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Trigger finger (flexor synovitis) is a condition where the flexor tendon catches on the tendon sheath resulting in clicking or locking of the finger.
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
Trigger finger typically presents with some of the following features:
None usually needed.
Usually a straightforward clinical diagnosis.
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:
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.
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-icb.ifr-newsdt@nhs.net
Exceptional /Individual Funding Requests (IFR).
Referral Form – Individual Funding Request (IFR)
e-Referral Service selection
British Society for Surgery of the Hand - Trigger Finger information
MyHealth Patient Information - Trigger Finger
British Society for Surgery of the Hand - Patient leaflet
This guideline has been signed off on behalf of the NHS Devon.
Publication Date: April 2019