Stenosing Tenosynovitis - Management

Management

Occupational therapy is based on relieving the symptoms and reducing the inflammation. Overall cure rate, for dutifully applied non-operative treatment, is over 95%. Several modalities of treatment exists, depending on the chronicity and severity of the condition.

• Modification of hand activities
• Exercise & stretching
• Local heat
• Oral non-steroidal anti inflammatory drugs (NSAIDs) (e.g. Ibuprofen, Diclofenac topical)
• Extension splitting during sleep (custom metacarpophalangeal (MCP) joint blocking splint, which has reported better patient's symptomatic relief and functionality and a distal interphalangeal (DIP) joint blocking splint)
• Corticosteroid injections (very effective in approximately 70-75% of the cases ) Treatment consists of injection of methylprednisolone often combined with anesthetic (lidocaine) at the site of maximal inflammation or tenderness. The inflitration of the affected site can be performed blinded or sonographycally guided, and often needs to be repeated 2 or three times to achieve remission. An irreducibly locked trigger, often associted with a flexion contracture of the PIP joint, should not be treated by injections.
• Transection of the fibrous annular pulley of the sheath

For symptoms that has been persistent or recurrent more than 6 months and/or unresponsive to conservative treatment, surgical release of the pulley may be indicated. Two approaches exists, open and percutaneous. The precutaneous approach, is preferred in some centers due to its reported shorter time of recuperation of motor function, less complications, and less painful. Complication of the surgical management include, persistent trigger finger, bowstringing, digital nerve injury, and continued triggering.

Of note, diabetes seems to be poor prognostic indicator for nonoperative treatment and may develop stiffness after surgical release.