Ultrasound-guided infiltration in trigger finger

What is ultrasound-guided injection of trigger finger?

This is an ultrasound-guided procedure in which we inject an anti-inflammatory medication around the affected flexor tendon and the obstructing pulley. Performing this injection requires ultrasound guidance, which allows us to view the target structures of our treatment in real time and precisely place the medication in the finger.

What are the indications for ultrasound-guided injection of trigger finger?

• Persistent symptoms that do not improve with conservative treatments: Injection is indicated when the patient presents pain and the characteristic "clicking" or blockage that has not responded to initial measures such as rest, stretching exercises, or oral nonsteroidal anti-inflammatory drugs (NSAIDs).
• Patients who wish to avoid surgery: Injection is an alternative for those who do not want or are not candidates for immediate surgery. With a high success rate (especially in long fingers), it can resolve symptoms and avoid the need for surgery.
• Treatment of choice for intermediate levels of severity: According to the medical literature, corticosteroid injections are especially effective in intermediate levels of severity of trigger finger, where the clicking sound is evident but there is no complete and permanent blockage of the finger.
• Trigger finger associated with systemic diseases: Although not the only indication, in patients with conditions such as diabetes or rheumatoid arthritis, who are at higher risk for this condition, ultrasound-guided injections are a safe and effective treatment option.

What is the procedure for an ultrasound-guided injection for trigger finger?

Ultrasound-guided injections for trigger finger are performed on an outpatient basis and last approximately 10 to 15 minutes. The following steps are followed:

• Preparation: The patient is seated with the palm facing up and supported on the table. The flexor tendon and its pulley are located with a prior ultrasound, and the entry site is marked on the skin.
• Local anesthesia: A small amount of local anesthesia can be applied to the skin to reduce pain during the injection.
• Asepsis: The entire procedure is performed with sterile materials and instruments.
• Ultrasound guidance: We visualize the needle in the correct position and the medication is administered in the correct location.

The main indication for ultrasound-guided injection of trigger finger is in cases with palmar pain at the pulley level and an active trigger finger at the time of the examination. It is also indicated in cases with flexion or extension blockages. The outcome is usually satisfactory in most patients, although in cases where the trigger finger persists or reappears after rhb and a maximum of three ultrasound-guided injections, surgical treatment will be mandatory.

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