A 66 year old diabetic lady complains of pain in the palm of her right hand at the base of her ring finger, which is held in flexion. Extension is painful, produces an audible click, and often requires the assistance of the other hand. What is the first line treatment of the condition?
This is a case of trigger finger, which is most common in is most common in the sixth decade, women, people with diabetes, and the dominant hand. Trigger finger is caused by inflammation and constriction of the retinacular sheath through which the flexor tendons run as they pass from the palm of the hand into the finger. This causes irritation of the tendon, sometimes resulting in the formation of a nodule, which impinges on the pulley, causing pain and restricting movement. Treatment: Coicosteroid injection into the tendon sheath is usually the first line treatment. Up to 57% of cases resolve with one injection, and 86% with two. Surgery--Usually indicated if two coicosteroid injections six weeks apa have failed, or the finger is irreversibly locked in flexion. Surgery to release the pulley is done as a day case through a palmar incision under local anaesthetic. Cure rates approach 100%. Splinting for six weeks can decrease inflammation. This is an option for those wishing to avoid injections or surgery. Congenital triggering usually presents in the first year of life. The digit is locked in flexion or extension. Steroid injections have no role in management; instead, refer to a hand surgeon. Ref: Benson L, Ptaszek A. Injection versus surgery in the treatment of trigger finger. J Hand Surg Am1997;22:138-44; Patel MR, Bassini L. Trigger fingers and thumb: when to splint, inject, or operate. J Hand Surg Am1992;17:110-3; Adult trigger finger; BMJ 2012;345:e5743.
Splinting for 6 weeks
Surgery under local anaesthesia
Coicosteroid Injection
Oral NSAIDs