Trigger Finger

Scope

Trigger finger (flexor synovitis) is a condition where the flexor tendon catches on the tendon sheath resulting in clicking or locking of the finger.

Referral criteria

In line with the local Policy referral criteria apply to this CRG.

Unless the criteria (below) have been fulfilled and are present in the body of the letter, the referral will be returned to the practice.

Mild cases which cause no loss of function require no treatment or avoidance of activities which precipitate triggering and may resolve spontaneously.

Cases interfering with activities or causing pain should first be treated with:

a) one or two steroid injections

or

b) splinting of the affected finger for 3-12 weeks.

Surgery should only be considered if:

a) the triggering persists or recurs after one of the above measures (particularly steroid injections);

or

b) the finger is permanently locked in the palm;

or

c) the patient has previously had 2 other trigger digits unsuccessfully treated with appropriate non-operative methods;

or

d) the patient has diabetes

Assessment

Trigger finger typically presents with some of the following features:

  • discomfort / tenderness at the base of the finger or in the palm, during movement of the involved digit
  • clicking as the person flexes and extends the digit – may be painless or painful
  • locking of the digit in a particular position, usually flexion, which may need passive manipulation to achieve a full range of movement
  • stiffness and progressive loss of full flexion and/or extension

Investigations

None usually needed.

Usually a straightforward clinical diagnosis.

Management

Mild cases which cause no loss of function require no treatment or simply avoidance of activities which precipitate triggering and may resolve spontaneously.

Cases interfering with activities or causing pain should first be treated with:

a) one or two steroid injections

or

b) splinting of the affected finger for 3-12 weeks.

Surgery should be considered if:

a) the triggering persists or recurs after one of the above measures (particularly steroid injections);

or

b) the finger is permanently locked in the palm;

or

c) the patient has previously had 2 other trigger digits unsuccessfully treated with appropriate non-operative methods;

or

d) the patient has diabetes

Consider early surgery before corticosteroid injection in people with:

  • chronic locked or stiff digit, secondary to trigger finger

Referral

Referral Criteria

Mild cases which cause no loss of function require no treatment or avoidance of activities which precipitate triggering and may resolve spontaneously.

Cases interfering with activities or causing pain should first be treated with:

a) one or two steroid injections

or

b) splinting of the affected finger for 3-12 weeks.

Surgery should be considered if:

a) the triggering persists or recurs after one of the above measures (particularly steroid injections);

or

b) the finger is permanently locked in the palm;

or

c) the patient has previously had 2 other trigger digits unsuccessfully treated with appropriate non-operative methods;

or

d) the patient has diabetes

Commissioning policy: Trigger finger release in adults

Where the circumstances of treatment for an individual patient do not meet the criteria described above exceptional funding can be sought. Individual cases will be reviewed by the appropriate panel of the CCG upon receipt of a completed application from the patient's GP, consultant or clinician. Applications cannot be considered from patients personally.

Queries and applications should be submitted by clinicians to the Individual Funding Request Panel via our generic email address: d-ccg.ifr-newsdt@nhs.net

Exceptional /Individual Funding Requests (IFR).

Referral Form – Individual Funding Request (IFR)

Referral Instructions

Refer to the Hand Clinic (Orthopaedics)

e-Referral Service selection

  • Specialty: Orthopaedics
  • Clinic Type: Hand and Wrist
  • Service: DRSS-South Devon & Torbay-Orthopaedics-Hand & Wrist-Devon CCG - 15N

Referral Forms

DRSS referral form

Torbay and South Devon seeking advice form

Supporting Information

GP Information

British Society for Surgery of the Hand - Trigger Finger information

Patient Information

British Society for Surgery of the Hand - Patient leaflet

Pathway Group

This guideline has been signed off on behalf of the NHS Devon Clinical Commissioning Group.

Publication Date: April 2019

 

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