Management of 'Trigger Finger'

I like to place a dot with a felt marker over the area of fullness/nodule/tenderness. I then infiltrate the skin and subcutaneous tissue with 1% or 2% Xylocaine with Epinephrine 1/100,0000. Thereafter I put some local deeper into the region of the flexor tendon sheath. (2-3 cc should suffice)

After 1-2 minutes I take a 3 cc syringe with 40 mg of Kenalog (Triancinalone, 40 mg/cc). I attach a long (1.5 inch) 25 gauge needle. After an alcohol wipe prep, I place the needle near the aforementioned dot, and go through skin and fat, until I feel the needle resting on the deeper firm flexor tendon sheath. I then advance slowly, sensing the needle go through the sheath, which is usually about 1 mm thick. I then ask the patient to bend the digit slowly at the PIP joint of the finger, or the IP joint of the thumb. When the needle hits the tendon it will bend from the force of the moving tendon, indicating you are indeed in the tunnel.

The needle is bent from being pulled by the tendon. It is important not to inject the steroid into the tendon (which would require moderate pressure), as this can cause atrophy and rupture. Pull the needle back ever so little, to position the needle deep to the sheath, but anterior to the tendon. Injection resistance should be quite low. If this proves difficult, an alternative approach is to go deep to the tendon(s) and inject when resistance first becomes low, hoping you are still in the tunnel, allowing the steroid to bathe the inflammatory process. Steroid injection outside the tunnel is likely useless.

I tell patients to move the digit easily for 24 hours, and then proceed to regular activity thereafter. It may take 2-3 weeks before improvement is noted. I personally try not to inject any given site more than once, due to concern of tendon atrophy from the steroid. I treat recurring trigger digits with an open release of the A1 pulley.

- Michael Brennan

You can search for abstracts of the above references by following this link: PubMed