Current Concepts in the Management of Trigger Finger in Adults

Joseph A. Gil, MD; Andrew M. Hresko, MD; Arnold-Peter C. Weiss, MD

Disclosures

J Am Acad Orthop Surg. 2020;28(15):e642-e650. 

In This Article

Abstract and Introduction

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.

Introduction

Trigger finger (TF), also known as stenosing tenosynovitis, is one of the most common causes of hand disability.[1,2] TF most commonly presents in a bimodal distribution in patients younger than eight years and in adults in their fifth and sixth decades. In the adult population, the lifetime prevalence of TF is 2% to 3% and the annual incidence is 28 per 100,000.[2,3] TF more commonly presents in women and in the long and ring fingers of the dominant hand.[3] Systemic conditions that predispose patients to a higher incidence and increased severity of TF include endocrine disorders (eg, diabetes mellitus, hypothyroidism, and mucopolysaccharidosis) and various inflammatory arthropathies.[2,4] Patients with diabetes have a predisposition to developing more frequent and more severe TF. Prevalence in diabetic patients is between 5% and 20%, at least 2-fold higher than the general population.[4]

Conservative treatment modalities for TF include activity modification, orthotic immobilization, hand therapy exercise protocols, nonsteroidal anti-inflammatory medications, and steroid injections. Surgical management includes open or percutaneous surgical release of the A1 pulley. The severity of TF has been correlated with the success of conservative management and time to recovery after open release.[5,6] The objective of this review is to provide a summary of the most recent literature regarding the etiology of adult TF and the efficacy of conservative and surgical treatment modalities.

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