Policy number: SRP 106
Policy name: Trigger Finger release in adults
Status: Individual Funding Approval
Effective date: 1 April 2024
Next review date: 1 April 2026
Mid and South Essex ICB commission surgery for Trigger Finger on a restricted basis.
Trigger digit occurs when the tendons which bend the thumb/finger into the palm intermittently jam in the tight tunnel (flexor sheath) through which they run. It may occur in one or several fingers and causes the finger to “lock” in the palm of the hand. Mild triggering is a nuisance and causes infrequent locking episodes. Other cases cause pain and loss and unreliability of hand function.
Mild cases which cause no loss of function require no treatment or avoidance of activities which precipitate triggering and may resolve spontaneously – up to 83% have been found to resolve spontaneously after a few months.
Cases interfering with activities or causing pain should first be treated with:
- Two steroid injections – 50-80% will resolve after a single injection and a second injection should be carried out after 6 weeks if no response to first injection. Patients should not be referred until they have tried two steroid injections unless contra-indicated
OR
- Splinting of the affected finger for 3-12 weeks (weak evidence)
Cases of Trigger Finger release will only be funded if they meet at least ONE of the criteria listed below:
- Patients who fail to respond to all appropriate conservative treatments as listed above for a minimum of 6 months.
- Triggering persists or recurs after one of the above measures (particularly steroid injections)
- The finger is permanently locked in the palm.
- The patient has previously had 2 other trigger digits unsuccessfully treated with appropriate nonoperative methods.
- Patient is diabetic.
Surgery is usually effective and requires a small skin incision in the palm but can be done with a needle through a puncture wound (percutaneous release).
For audit purposes, the referral letter and hospital records must include evidence that the patient meets the criteria, including the dates of the corticosteroid injections and any other conservative management.
Funding for patients not meeting the above criteria will only be granted in clinically exceptional circumstances.
Find out more information on applying for funding in exceptional clinical circumstances
References:
Trigger finger release in adults– NHSE Evidence Based Interventions