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Trigger Finger Injection

When to inject

trigger finger injection
trigger finger injection

As a treatment where significant symptoms.

For symptom control prior to surgery

Diabetic patients with cheiroarthropathy

When to avoid injection

If locked proximal interphalengeal joint / fixed flexion deformity

(May be usefiul while waiting for surgery to give some symptomatic relief but not in isoloation)

If there is significant tendon damage

Local or systemic infection

Risks and complications

Infection – very rare probably 1 in 15000

Skin depigmentation, dermal atrophy, adipose atrophy, particularly if injection too superficial

Tendon rupture – very rare in non-rheumatoid patients

Flare of symptoms

Increased blood sugars in diabetic patients, this may last for 3-7 days with significant elevation of blood sugars

Facial flushing particularly in ladies

Equipment

Antiseptic spray ( alcoholic chlorhexideine), dressings/ plaster for after injection, gloves.

5ml of 1 or 2 % lidocaine, 5 ml syringe, drawing up needle.

Long orange needle 25mm, 25 guage

10- 20mg of triamcinolone or Kenalog in a separate 1ml syringe

Positioning

The patient is seated, and the affected hand is supinated on a table or other flat surface.

The patient is asked to keep the hand as flat as possible, with the affected finger flexed. This assists with placing the needle in the midline of the finger.

Where to inject

After antiseptic application and under strict asceptic technique.

With the local anaesthetic first and the orange needle , at 30 degrees to the skin, entry point just proximal to the MCP skin crease, with the finger flexed, in line with the midline of the finger.

Infiltrate skin, subcutaneous tissue, feel the needle pass through the flexor sheath then extend the finger, continue injecting local anaesthetic, this should flow reasonable freely. Change the syringe, inject 10-20 mg of steroid.

Apply pressure for 5 minutes then a light dressing. Advise the patient to be cautious with use of the finger until normal sensation returns. Expect some discomfort for a day or two.

Pearls

Placing the needle at the base of the finger flexion crease often easier than placing it right at the A1 pulley in the hand. This is especially true if there is a large palpable nodule present. The patient is generally much less tender distal to the lesion at the A1 pulley.

Remind the patient that steroids take some time to have effect. Patients often wait 3-7 days to experience a difference in clinical symptoms.

Injections around the tendon sheath have been shown to have effect. If the injectate escapes the sheath and subcutaneous fluid is seen, the injection may still have effect.

To avoid potential complications of vascular or nerve ischemia, tissue necrosis, and serious damage to nerve, lidocaine with adrenaline should not be used.