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    Trigger Finger Aug 2020 v5

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    Anne Serneo
    Trigger finger, also known as stenosing tenosynovitis, causes thickening and narrowing of the tendon sheath in the finger. This prevents the flexor tendon from gliding smoothly, resulting in pain, snapping, or locking of the finger. The policy outlines criteria for referral for nonsurgical or surgical treatment, recommending initial conservative treatment including rest, splinting, NSAIDs, and corticosteroid injections. Surgery is only funded if moderate symptoms do not improve with conservative treatment or severe symptoms cannot be corrected otherwise. Trigger finger is most common in middle-aged women and people with diabetes or rheumatologic conditions.

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    Trigger Finger Aug 2020 v5

    Uploaded by

    Anne Serneo
    22 views2 pages
    Trigger finger, also known as stenosing tenosynovitis, causes thickening and narrowing of the tendon sheath in the finger. This prevents the flexor tendon from gliding smoothly, resulting in pain, snapping, or locking of the finger. The policy outlines criteria for referral for nonsurgical or surgical treatment, recommending initial conservative treatment including rest, splinting, NSAIDs, and corticosteroid injections. Surgery is only funded if moderate symptoms do not improve with conservative treatment or severe symptoms cannot be corrected otherwise. Trigger finger is most common in middle-aged women and people with diabetes or rheumatologic conditions.

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    Trigger finger, also known as stenosing tenosynovitis, causes thickening and narrowing of the tendon sheath in the finger. This prevents the flexor tendon from gliding smoothly, resulting in pain, snapping, or locking of the finger. The policy outlines criteria for referral for nonsurgical or surgical treatment, recommending initial conservative treatment including rest, splinting, NSAIDs, and corticosteroid injections. Surgery is only funded if moderate symptoms do not improve with conservative treatment or severe symptoms cannot be corrected otherwise. Trigger finger is most common in middle-aged women and people with diabetes or rheumatologic conditions.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    22 views2 pages

    Trigger Finger Aug 2020 v5

    Uploaded by

    Anne Serneo
    Trigger finger, also known as stenosing tenosynovitis, causes thickening and narrowing of the tendon sheath in the finger. This prevents the flexor tendon from gliding smoothly, resulting in pain, snapping, or locking of the finger. The policy outlines criteria for referral for nonsurgical or surgical treatment, recommending initial conservative treatment including rest, splinting, NSAIDs, and corticosteroid injections. Surgery is only funded if moderate symptoms do not improve with conservative treatment or severe symptoms cannot be corrected otherwise. Trigger finger is most common in middle-aged women and people with diabetes or rheumatologic conditions.

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    Trigger Finger (Stenosing Tenosynovitis)

    Definition
    Trigger finger (stenosing tenosynovitis) is an acquired condition in which the sheath for the flexor
    tendon of a finger or the thumb thickens and narrows. This causes the flexor tendon to not glide
    freely through it, leading to pain, intermittent snapping (“triggering”) or actual locking (in flexion or
    extension) of the affected digit (finger).
    Policy
    Referral for treatment should be through the MSK service/pathway.
    It is the responsibility of referring and treating clinicians to ensure compliance with this
    policy. Referral proforma should be attached to the patient notes to aid the clinical audit
    process and provide evidence of compliance with the policy. For patients not meeting the
    policy criteria, clinicians can apply for funding to the Exceptional Cases Panel by
    completing the exceptional funding section of the referral proforma.
    The CCG will ONLY fund surgery for trigger finger (preferably percutaneous) according to the
    Surgical Threshold Policy

    following criteria:
    The patient has moderate symptoms as defined below which have not improved following
    conservative treatment, eg encouragement to regularly move the finger, rest from aggravating
    activities, splinting, NSAIDs, and at least one corticosteroid injection (unless contraindicated).
    OR
    The patient has severe symptoms as defined below that cannot be corrected with any other
    method.
    Classification for Severity of Trigger Finger:
    Mild (pre-triggering): History of pain and catching or “click”.
    or tender A1 pulley (tendon); but fully mobile finger.
    Moderate: Triggering with difficulty actively extending finger or need for passive
    finger extension.
    or loss of complete active flexion.
    Severe: Fixed contracture.

    Note:
    Patients who smoke should be advised to attempt to stop smoking and referred to stop-smoking
    services – see stop smoking policy1, 2.
    We acknowledge there may be a difference in response of some patients with diabetes to
    conservative treatments3 but suggest these are offered in the context of the shared decision-
    making process.
    Rationale and Evidence
    • Spontaneous recovery has been reported in up to 29% of cases4.
    • Steroid injections are advised before surgery due to ease of use within the outpatient setting
    and low morbidity rate or complications5.
    • Initial treatment of trigger finger is conservative. Steroid injections are efficacious and should
    be attempted before surgical intervention6, 7.

    _____________
    Page 1 of 2
    Rational and Evidence cont’d
    • Trigger finger cure rate has been shown in patients who were treated with corticosteroid
    injections (57%) and this improved with two injections (86%) whilst remission was achieved in
    all cases for surgical methods at 6 months8.
    • Some evidence suggests that patients with diabetes respond less well to corticosteroid
    injection9
    Estimated number of
    people affected
    The overall lifetime incidence of trigger finger is 2 in 1004. It occurs in childhood and adulthood
    (most frequently in the fifth to sixth decades) and is more common in women5. Diabetes,
    rheumatoid arthritis, thyroid disease, kidney disease and other rarer disorders are risk factors for
    trigger finger
    References
    1. C Furlong. Preoperative Smoking Cessation: A Model to Estimate Potential Short Term Health Gain
    and Reductions in Length of Stay. A report by London Health Observatory. September 2005.
    2. S Hajioff, M Bhatti. Pre-operative smoking cessation therapy in NCL. A case of short-term gain for
    long-term gain?
    3. NHS England Medical directorate and Strategy and Innovation directorate, 2018, Evidence-Based
    Interventions: Guidance for Clinical Commissioning Groups, NHS England, viewed 16th January 2020,
    <https://www.england.nhs.uk/wp-content/uploads/2018/11/ebi-statutory-guidance-v2.pdf>
    4. Schofield C B, Citron N D. (1993). The natural history of adult trigger thumb. J Hand Surg [Br]. 1993
    Apr;18(2):247-8.
    5. Wolfe S W. Tenosynovitis, 2137-2158, Chapter 60. Green’s Operative Hand Surgery Ed’s Green DP,
    Hotchkiss RN, Pederson W C, Wolfe S W . Elsevier, Churchill Livingstone, 2005.
    6. Sheryl B, Fleisch, B S, et al. (2007). Corticosteroid Injections in the Treatment of Trigger Finger: A
    Level I and II Systematic Review. J Am Acad Orthop Surg, Vol 15, No 3, March 2007, 166-171.
    7. Kerrigan C L, Stanwix M G. (2009). Using evidence to minimize the cost of trigger finger care. J Hand
    Surg Am. 2009 Jul-Aug;34(6):997-1005.
    8. Sato E S, Gomes Dos Santos J B, et al. (2011). Treatment of trigger finger: randomized clinical trial
    comparing the methods of corticosteroid injection, percutaneous release and open surgery.
    Rheumatology (Oxford). 2012 Jan;51(1):93-9
    9. Chang C – J, et al (2018). A Meta-analyisis of Corticosteroid Injection for Trigger Digits among
    Patients with Diabetes. Orthopedics, Doyle J R. (1988). Anatomy of the finger flexor tendon sheath
    and pulley system. J. Hand Surg. Vol 13-A. 1988. p 473.
    10. Doyle J R (1988). Anatomy of the finger flexor tendon sheath and pulley system. J Hand Surg. Vol
    13. 1988. p473
    11. Blacks Medical Dictionary. 42nd Edition. A & C Black. London 2010.

    Glossary10, 11
    Flexor tendon: Flexor tendons are strong smooth cords that connect the muscles of the forearm to
    the bones in the fingers and thumb. There are two to each finger and one for the
    thumb.
    Stenosing: An abnormal narrowing or contraction of a duct or canal.

    Reviewed policy ratified by CCG Governing Body 7 July 2020


    Reviewed policy approved by IPAC 30 June 2020
    Reviewed policy approved by CPF 9 March 2020
    Policy effective from August 2020
    Policy to be reviewed: August 2022
    onedrive\CPF Pols & Working Area\Surg Threshold Pols\CCG Policies\ Trigger Finger\Agreed\
    Reference: TRIGGER FINGER AUG 2020 V5
    _____________
    Page 2 of 2

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