Ask Dr. Parisi: What Are the Trigger Finger Treatments?
Learn about the benefits and risks of conservative and surgical trigger finger treatments.
One of your fingers gets stuck down after you bend it. You may experience a crackling sensation in your palm at the base of your finger when you try to move it. These are classic symptoms of a condition known as trigger finger. Hand specialist Dr. Debra Parisi discusses the conservative and surgical trigger finger treatments available, explaining how she evaluates treatment options with her patients.
Factors influencing trigger finger treatments
There are a number of conservative and surgical treatments available for trigger finger. The treatment that’s best for you depends on the severity of the condition and whether you have other contributing health factors. “Sometimes,” explains Dr. Parisi, “a patient may have an underlying condition that contributes to this finger disorder. An underlying condition is definitely going to influence the treatment plan.” Dr. Parisi lists the factors she considers with patients when designing a tailored treatment plan.
- Severity of the condition. “If it’s a very mild trigger finger and it’s not actually getting locked, then I may recommend simple things like therapy or oral anti-inflammatory medications,” says Dr. Parisi. “If the condition is more advanced, I may recommend cortisone injections or surgery.”
- Underlying chronic conditions. “Underlying conditions like rheumatoid arthritis, diabetes, or a thyroid condition make trigger finger a bit more difficult to treat,” notes Dr. Parisi. “The presence of these conditions means that these patients often don’t respond as well to conservative trigger finger treatments. We may recommend surgery sooner. In addition, we’ll want to collaborate with the patient’s other specialists to address and control the underlying condition. For example, if patients have rheumatoid arthritis, I want them seen by a rheumatologist to make sure they are getting proper medication. When the patient’s overall health is well managed, there are two advantages. First, good overall health can improve response to trigger finger treatments. Second, good management of underlying chronic conditions reduces the risk of trigger finger recurring or occurring in other fingers.”
Conservative trigger finger treatments
Dr. Parisi explains that conservative treatments are most appropriate for very mild cases of trigger finger. “A mild case of trigger finger is characterized by discomfort in the palm of the hand,” she says. “There’s pain with movement, but you have full motion and the finger isn’t clicking, locking, or sticking. You can give mild trigger finger some time to see if it will get better on its own. However, if your condition continues for six to eight weeks, it’s worth coming in and discussing options. When we catch this condition early, three to four weeks of physical therapy and oral NSAIDs can help reduce inflammation.”
- Physical therapy. Therapists may use ultrasound to reduce inflammation in the tendon sheath. In addition, hand exercises can enhance tendon gliding. “It’s the motion is lotion concept,” Dr. Parisi explains. “When you’re moving your fingers, it helps to pump fluid around the tendon sheath. In very mild cases, this can be helpful.”
- Night splinting.“I don’t typically splint during the day, because it’s so difficult for us to rest our hands during waking hours,” says Dr. Parisi. “But often, my patients complain that they wake up in the morning with their finger stuck down. Many of us sleep with a clenched or curled fist, which can cause a trigger finger to stick. For this reason, splinting at night can be beneficial. Night splinting prevents the finger from becoming painfully locked down during sleep.”
- Anti-inflammatory medications. An over-the-counter or prescription anti-inflammatory can help bring down the inflammation that causes the tendon to stick as it moves through the tendon sheath.
Cortisone injection treatment
“Unless the condition is very mild, injections are my first recommendation among trigger finger treatments,” states Dr. Parisi. “That’s because more than 70 percent of trigger finger patients get better with one or two injections. The cortisone is injected in the palm at the base of the affected finger. It takes about three to four seconds to do the injection, and during that time, it is admittedly painful. However, there’s a numbing medication in the injection, so the pain is very short-lived.”
Some patients report that their finger feels great the morning after the injection. Others may not experience improvement for several weeks. But on average, it takes three to seven days for a cortisone injection to take effect. “If six weeks go by and a patient is still experiencing discomfort or a catching sensation, I want to see them again,” says Dr. Parisi. “Fifty percent of patients get better after one injection. The other 50 percent come back in to see me a second time. They usually require a second injection. Of the patients who get two injections, half will have symptom resolution with the second injection. That means 25 to 30 percent of trigger finger patients don’t improve after two injections. For these patients, I usually recommend surgery.”
Dr. Parisi does have a caution about cortisone treatments. “Sometimes we do the cortisone injection and it works great,” she says. “But after a period of months, it can stop working. I may do two or up to three injections over a period of 18 months to two years. But if the benefit continues to subside, I recommend surgery. That’s because indefinite treatment with cortisone shots is not recommended. If we continue beyond three shots, there’s a risk that the cortisone will weaken the tendon and cause it to rupture.”
Surgical trigger finger treatments
“Trigger finger treatments include a procedure called percutaneous release, involving a needle inserted through the palm into the affected tendon,” says Dr. Parisi. “However, I like to treat trigger finger with a more precise and classic outpatient open surgical procedure done under local anesthesia. I make a very small incision in the palm over the A1 pulley, which is the entrance of the tendon sheath. Then, I make a second tiny incision in the ligament at the top of the tunnel. The second incision allows the tendon to glide smoothly through the sheath. The actual procedure takes about 10 minutes. We recommend that patients elect to have the surgery done under straight local anesthesia. When they do, they recover quickly and can drive themselves home afterward. However, some people are just really nervous about surgery. In that case, Valium or sedation are options we can discuss.”
For more than 98 percent of patients requiring surgery, the open procedure is successful. “My surgical patients are back to doing just about everything in two to four weeks following surgery,” says Dr. Parisi. “This is a very treatable, very fixable condition. Trigger finger surgery is a very safe procedure with a high degree of success.”
Risks accompanying trigger finger treatments
“I caution my patients that trigger finger can recur,” says Dr. Parisi. “Recurrence is not common, but it is possible. Insulin-dependent brittle diabetics are most at risk for recurrence. In addition, some patients can develop scar tissue following surgery. When this happens, that painful scar tissue can cause aching in the palm of the hand at the surgery site. This aching eventually subsides, but it will lengthen the time until full recovery.”
Summit Orthopedics provides personalized hand and wrist expertise
The function of our hands is integrated through our wrists and arms to our shoulders; a problem anywhere along our arm may have a significant impact on hand function and quality of life. If you experience an injury or uncomfortable symptoms, our fellowship-trained hand and wrist surgeons are here to help. Summit physicians receive the highest levels of training and exclusively provide individualized care for conditions of the hand, wrist, and elbow.
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More resources for you
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At Summit Orthopedics, we work closely with the physicians to provide state of the art treatment techniques. Hand therapists bridge the gap from medical management of upper extremity conditions to successful recovery, allowing individual to function normally in their daily lives.