Trigger Finger Medication

Updated: Apr 26, 2021
  • Author: Satishchandra Kale, MD, MBBS, MBA, MCh(Orth), FRCS(Edin), FRCS(Tr&Orth); Chief Editor: Harris Gellman, MD  more...
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Medication

Medication Summary

For patients with trigger finger (TF), medications are used primarily to decrease pain and inflammation in conjunction with the rehabilitation plan. Thus, the most common medication treatments are focal corticosteroid injection at the site of maximal tenderness or inflammation and the administration of nonsteroidal anti-inflammatory drugs (NSAIDs).

The most common corticosteroid preparations used include prednisolone, dexamethasone, and triamcinolone. Commonly, the corticosteroid is mixed with a local anesthetic agent prior to injection.

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Nonsteroidal Anti-inflammatory Drugs

Class Summary

Oral NSAIDs can help to decrease pain and inflammation. Various oral NSAIDs can be used, although none of these agents holds a clear distinction as the drug of choice (DOC). The choice of NSAID is largely a matter of convenience (how frequently doses must be taken to achieve adequate analgesic and anti-inflammatory effects) and cost.

Ibuprofen (Motrin, Advil, NeoProfen, Provil)

Ibuprofen is the drug of choice for patients with mild to moderate pain. NSAIDs inhibit inflammatory reactions and pain by decreasing prostaglandin synthesis.

Diclofenac topical (Zorvolex, Zipsor, Cambia, Cataflam, Voltaren XR)

NSAIDs inhibit inflammatory reactions and pain by decreasing prostaglandin synthesis.

Ketoprofen

Ketoprofen has good anti-inflammatory properties and exceptional analgesic properties. It is a first-line medication because of its daily dosing, which helps with compliance. Small dosages are initially indicated in small and elderly patients and in those with renal or liver disease. Doses higher than 75 mg do not increase therapeutic effects. Administer high doses with caution, and closely observe the patient for response.

Naproxen or naproxen sodium (Naprelan, Naprosyn, Aleve, Anaprox)

Naproxen is used for relief of mild to moderate pain and inflammation; it inhibits inflammatory reactions and pain by decreasing activity of COX, which results in a decrease of prostaglandin synthesis. Naproxen is available in many dosages and delivery systems. It is fairly inexpensive and has a therapeutic profile similar to those of other NSAIDs.

Indomethacin (Indocin)

Indomethacin is used for relief of mild to moderate pain; it inhibits inflammatory reactions and pain by decreasing the activity of COX, which results in a decrease of prostaglandin synthesis.

Celecoxib (Celebrex)

Celecoxib primarily inhibits COX-2. COX-2 is considered an inducible isoenzyme, induced during pain and inflammatory stimuli. Inhibition of COX-1 may contribute to the GI toxicity of NSAIDs. At therapeutic concentrations, the COX-1 isoenzyme is not inhibited; thus, GI toxicity may be decreased. The lowest dose that is effective in a given patient should be given.

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Corticosteroids

Class Summary

In contrast to the widespread systemic distribution that occurs when an oral anti-inflammatory drug is administered, a local corticosteroid injection can achieve the focal placement of a potent anti-inflammatory agent at the site of maximal tenderness or inflammation. A variety of corticosteroid preparations are available. Commonly, the corticosteroid is mixed with a local anesthetic agent prior to injection. The clinician has numerous local anesthetic agents from which to choose.

Methylprednisolone (A-Methapred, Depo-Medrol, Solu-Medrol, Medrol)

Corticosteroids are commonly used in local injections administered to bursae or joints. The drugs provide a local anti-inflammatory effect while minimizing some of the gastrointestinal and other risks of systemic medications.

Dexamethasone acetate (Baycadron)

This agent decreases inflammation by suppressing the migration of polymorphonuclear leukocytes and reducing capillary permeability. The dosage varies with the degree of inflammation and the size of the affected area.

Hydrocortisone acetate (Solu-Cortef, Cortef, A-Hydrocort)

Hydrocortisone acetate decreases inflammation by suppressing the migration of polymorphonuclear leukocytes and reversing increased capillary permeability. The dosage varies with the degree of inflammation and the size of the affected area.

Betamethasone (Celestone, Celestone Soluspan)

Betamethasone is the drug of choice for intra-articular injections. It does not crystallize if used with paraben-free anesthetic preparations.

Triamcinolone (Aristospan, Kenalog-10, Kenalog-40)

Triamcinolone is used for inflammatory conditions responsive to steroids; it decreases inflammation by suppressing the migration of polymorphonuclear leukocytes and reversing capillary permeability. This is the preferred drug, owing to its longer duration of action.

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