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. Initially, there is focal pain with finger movement. Then, as the tendon swells, a clicking sound is heard. 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.
Trigger fingers are more common in older individuals or those who perform repetitive finger movements, such as tradespeople, office workers, and individuals who frequently climb. Some medical issues that cause swelling, such as diabetes or thyroid problems, can increase the risk of developing trigger finger.
How to diagnose trigger finger
Doctors use a combination of clinical assessment and ultrasound scanning. Imaging shows thickening of the A1 pulley. If the pulley is thicker than 0.63mm, we regard the pulley as pathological. Occasionally, other pulleys are involved. As the disease progresses, the finger tendons become thicker, producing a nodular structure. Ultrasound can also help diagnose secondary causes of trigger finger, including bony spurs and arthritis in the finger joints.
Trigger finger vs. carpal tunnel.
It can often be challenging to differentiate between trigger finger and carpal tunnel. Generally, however, trigger finger pain is typically focused on one finger, whereas carpal tunnel syndrome causes pain in more than one finger. Additionally, carpal tunnel syndrome is characterised by numbness, tingling, and weakness in the hand.
How to treat trigger finger?
Reducing excessive finger movements (such as during office hours or sports) can lower pain and swelling. Additionally, consulting a hand therapist may help with stretching and strengthening exercises for the fingers and wrist. Moreover, a hand therapist can create a small finger splint to reduce the pressure on the finger tendons from the A1 pulley. Additionally, applying an anti-inflammatory gel to the base of the finger can sometimes be effective.
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 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, skin thinning, and tendon weakening. Nevertheless, significant side effects are rare, and injections are usually well-tolerated.
Does ultrasound make a difference? Ultrasound-guided trigger finger injection.
Ultrasound serves three essential functions in the treatment of trigger finger. First, it visualises the thickening of the small pulley of the finger, confirming the diagnosis. Second, it can direct the needle to the spot above and below the tendon sheath. Ultimately, we recognise that ultrasound-guided trigger finger injections enhance accuracy and effectiveness. As a result of improved accuracy, the cortisone is injected into the correct spot, reducing side effects.
Ultrasound also allows us to target the correct pathology. If the A1 pulley is significantly thickened, then injecting above and below the pulley might be a more effective intervention. If the tendon is inflamed, injecting the tendon sheath may be the only intervention needed.
In cases where one or two injections fail, a percutaneous trigger finger release or an open surgical release of the pulley can provide permanent relief from the pain.
What about percutaneous trigger finger release?
Some doctors are now performing a percutaneous trigger finger release using a special needle. This procedure releases the pulley without cutting the skin or needing sutures, reducing costs and accelerating recovery.
Generally, we think about this more invasive procedure for cases of trigger finger that fail simple treatments and one or two cortisone injections.
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 skin and soft tissue side effects.
What is the usual trigger-finger steroid injection dose?
For trigger finger, we advise Depo-Medrol 20mg. Generally, we recommend avoiding Kenalog or triamcinolone due to their 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.
What diseases are associated with trigger finger?
Trigger finger is more common in diabetes, rheumatoid arthritis, gout and thyroid disease. If you develop recurring trigger finger, you should consult your doctor about checking for other potential underlying conditions.
Is shockwave therapy effective in trigger finger?
Yes, one study comparing shockwave to a cortisone injection found similar results in both groups. Shockwave could be an option for trigger finger cases with significant finger tendon thickening.
Can we use hyaluronic acid for trigger finger?
Yes. One study found that using hyaluronic acid was as effective as cortisone at the 6-month post-injection mark. However, cortisone injections had a faster effect, being more effective at 3 months.
Final word from Sportdoctorlondon about trigger finger steroid injection
A trigger finger is a common condition that causes pain and clicking at the base of a finger or thumb. Simple treatments, such as rest, physiotherapy, and anti-inflammatory creams, can 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 a suitable option.
Good info
Nice article. But, I would like to know whether the effect of cortisone injections are long lasting.
hi – yes good question. We don’t have long term data for injection after trigger finger (or at least, I’m not aware of long term data). Lorenzo
Thank you for this information. I had ultrasound guided steroid injection 2 weeks ago for my trigger thumb. The stiffness and complete inability to bend my thumb improved this week (week 2). I can slightly bend my thumb now, but my thumb still “clicks” locks when I try to bend more fully. I read another article which suggests that mechanical locking only resolves around the 3 week mark. Is this your experience in treating similar patients? Thank you in advance and greetings from Sydney, Australia.
Hi Jenny, Yes – the maximal effect of cortisone occurs at about 4-5 weeks so your thumb will continue to improve for a few more weeks. The clicking is related to the tendon swelling – which is improved by cortisone. LM
Just to clarify for anyone else reading these comments, I have swelling and thickening of the A 1 pulley at the base of my thumb. At the time of writing my comment, I had no idea that you were from Australia! Best wishes for your career in London! Australia has lost out on your skills! Obrigada!
I just had an injection this morning for trigger finger (my first time for this) but my Dr. left so quickly afterwards that I didn’t get a chance to ask how long before my finger starts to work better, a few hours, a few days???
