eMedicine Specialties > Physical Medicine and Rehabilitation > Upper Limb Musculoskeletal Conditions

Trigger Finger: Follow-up

Author: Patrick M Foye, MD, FAAPMR, FAAEM, Associate Professor of Physical Medicine and Rehabilitation, Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, Director of Coccyx Pain (Tailbone Pain, Coccydynia) Service, University of Medicine and Dentistry of New Jersey, New Jersey Medical School
Coauthor(s): Todd P Stitik, MD, Professor, Department of Physical Medicine and Rehabilitation, Acting Director of Sports Medicine, UMDNJ-New Jersey School of Medicine; Lead Physician, Practice Medical Director of University Hospital PM & R Clinic
Contributor Information and Disclosures

Updated: Apr 18, 2008

Follow-up

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.

Inpatient & Outpatient Medications

  • Oral NSAIDs may be somewhat helpful.

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.

Complications

  • The complications of corticosteroid injection include the following:
    • Infection
    • Bleeding
    • Tendon rupture
    • Atrophy of subcutaneous fat
    • Digital nerve injury

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.

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.

Miscellaneous

Medicolegal Pitfalls

  • Perhaps the most important differential diagnosis is infection, such as suppurative tenosynovitis. Any such infection requires immediate referral to a hand surgeon or plastic surgeon for aggressive management, which includes antibiotics and local procedures.
  • Before injecting any medication, always withdraw on the syringe to ensure that the needle tip is not located within an intravascular space.
  • Do not inject the corticosteroid solution if there is significant resistance to injection flow, which may indicate that the needle tip is in the tendon rather than just within the tendon sheath.

Special Concerns

  • Pregnant patient - Splinting and local corticosteroid injection can be performed if the patient is pregnant. Surgical release of the A1 pulley is generally an elective procedure and is usually deferred until after delivery.
  • Pediatric patient - In infants, the nodule on the flexor pollicis longus tendon can be resected with good results. Corticosteroid injections are generally not helpful in these cases of congenital trigger thumb.
  • Elderly patient with a history of gastrointestinal problems or other complications from NSAIDs - Consider cyclo-oxygenase-2 (COX-2) inhibitors if oral NSAIDs are needed.

See also the following related Medscape topic:
 CME GI Risks and Benefits of Traditional and COX-2-Selective NSAIDs

 
Acknowledgments

Debra Ibrahim, 4th year medical student, New York College of Osteopathic Medicine, Class of 2008, assisted with the 2007 revision of this manuscript.



More on Trigger Finger

Overview: Trigger Finger
Differential Diagnoses & Workup: Trigger Finger
Treatment & Medication: Trigger Finger
Follow-up: Trigger Finger
Multimedia: Trigger Finger
References
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References

  1. Trigger finger. In: Snider RK, ed. Essentials of Musculoskeletal Care. Rosemont, Ill: American Academy of Orthopaedic Surgeons; 1997:249-53.

  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. 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].

  7. 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].

  8. 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].

  9. 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].

  10. 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].

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

  12. [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].

  13. [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].

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

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

  16. 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].

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Further Reading

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Keywords

trigger finger, digital flexor tenosynovitis, digital tenovaginitis stenosans, flexor tendon stenosing tenosynovitis, locked finger, stick palsy, trigger digit, trigger thumb, volar flexor tenosynovitis, flexor pollicis longus tendon nodule

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Contributor Information and Disclosures

Author

Patrick M Foye, MD, FAAPMR, FAAEM, Associate Professor of Physical Medicine and Rehabilitation, Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, Director of Coccyx Pain (Tailbone Pain, Coccydynia) Service, University of Medicine and Dentistry of New Jersey, New Jersey Medical School
Patrick M Foye, MD, FAAPMR, FAAEM 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, Acting Director of Sports Medicine, UMDNJ-New Jersey School of Medicine; Lead Physician, Practice Medical Director of University Hospital PM & R Clinic
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.

Medical Editor

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, Physiatric Association of Spine, Sports and Occupational Rehabilitation, and Texas Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Michael T Andary, MD, MS, Residency Program Director, Professor, 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: Nothing to disclose.

CME Editor

Kelly L Allen, MD, Consulting Staff, Department of Physical Medicine and Rehabilitation, Lourdes Regional Rehabilitation Center, Our Lady of Lourdes Medical Center
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.

 
 
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