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Trigger Finger: Non Operative Treatment

- DIP Joint Immobilization:
    - immoblization of the DIP joint is extremely useful in preventing triggering in all of the fingers including the thumb;
    - DIP immobilization (leaving the PIP free), has minimal functional limitations and most patients can work without restrictions;
    - technique: consider applying two layers of Coban wrap, then a paper clip over the dorsum of the joint, and then 2 more layers of Coban;

- Steroids:
    - steroid injection into the sheath may alleviate the triggering;
    - try combination of 0.5 ml of the steroid dexamethasone (4 mg/ml) combined with 0.5 ml of 1% plain lidocaine;
           - alternatively, try 0.5 ml of triamcinolone and 0.5 ml of plain lidocaine mixed in a 3 cc syringe, utilizing a 5/8 no 27 needle;
    - technique of injection:
           - sterile precautions
           - inject the sheath, not into the tendon, #25 or #26 gauge needle;
           - insert needle obliquely penetrating thru flexor tendon until resistance is met;
           - to avoid injecting into the tendon, needle is withdrawn slowly until the digit flexion fails no longer moves needle;
                  - if difficulty in injecting is encountered, needle may still be within the tendon substance;
           - syringe is withdrawn, keeping steady pressure on the plunger;
           - when the needle lies in the sheath the liquid will easily flow out and into the flexor tendon sheath & syringe plunger will depress easily;
           - palpate the distal finger for solution flowing into the tendon;
           - alternatives:
                  - consider injecting around the tendon sheath, as this also seems to improve symptoms;
                  - consider injecting into the A2 pulley in the midline of the proximal phalanx;
                         - this may be technically easier than injecting into the A1 tendon sheath;
    - a successful injection into the tendon sheath will result in anesthesia in the entire digit;
    - if the painful triggering continues, consider surgery;
    - contra-indications:
           - non operative treatment (steroid treatment) is not used in infants and children (congenital trigger thumb)

Treatment of flexor tenosynovitis of the hand ('trigger finger') with corticosteroids. A prospective study of the response to local injection..

Treatment of trigger finger by steroid injection.

Controlled study of the use of local steroid injection in the treatment of trigger finger and thumb.

Year Book: Stenosing Tenosynovitis of the Fingers and Thumb: Results of a Prospective Trial of Steroid Injection and Splinting.

Steroid injection for flexor tenosynovitis

Comparison of transthecal and subcutaneous single-injection digital block techniques in cadaver hands.  

Comparison of transthecal and subcutaneous single injection digital block techniques. 

Corticosteroid Injection in Diabetic Patients with Trigger Finger. A Prospective, Randomized, Controlled Double-Blinded Study