost savings; however, proper patient selection is critical. Similar to other soft-tissue hand procedures, TF surgery rarely necessitates a postoperative opioid prescription.

Publication types

  • Review

MeSH terms

  • Adrenal Cortex Hormones / administration & dosage
  • Adult
  • Anesthesia, Local / economics
  • Anesthesia, Local / methods
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
  • Conservative Treatment
  • Cost Savings
  • Hand / surgery
  • Humans
  • Immobilization / methods
  • Injections, Intralesional
  • Learning Curve
  • Orthopedic Procedures / economics
  • Orthopedic Procedures / education
  • Orthopedic Procedures / methods*
  • Trigger Finger Disorder / diagnosis
  • Trigger Finger Disorder / surgery*
  • Trigger Finger Disorder / therapy

Substances

  • Adrenal Cortex Hormones
  • Anti-Inflammatory Agents, Non-Steroidal