LLR Policy for Trigger Finger    

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Category

Threshold Criteria

Trigger finger is a condition that affects one or more of the hand’s tendons, making it difficult to bend the affected finger or thumb.

If the tendon becomes swollen and inflamed it can ‘catch’ in the tunnel it runs through (the tendon sheath). This can make it difficult to move the affected finger or thumb and can result in a clicking sensation.

Trigger finger is also known as stenosing tenosynovitis or stenosing tenovaginosis. It usually affects the thumb, ring finger or little finger. One or more fingers can be affected, and the problem may develop in both hands. It’s more common in the right hand, which may be because most people are right-handed.

Symptoms of trigger finger can include pain at the base of the affected finger or thumb when you move it or press on it, and stiffness or clicking when you move the affected finger or thumb, particularly first thing in the morning.

Eligibility

LLR ICB will fund release of a trigger finger in the following circumstance
 
·         Severe Symptoms
Refer for surgical assessment

·         Moderate Symptoms
6     months of symptoms – during this time
no response to conservative management e.g. splinting and analgesia
minimum of 1 steroid injection
 
·         Mild Symptoms
Treat with simple analgesia

Definitions of symptom severity

MildModerateSevere
Clinical
Presentation
Swelling +/- pain with intermittent catching or clicking of the digit on flexion/ extension but the digit is fully mobileAs for mild but also difficulty in actively extending the digit and need for passive finger extensionFixed contraction of the digit is present

Guidance

British Society for Surgery of the Hand – Recommendations for Treatment and
BSSH – Evidence for Surgical Treatment (BEST): Trigger Finger (Thumb): Optimal number of steroid injections (2011)
 
http://www.bssh.ac.uk/patients/commonhandconditions/triggerdigits 
 
http://www.nhs.uk/conditions/Trigger-finger/Pages/Introduction.aspx
ARP 96. Review Date: 2026

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