Treatment Algorithm Based on Current Concepts
We propose a treatment algorithm based on our review of the current evidence. Immobilization of TF can effectively relieve pain and improve function. Patients with acute onset (<3 months) of TF can be prescribed a nighttime PIP or MCP joint blocking orthosis for up to 6 to 8 weeks.[11,12] If splinting fails to resolve the symptoms, at least one corticosteroid injection should be offered to all patients, irrespective of the comorbidities (including diabetes) as long as the patient can tolerate the steroid or the injection procedure. Steroid injections have been demonstrated to be both clinically effective and cost effective and can be offered up to three times. If the patient fails splinting and injections, surgical release should be offered. Open release of the A1 pulley effectively alleviates the subjective and objective manifestations of TF and remains the benchmark operation. However, a percutaneous release can be effective if performed by a surgeon who has additional training to become proficient with a percutaneous technique and overcome the initial 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 been demonstrated to be a cost-effective option for patients who prefer to be awake for their procedure. Postoperatively, pain can be adequately controlled with a nonopioid regimen.
J Am Acad Orthop Surg. 2020;28(15):e642-e650. © 2020 American Academy of Orthopaedic Surgeons