Editing Trigger finger (section)

==Treatment==
[[File:Post-operative photo of trigger finger release surgery.jpg|thumb|Post operative photo of trigger finger release surgery in a diabetic patient. See:<ref name="Eisen 2013">{{cite web |url = https://plus.google.com/103101121348859087349/posts/V492nruyUTK |title = Trigger finger surgery. Fun. | vauthors = Eisen J |access-date = 17 May 2013 }}</ref>]]
Depending on the number of affected digits and the clinical severity of the condition, [[Corticosteroid]] injections can cure trigger digits.<ref name="pmid32732655">{{cite journal | vauthors = Gil JA, Hresko AM, Weiss AC | title = Current Concepts in the Management of Trigger Finger in Adults | journal = J Am Acad Orthop Surg | volume = 28 | issue = 15 | pages = e642–e650 | date = August 2020 | pmid = 32732655 | doi = 10.5435/JAAOS-D-19-00614 | s2cid = 220892746 }}</ref>

Treatment consists of injection of a corticosteroid such as [[methylprednisolone]] often combined with a local anesthetic ([[lidocaine]]) at the A1 pulley in the palm. The infiltration of the affected site is straightforward using standard anatomic landmarks. There is evidence that the steroid does not need to enter the sheath.<ref>{{cite journal | url=https://pubmed.ncbi.nlm.nih.gov/9708388/ | pmid=9708388 | year=1998 | last1=Taras | first1=J S | last2=Raphael | first2=J S | last3=Pan | first3=W T | last4=Movagharnia | first4=F | last5=Stereanos | first5=D G | title=Corticosteroid injections for trigger digits: is intrasheath injection necessary? | journal=The Journal of Hand Surgery | volume=23 | issue=4 | pages=717–722 | doi=10.1016/S0363-5023(98)80060-9}}</ref> The role of sonographic guidance is therefore debatable.

Injection of the tendon sheath with a corticosteroid is effective over weeks to months in more than half of people.<ref name="Baumgarten_2007" /> Steroid injection is not effective in people with Type 1 diabetes.<ref>{{cite journal | url=https://pubmed.ncbi.nlm.nih.gov/18056491/ | pmid=18056491 | year=2007 | last1=Baumgarten | first1=K. M. | last2=Gerlach | first2=D. | last3=Boyer | first3=M. I. | title=Corticosteroid injection in diabetic patients with trigger finger. A prospective, randomized, controlled double-blinded study | journal=Journal of Bone and Joint Surgery | volume=89 | issue=12 | pages=2604–11 | doi=10.2106/JBJS.G.00230 }}</ref> If triggering persists 2 months after injection, a second injection can be considered.  Most specialists recommend no more than 3 injections because corticosteroids can weaken the tendon and there is a possibility of tendon rupture. 

Triggering is predictably resolved by a relatively simple surgical procedure under local anesthesia. The surgeon will cut the sheath that is restricting the tendon. The patient should be awake in order to confirm adequate release. On occasion, triggering does not resolve until a slip of the FDS (flexor digitorum superficialis) tendon is resected.<ref name="pmid32732655"/>&nbsp;

One study suggests that the most cost-effective treatment is up to two corticosteroid injections followed by open release of the first annular pulley.<ref name="Kerrigan_2009">{{cite journal | vauthors = Kerrigan CL, Stanwix MG | title = Using evidence to minimize the cost of trigger finger care | journal = The Journal of Hand Surgery | volume = 34 | issue = 6 | pages = 997–1005 | date = Jul–Aug 2009 | pmid = 19643287 | doi = 10.1016/j.jhsa.2009.02.029 }}</ref> Choosing surgery immediately is an option and can be affordable if done in the office under local anesthesia.<ref name="Kerrigan_2009" />

===Surgery===
Trigger digits can be released percutaneously using a needle. This is not used for the thumb where the digital nerves are at greater risk.<ref>{{cite journal | vauthors = Pavlicný R | title = [Percutaneous release in the treatment of trigger digits] | journal = Acta Chirurgiae Orthopaedicae et Traumatologiae Čechoslovaca | volume = 77 | issue = 1 | pages = 46–51 | date = February 2010 | doi = 10.55095/achot2010/008 | pmid = 20214861 | s2cid = 26595001 | doi-access = free }}</ref>

====Postoperative outcome====
In some trigger finger patients, tenderness is found in the dorsal proximal interphalangeal (PIP) joint. Dorsal PIP joint tenderness is more common in trigger fingers than previously thought. It is also associated with higher and prolonged levels of postoperative pain after A1 pulley release. Therefore, patients with pre-existing PIP tenderness should be informed about the possibility of sustaining residual minor pain for up to 3 months after surgery.<ref>{{cite journal | vauthors = Monteerarat Y, Misen P, Laohaprasitiporn P, Wongsaengaroonsri P, Lektrakul N, Vathana T | title = Dorsal proximal interphalangeal joint tenderness is associated with prolonged postoperative pain after A1 pulley release for trigger fingers | journal = BMC Musculoskeletal Disorders | volume = 24 | issue = 1 | pages = 13 | date = January 2023 | pmid = 36611160 | pmc = 9824922 | doi = 10.1186/s12891-023-06130-5 | doi-access = free }}</ref>