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 steroid 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 thumb, middle, and ring fingers are the most commonly affected fingers. Initially, there is focal pain with movement of the finger. Then, 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 older people or those who perform repetitive finger movements, such as tradesmen, office-based workers, and climbers. Also, some medical issues 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 challenging to differentiate between trigger finger and carpal tunnel. Generally, however, trigger finger pain is focused 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.

 

trigger finger picture

How to treat trigger finger? 

Reducing excessive finger movements (such as during office hours or sports) can lower pain and swelling. Additionally, seeing a hand therapist may help with stretching and strengthening the fingers and wrist exercises. Also, applying an anti-inflammatory gel to the finger’s base is sometimes effective. 

What happens when simple measures fail?

trigger finger injection using cortisone

In cases that fail simple treatments, a trigger finger injection can help. Generally, we inject a small dose of cortisone under the thickened pulley above and below the tendon sheath. Recent studies show excellent results for a cortisone injection for a trigger finger. Occasionally, we perform a second injection about eight weeks after the first injection if the pain is still present. In general, we perform ultrasound-guided trigger finger injections. 

What are the common side effects of a trigger finger steroid 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, significant side effects are rare, and injections usually do well.

Does ultrasound make a difference? Ultrasound-guided trigger finger injection.

Ultrasound performs three essential 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 spot above and below the tendon sheath. Finally, we know that ultrasound-guided trigger finger injection improves accuracy and effectiveness. 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, a surgical release of the pulley can relieve the pain for good.

What about percutaneous trigger finger release? 

trigger finger release under ultrasound

Some doctors are now doing a release using a special needle with a tiny blade. Releasing the pulley occurs without cutting the skin or needing sutures. This percutaneous procedure reduces costs and accelerates recovery.

Other common questions about trigger finger: 

Is pain after a cortisone shot for trigger finger common? 

Yes. In general, people report pain lasting for up to three days. However, we think an ultrasound-guided trigger finger injection might reduce side effects, including post-injection pain, due to improved accuracy.

Is a cortisone shot in the thumb pulley possible?

Yes. Trigger thumb is also common. An ultrasound-guided trigger thumb is easy to do and effective.

What steroid is used for trigger finger injections? 

We generally use Depo-medrol as this steroid has fewer side effects on the skin and soft tissue.

What is the usual trigger finger steroid injection dose? 

For trigger finger, we advise Depo-medrol 20mg. Generally, we suggest you avoid Kenalog or triamcinolone due to potent skin side effects.

How long after a steroid injection does the trigger finger improve?

Usually, symptom improvement occurs 5-7 days after a cortisone injection. However, sometimes, an injection can take up to two weeks to start working. 

Final word from Sportdoctorlondon about trigger finger steroid injection

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, an ultrasound-guided trigger finger injection is very effective, and more than one injection may be needed. In complex cases, a percutaneous trigger finger release may be for you.

Other hand conditions:

Dr. Masci is a specialist sport doctor in London. 

He specialises in muscle, tendon and joint injuries.