Physical Medicine and Rehabilitation for Trigger Finger Follow-up

  • Author: Patrick M Foye, MD; Chief Editor: Rene Cailliet, MD   more...
 
Updated: Nov 2, 2010
 

Further Outpatient Care

The patient should return for a follow-up visit within 1-4 weeks. At this time, further treatment, such as splinting, repeat corticosteroid injection (but not within a few weeks of a previous injection), or surgical referral for severe, unresponsive cases should be considered. In addition, any complications from previous injections should be assessed.

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Inpatient & Outpatient Medications

Oral NSAIDs may be somewhat helpful.

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Transfer

Because injection is the primary treatment for trigger finger, physicians who are not trained or experienced in the administration of trigger finger injections and who are uncomfortable with performing them should consider transferring care to a skilled clinician.

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Complications

The complications of corticosteroid injection include the following:

  • Infection
  • Bleeding
  • Tendon rupture
  • Atrophy of subcutaneous fat
  • Digital nerve injury
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Prognosis

The prognosis is very good; most patients respond to corticosteroid injection with or without associated splinting. Some cases of trigger finger may resolve spontaneously and then reoccur without obvious correlation with treatment or exacerbating factors.

Patients who need surgical release generally have a very good outcome.

The prognosis is also very good for congenital trigger thumb that is treated with resection of the tendon nodule.

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Patient Education

As with patient education following any local injection, patients should be told to watch for signs and symptoms of infection and bleeding. Any suggestion of infection or excessive bleeding should be reported to the physician immediately.

Patients should understand that some increased tenderness may be noted at the injection site for 2-4 days, until the corticosteroid begins to have a significant therapeutic effect. If there is an inordinate amount of pain after the procedure, patients should contact the physician who performed the injection.

Patients should understand that a certain amount of numbness in the digit may occur if some of the local anesthetic has come into contact with a digital nerve; however, the numbness should resolve within a matter of hours after the injection. Significant, persistent numbness should be reported to the physician who performed the injection.

To minimize the risk of tendon rupture after corticosteroid injection, the patient should be advised that, for a few weeks following the injection, he/she should avoid using the injected structures for excessively strenuous or forceful activity.

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Contributor Information and Disclosures
Author

Patrick M Foye, MD  Associate Professor of Physical Medicine and Rehabilitation, Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, Director of Coccyx Pain Service (Tailbone Pain Service: www.TailboneDoctor.com), University of Medicine and Dentistry of New Jersey, New Jersey Medical School

Patrick M Foye, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists, and International Spine Intervention Society

Disclosure: Nothing to disclose.

Coauthor(s)

Todd P Stitik, MD  Professor, Department of Physical Medicine and Rehabilitation; Director, Outpatient Occupational/Musculoskeletal Medicine, UMDNJ-New Jersey School of Medicine

Todd P Stitik, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Association of Academic Physiatrists, Phi Beta Kappa, and Physiatric Association of Spine, Sports and Occupational Rehabilitation

Disclosure: Nothing to disclose.

Dev Sinha, MD  Research Associate/Physiatrist Observership, Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Disclosure: Nothing to disclose.

Specialty Editor Board

Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM  President and Director, Georgia Pain Physicians, PC; Clinical Associate Professor, Department of Physical Medicine and Rehabilitation, Emory University School of Medicine

Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, American Medical Association, International Association for the Study of Pain, and Texas Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Michael T Andary, MD, MS  Professor, Residency Program Director, Department of Physical Medicine and Rehabilitation, Michigan State University College of Osteopathic Medicine

Michael T Andary, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, and Association of Academic Physiatrists

Disclosure: Allergan Honoraria Speaking and teaching; Pfizer Honoraria Speaking and teaching

Kelly L Allen, MD  Medical Director, Medevals

Disclosure: Nothing to disclose.

Chief Editor

Rene Cailliet, MD  Professor-Chairman Emeritus, Department of Rehabilitation Medicine, University of Southern California School of Medicine; Former Director, Department of Rehabilitation Medicine, Santa Monica Hospital Medical Center

Rene Cailliet, MD is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American Pain Society, Association of American Medical Colleges, International Association for the Study of Pain, and Pan American Medical Association

Disclosure: Nothing to disclose.

References

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  2. Strakowski JA, Wiand JW, Johnson EW. Upper limb musculoskeletal pain syndromes. In: Braddom RL, ed. Physical Medicine and Rehabilitation. Philadelphia, Pa: WB Saunders; 1996:756-82.

  3. Breen TF. Wrist and hand. In: Steinberg GG, Akins CM, Baran DT, eds. Orthopaedics in Primary Care. 3rd ed. Baltimore, Md: Lippincott Williams & Wilkins; 1999:99-138.

  4. Brinker MR, Miller MD. The adult hand. In: Fundamentals of Orthopaedics. Philadelphia, Pa: WB Saunders; 1999:196-220.

  5. McGee DJ. Forearm, wrist and hand. In: Orthopedic Physical Assessment. 2nd ed. Philadelphia, Pa: WB Saunders; 1992:168-215.

  6. Moore JS. Flexor tendon entrapment of the digits (trigger finger and trigger thumb). J Occup Environ Med. May 2000;42(5):526-45. [Medline].

  7. Moriya K, Uchiyama T, Kouda H, Kawaji Y. Acromegaly as a cause of trigger finger. Scand J Plast Reconstr Surg Hand Surg. 2009;43(4):236-238.

  8. Kumar P, Chakrabarti I. Idiopathic carpal tunnel syndrome and trigger finger: is there an association?. J Hand Surg Eur Vol. Feb 2009;34(1):58-9. [Medline].

  9. Ryzewicz M, Wolf JM. Trigger digits: principles, management, and complications. J Hand Surg Am. Jan 2006;31(1):135-46. [Medline].

  10. Fitzgerald BT, Hofmeister EP, Fan RA, et al. Delayed flexor digitorum superficialis and profundus ruptures in a trigger finger after a steroid injection: a case report. J Hand Surg [Am]. May 2005;30(3):479-82. [Medline].

  11. Jianmongkol S, Kosuwon W, Thammaroj T. Intra-tendon sheath injection for trigger finger: the randomized controlled trial. Hand Surg. 2007;12(2):79-82. [Medline].

  12. Anderson B, Kaye S. Treatment of flexor tenosynovitis of the hand ('trigger finger') with corticosteroids. A prospective study of the response to local injection. Arch Intern Med. Jan 1991;151(1):153-6. [Medline].

  13. Nimigan AS, Ross DC, Gan BS. Steroid injections in the management of trigger fingers. Am J Phys Med Rehabil. Jan 2006;85(1):36-43. [Medline].

  14. 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. Mar 2007;15(3):166-71. [Medline].

  15. Geiringer SR. Tendon sheath and insertion injections. In: Lennard TA, ed. Physiatric Procedures in Clinical Practice. Philadelphia, Pa: Hanley & Belfus; 1995:44-8.

  16. [Best Evidence] Peters-Veluthamaningal C, Winters JC, Groenier KH, et al. Corticosteroid injections effective for trigger finger in adults in general practice: a double-blinded randomized placebo controlled trial. Ann Rheum Dis. Jan 7 2008;[Medline].

  17. [Best Evidence] 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. Dec 2007;89(12):2604-11. [Medline].

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

  19. Nonsteroidal anti-inflammatory drugs (NSAIDs). In: Green SM, ed. Tarascon Pocket Pharmacopoeia 2000. Loma Linda, Calif: Tarascon Pub; 2000:11-2.

  20. Akhtar S, Bradley MJ, Quinton DN, et al. Management and referral for trigger finger/thumb. BMJ. Jul 2 2005;331(7507):30-3. [Medline].

  21. Taras JS, Raphael JS, Pan WT, et al. Corticosteroid injections for trigger digits: is intrasheath injection necessary?. J Hand Surg [Am]. Jul 1998;23(4):717-22. [Medline].

  22. Colbourn J, Heath N, Manary S, Pacifico D. Effectiveness of splinting for the treatment of trigger finger. J Hand Ther. Oct-Dec 2008;21(4):336-43. [Medline].

 
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Flexor tendons pass within the tendon sheath and beneath the A-1 pulley at approximately the metacarpal head, beyond which they travel into the digit.
An inflamed nodule can restrict the tendon from passing smoothly beneath the A-1 pulley. If the nodule is distal to the A-1 pulley (as shown in this sketch), then the digit may get stuck in an extended position. Conversely, if the nodule is proximal to the A-1 pulley, then the patient's digit is more likely to become stuck in the flexed position.
A trigger finger often results in difficulty flexing or (in this case) extending the metacarpophalangeal joint of the involved digit.
 
 
 
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