Tips for managing 4 common soft-tissue finger and thumb injuries
After examination and, in some cases, imaging, most of these injuries can be managed conservatively with splinting or injection. Some cases require prompt surgical referral.
PRACTICE RECOMMENDATIONS
› Treat trigger finger with a corticosteroid injection into the flexor tendon sheath. A
› Refer a case of jersey finger to a hand surgeon within 1 week after injury for flexor tendon repair. C
› Treat mallet finger with strict distal interphalangeal joint immobilization for 6 to 8 weeks. A
› Treat Grades 1 and 2 skier’s thumb with immobilization in a thumb spica splint or a cast for 4 to 6 weeks. B
Strength of recommendation (SOR)
A Good-quality patient-oriented evidence
B Inconsistent or limited-quality patient-oriented evidence
C Consensus, usual practice, opinion, disease-oriented evidence, case series
Imaging. Trigger finger is a clinical diagnosis. Imaging is therefore unnecessary for diagnosis or treatment.5
Treatment. Trigger finger resolves spontaneously in 52% of cases.3 Most patients experience relief in 8 to 12 months.3
First-line treatment is injection of a corticosteroid into the flexor tendon sheath, which often alleviates symptoms.4,5 Injection is performed at the level of the A1 pulley on the palmar surface, just proximal to the MCP joint at the level of the distal palmar crease6 (FIGURE 1). The needle is inserted at an oblique angle until there is an increase in resistance. The needle is then slightly withdrawn to reposition it in the tendon sheath; 0.5 to 1 mL of 50% corticosteroid and 50% local anesthetic without epinephrine is then injected.6
The cure rate of trigger finger is 57% to 70% with 1 injection and 82% to 86% after 2 injections.3,4,19
Many patients experience symptom relief in 1 to 4 weeks after a corticosteroid injection; however, as many as 56% experience repeat triggering within 6 months—often making multiple injections (maximum, 3 per digit) necessary.19,20 Patients who have a longer duration of symptoms, more severe symptoms, and multiple trigger fingers are less likely to experience relief with injections.3,5
Continue to: Splinting is an effective treatment...
