Trigger finger is a common overuse condition affecting one or more fingers or thumbs. One of the more effective treatments for trigger finger is a cortisone injection. But how effective is a trigger finger injection and when should you do it?
What is a trigger finger?
Trigger finger describes painful clicking as the tendon of the finger passes through tiny pulleys at the bottom of each finger. The most common fingers affected are the thumb, middle, and ring fingers. Initially, there is focal pain with movement of the finger. As the tendon swells, there is clicking. Eventually, the tendon can get stuck in the fully bent position. Often, symptoms are better in the morning and worsen toward the end of the day.
Some people report their fingers locking up when holding something. Others describe pain when straightening the finger.
Generally, a trigger finger is more common in the elderly or those who perform repetitive finger movements such as tradesmen, office-based workers, and climbers. Also, certain medical problems that cause swelling such as diabetes or thyroid problems can increase the risk of developing a trigger finger.
Trigger finger vs carpal tunnel
Often, it can be difficult to differentiate between trigger finger and carpal tunnel. Generally, however, trigger finger pain is focussed on one finger while carpal tunnel causes pain in more than one finger. Also, carpal tunnel is associated with numbness, pins and needles, and weakness in the hand.
How to treat trigger finger?
In general, reducing excessive finger movements (such as reducing office hours or sport) can lower pain and swelling. Additionally, seeing a hand therapist may help with stretching and strengthening exercises of the fingers and wrist. Also, applying an anti-inflammatory gel to the base of the finger is effective in some cases.
What happens when simple measures fail?
In cases that fail simple treatments, a trigger finger injection can help. Generally, we inject a small dose of cortisone just under the thickened pulley above and below the tendon sheath. Recent studies show great results for a cortisone injection for a trigger finger. Occasionally, we perform a second injection about 8 weeks after the first injection if the pain is still present.
What are the common side effects of a trigger finger injection?
Although a trigger finger injection uses a low dose of cortisone, possible side effects include a cortisone flare, infection, thinning of the skin, and weakening of tendon structure. Nevertheless, we find that significant side effects are rare and injections usually do well.
Does ultrasound make a difference to trigger finger injections?
Ultrasound performs three basic functions in trigger finger. Firstly, ultrasound visualises the thickening of the small pulley of the finger confirming the diagnosis. Secondly, ultrasound can direct the needle to the exact spot above and below the tendon sheath. We know that ultrasound improves the accuracy and effectiveness of injections for joints and tendons. Finally, as a result of improved accuracy, the cortisone is injected into the correct spot reducing side effects.
In rare cases that fail one or two injections, then a surgical release of the pulley can get rid of the pain for good.
What about percutaneous trigger finger release?
Some doctors are now doing a release using a special needle with a tiny blade. The procedure of releasing the pulley can be performed without cutting the skin or needing sutures. This reduces costs and accelerates recovery.
Final word from Sportdoctorlondon
Overall, a trigger finger is a common condition causing pain and clicking at the base of a finger or thumb. Simple treatments such as rest, physiotherapy, and anti-inflammatory cream help. In some cases, a trigger finger injection under ultrasound is very effective and more than one injection may be needed. In difficult cases, then a percutaneous trigger finger release may be for you.
Other hand conditions: