Trigger finger and thumb

• Nodule at level of A1 Pulley (over Palmar MCPJ) – palpate this area and ask patient to flex – nodule usually obvious.
• Patient may feel a “CLICK”
• Locking may be actively correctable i.e. patient can force straight again, or passively correctable whereby need to pull straight with other hand.
• Nodules may be painful especially if in contact with objects in the palm as when gripping

• Spontaneous recovery may occur
• Try a finger splint as per information in advice sheet
• Avoid Prolonged flexion when gripping onto objects
• Try icing over nodule to reduce inflammation around tendon
• Activity modification – reduce repetitive tasks, take regular stretch breaks

• Issue TRIGGER FINGER AND THUMB PATIENT LETTER* to patient and encourage to try a splint intermittently for 6 weeks
  
• Try steroid injection by appropriately trained Healthcare Practitioner if these skills are available in Surgery – if not refer to OT Hand clinic for injection (less successful in Diabetic Patients)
• Repeat only once if initial relief temporary
• Surgical release may be required if symptoms persist

• If symptoms persist following 6-8 weeks of self management
• No Active Flexion / Finger completely locked in flexion or unable to initiate active flexion

Refer via SCI Gateway to Occupational Therapy Hand Clinic and include following in referral:

• Duration of symptoms
• Duration of self management inc splint
• Precipitating factors i.e. injury/trauma, occupation