Hi Penny – generally cortisone starts working within a week – sometimes a bit earlier and sometimes a bit later (2 weeks). Lorenzo
I received an injection yesterday and like the previous post, my Dr left the room too quickly to answer any questions. When he injected my hand he said “I know it’s in because I heard the tendon pop”. Can you explain what that means? I have had surgery on my right hand for this condition, but hope that the cortisone shot will work with the left hand.
Often during injection of trigger finger, you can feel a pop as the injectate is forced through the tight space caused by the thickened pulley.
Hi, I have just been seen by the consultant, I have lost the ability to bend my little finger and my ring finger locks when a slight fist is made. I have other issues with c6 c7 c8 vertebrae narrowing leading to neve damage, which they think is the cause of loss of little finger bending.
I was then given a steroid injection into the lower part of my ring finger, others have mentioned having ultrasounds/scans should this have been done before an injection was carried out? Should I do any exercises to help ease the pain and movement, doctor left straight after the injection without any advise for aftercare. Many Thanks
Ultrasound does not need to be done in all cases. But I think ultrasound has advantages including confirming a diagnosis and improving accuracy.
Yes, I would perform hand therapy to improve the effectiveness of an injection.
Lorenzo
I had a cortisone shot for trigger finger 2 weeks ago however where they stuck the needle is very painful can hardly touch that area any thoughts?
Sometimes, the injection site can remain sensitive for weeks. I’d speak to your doctor if the sensitivity does not settle within another 1-2 weeks.
Hello
I had cortisone shots for both carpal tunnel and trigger finger in my right hand four days ago. The trigger finger is in my middle right finger. About 45 mins after the injections, my entire hand was hurting really bad. I could not use it to do anything from making my sandwich for dinner that night to opening and closing doors. It was slightly better by noon the following day, about 20 hours after the injections. I iced a lot and also began an oral corticosteroid. By 48 hours a lot of the discomfort subsided but I’m still having a hard time with my right index and middle fingers. I can’t pick certain things up with my right hand, such as my phone, without a sudden sharp shooting pain in these fingers. I can’t completely straighten them out without the sharp pain. I can’t even use my thumb to type this without feeling a sharp pain . Opening and closing doors is still causing those same “zingers” as does washing my hair, brushing my teeth, pouring a glass of milk ect…. Is this normal? Or should I contact my doctor sooner than the six week check up?
I should also note my injections were not done with guided ultrasound. He also didn’t mention I’d lose the ability to use my hand for certain things after the shots. We even talked about what I do for work. He knew I 100% use my hands all day and said nothing about possibly being unable to perform certain job duties in the following days. He also gave me no aftercare instructions.
It is common to have a flare – sometimes lasting for up to 7 days.
I’d contact your doctor after the 7th day if not settling.
See this blog for more information on flare:
https://sportdoctorlondon.com/how-long-does-it-take-for-a-cortisone-shot-to-work/
Hi, I had a cortisone injection today for a trigger finger and found out later that day that I’m booked for TKR IN 3 and a half weeks time. Will it still be able to go ahead?
You should be fine – as long as you don’t have a cortisone injection into the knee joint.
Is a hand compression glove (copper) effective for thumb arthritis or trigger finger?
Perhaps – I’d give it a try.
Hi, I had a cortisone injection 7 months ago, but the trigger has returned. Can the second injection of steroid damage the tendon?
I generally recommend a repeat injection if the first one was effective.
LM
My brother had a cortisone injection in both hands yesterday for trigger finger to both middle fingers of his hands.
He said the pain was absolutely excruciating and he was almost in tears.
Today he cannot bend one of his fingers affected.
Has other people experienced this?
Hello
I had a steroid injection in my index finger to sort a trigger finger. It occurs only when I play the clarinet. The injection worked for a few weeks but the condition returned. Would a second injection be fully successful?
Hi John,
I’d often try one more cortisone injection. Sometimes, I consider a percutaneous needle procedure to ‘cut’ the A1 pulley using a special needle (as outlined in the blog). Your other option is open surgery to cut the A1 pulley.
Lorenzo
My thumb still feels numb after steroid shots and spread to my first finger numb is that normal and it’s 6 hours ago I got the steroid shot on my thinner “trigger finger” is that normal to feel numb that long?
Hi Missy,
It depends on the type of local anaesthetic used. For short acting anaesthetic like lidocaine, the numbness lasts for a few hours but sometimes up to 6 hours. For longer acting anaesthetic, the effects last for about 6 hours and occasionally longer than 1 day. If your symptoms don’t settle within a few days, I’d contact your doctor.
Lorenzo
Lorenzo
Sounds to me like a percutaneous needle might be the best 1st option, as it directly resolves the dysfunction causing the issue. Is there a reason this doesn’t make sense?
BTW, I have trigger finger on my left hand, and my ‘walk in clinic’ doctor has just recommended steroid injection, and suggests surgery is not a good option.
Hi John, I usually recommend a simple cortisone injection first as some patients get a total cure with an injection. Percutaneous needling is a more advanced procedure with slightly increased risks (such as nerve damage).
Lorenzo