Treatment Options
3) Treatment Options: The main goals of treatment for trigger finger/thumb are to reduce the swelling present in the tendon and sheath and to restore the smooth gliding of the tendon in its sheath.
NONOPERATIVE
The main nonoperative treatment involves injecting the
thickened tendon sheath with a combination of an anti-inflammatory drug
(steroid) and local anesthetic. The triggering may actually be worsened
after the injection since there will be extra fluid within the sheath.
A recent study disputed the popular belief that the steroid needs to be
injected directly into the sheath, which may be difficult for the physician
to locate. The study found a 70% response to the injection when placed
in the vicinity of the sheath, and only 47% response with injections directly
into the sheath. Splinting the finger in extension after the injection
is used by some physicians. The patient is also instructed to restrict
pinching and gripping with the affected digit. Approximately 2/3 of patients
are relieved with one injection. If there isn't relief from
the injection, then it can be repeated a week later. If two
injections fail to bring relief from the triggering, surgical management
become appropriate. However, a recent study suggested that surgical
release may be more cost effective after failure of the first injection
due
to the effectiveness and permanency of the surgical release.
OPERATIVE
Surgical management involves making a skin incision over
the involved flexor tendon sheath under local anesthesia. The surgeon
then identifies the tendon sheath and cuts the constricted area, avoiding
any nerves in the area. After the sheath is incised, there should
be free movement (flexion and extension) of the previously triggering digit.
Complete recovery may take up to four weeks. The procedure is very
effective and has a low complication and recurrence rate (0-3% in recent
studies).
NEXT: REFERENCES AND OTHER RESOURCES