Ultrasound-Guided Cortisone Injections for Trigger Finger

 

Introduction

Trigger finger, also known as stenosing tenosynovitis, is a condition that affects the tendons in the fingers or thumb, causing pain, stiffness, and a characteristic locking or catching sensation when trying to bend or straighten the affected digit. This occurs due to inflammation and narrowing of the tendon sheath, making it difficult for the tendon to glide smoothly.

At Alton Pain Clinic, we offer ultrasound-guided cortisone injections as an option for managing symptoms associated with trigger finger. These injections are performed under ultrasound guidance to ensure accurate placement of the medication, which may help in reducing inflammation and improving finger movement.

This blog provides comprehensive information on trigger finger, including its anatomy, pathology, risk factors, symptoms, diagnosis, and treatment options. Additionally, it explores how cortisone injections work, their mechanism of action, and the benefits of undergoing an ultrasound-guided procedure at Alton Pain Clinic.


Anatomy of the Finger and Tendon System

To understand trigger finger, it is essential to know the structure of the fingers and how they function. The movement of the fingers and thumb is controlled by a complex system of tendons, sheaths, and pulleys.

Tendons and Flexor Sheaths

  • The flexor tendons are strong, fibrous cords that connect the muscles of the forearm to the bones of the fingers, allowing them to bend and straighten.
  • These tendons run through a series of tendon sheaths and pulleys, which help keep them in place and guide their movement.
  • The A1 pulley, located at the base of the finger, plays a crucial role in maintaining normal tendon movement.

The Role of the Synovial Sheath

  • The tendons are enclosed in a synovial sheath, which produces fluid that lubricates the tendon and allows for smooth movement.
  • In trigger finger, this sheath becomes inflamed and thickened, restricting normal tendon gliding.

Pathology of Trigger Finger

Trigger finger develops when the flexor tendon becomes irritated and inflamed due to repetitive movements, prolonged strain, or underlying medical conditions. This leads to:

  • Thickening of the tendon sheath, causing restricted movement.
  • Formation of nodules or swelling in the tendon, leading to difficulty in gliding.
  • Locking or catching of the finger when attempting to flex or extend.

Over time, trigger finger can progress from mild stiffness to complete locking of the affected digit, significantly impacting hand function.

Risk Factors for Trigger Finger

Several factors contribute to the development of trigger finger, including:

Repetitive Hand Movements

  • Occupations or activities that involve frequent gripping, pinching, or repetitive finger movements increase the risk.
  • Common in musicians, manual labourers, and office workers who use keyboards extensively.

Underlying Medical Conditions

  • Diabetes – Individuals with diabetes have a higher risk due to changes in tendon structure and blood supply.
  • Rheumatoid Arthritis – Inflammatory conditions can lead to thickening of the tendon sheath.
  • Gout – The presence of urate crystals can contribute to inflammation.

Age and Gender

  • More common in individuals over 50 years of age.
  • Women are affected more frequently than men, possibly due to hormonal influences.

Trauma or Injury

  • Direct injury to the palm or repetitive strain may cause tendon irritation, leading to trigger finger.

Symptoms of Trigger Finger

The symptoms of trigger finger vary depending on the severity of the condition. Common symptoms include:

  • Pain and tenderness at the base of the affected finger or thumb.
  • Clicking or popping sensation when bending or straightening the digit.
  • Finger locking in a bent position, which may require manual straightening.
  • Morning stiffness, which may improve with movement.
  • Swelling or nodule formation at the base of the affected finger.

In severe cases, the finger may become permanently locked in a flexed position, significantly affecting hand function.

Diagnosis of Trigger Finger

A diagnosis of trigger finger is typically based on:

Medical History

  • Discussion of symptoms, occupation, and medical conditions that may contribute to tendon inflammation.

Physical Examination

  • Palpation of the base of the affected finger to check for tenderness or nodules.
  • Assessment of finger movement and the presence of locking or clicking.

Ultrasound Imaging

At Alton Pain Clinic, ultrasound imaging may be used to assess the condition of the flexor tendon, identify inflammation, and ensure accurate injection placement if treatment is required.

Management of Trigger Finger

The treatment of trigger finger depends on the severity of symptoms.

Non-Surgical Management

  1. Activity Modification – Avoiding repetitive gripping or strain on the affected finger.
  2. Splinting – Immobilising the finger in an extended position to reduce inflammation.
  3. Anti-Inflammatory Medications – Non-steroidal anti-inflammatory drugs (NSAIDs) may help alleviate pain and swelling.
  4. Physiotherapy – Stretching and strengthening exercises may improve finger function.

Ultrasound-Guided Cortisone Injections for Trigger Finger

If symptoms persist despite conservative treatments, ultrasound-guided cortisone injections may be considered at Alton Pain Clinic.

How Cortisone Helps with Trigger Finger

Cortisone (a corticosteroid) is a potent anti-inflammatory medication that may help in reducing the swelling of the tendon sheath, thereby:
✔ Alleviating pain associated with trigger finger.
✔ Reducing inflammation, improving tendon gliding.
✔ Enhancing finger movement, minimising stiffness and locking.

The use of ultrasound guidance ensures that the cortisone injection is precisely delivered to the affected area for maximum effectiveness.

Mechanism of Action of Cortisone Injections

Cortisone injections work through several mechanisms:

  1. Inhibition of Inflammatory Mediators

    • Cortisone suppresses pro-inflammatory cytokines such as interleukin-1 (IL-1) and tumour necrosis factor-alpha (TNF-α), reducing inflammation.

  2. Reduction of Synovial Thickening

    • By decreasing immune cell activity in the tendon sheath, it reduces swelling and improves movement.

  3. Pain Modulation

    • Cortisone affects pain-sensitive nerve endings, decreasing discomfort and allowing for smoother movement.

  4. Improved Tendon Function

    • With reduced inflammation, the flexor tendon can glide more freely through the sheath, minimising locking and clicking.

Benefits of Ultrasound-Guided Cortisone Injections at Alton Pain Clinic

At Alton Pain Clinic, we use ultrasound technology to guide cortisone injections, providing several advantages:
✔ Enhanced Accuracy – Ensures precise placement of the medication.
✔ Minimised Discomfort – Real-time imaging reduces the risk of unnecessary tissue irritation.
✔ Optimised Effectiveness – Directly targets the affected area for improved symptom relief.
✔ Quick and Minimally Invasive – Performed as an outpatient procedure with minimal recovery time.

Conclusion

Trigger finger is a common tendon condition that can cause pain, stiffness, and difficulty in finger movement. While conservative treatments may provide relief, ultrasound-guided cortisone injections at Alton Pain Clinic may be an option for managing symptoms. These injections help reduce inflammation, alleviate pain, and restore normal finger movement.

If you are experiencing symptoms of trigger finger and seeking expert care, Alton Pain Clinic provides advanced pain management solutions tailored to your needs.

Contact us today to learn more about your options!

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