Ultrasound-guided trigger finger release

Trigger finger

Trigger finger (stenosing tenosynovitis) is a condition that affects the tendon in the hand. The tendon can get stuck, which causes the finger/thumb to click or lock when bent towards your palm.

What is an ultrasound-guided trigger finger injection and/or release?

An ultrasound-guided trigger finger injection delivers steroid into the tendon pulley sheath to allow improvement of your symptoms. If deemed clinically necessary by your referring clinician, a trigger finger release may be carried out. This involves releasing the pulley to allow the tendon inside to move freely again.

What are the benefits?

Reduction of hand pain and improved finger movement.

What are the risks and complications?

With any procedure, there is always a risk. It has been demonstrated that ultrasound-guided trigger finger injection or release is safe. This procedure has been shown to have less risk of post-operation infection than an open procedure.

Occasional side effects of a steroid injection include:

  • A temporary increase in pain for 24-48 hours after the injection (called a ‘steroid flare’). If you experience a worsening in pain, it is advisable to take over the counter painkillers such as paracetamol or ibuprofen to relieve your discomfort. Discuss with your pharmacist if you are unsure if you can take or are on any other medication.
  • Mild facial flushing, which may last for a few hours
  • Menstrual cycle alteration
  • Loss of fat at the injection site, which may cause dimpling in the skin and may be permanent
  • Paler or darker skin at the injection site
  • Diabetic patients may find their blood sugar levels rise for a few days after the injection.
  • Bruising may appear at the injection site.

Rare complications of the injection include:

  • Infection (occurs in approximately 1 in 10,000 procedures). If the area injected becomes red, hot and swollen, and/or you feel feverish, this will require antibiotics. It is important to seek an immediate medical review by your GP, or attend an Emergency Department.
  • Bleeding into a joint or soft tissue. This is usually only a concern for people taking warfarin or similar anticoagulation (blood-thinning medicine).
  • Allergic reaction to the local anaesthetic.
  • When the area around a tendon or ligament has been injected, there is an extremely low risk of tendon rupture/tear. This most likely occurs due to overuse after the injection of an already inflamed/worn out tendon. The doctor performing the injection will assess the state of the tendon using the ultrasound scan before deciding whether to proceed with the injection.

Please bear in mind that your doctor has recommended you for this procedure because they believe that the potential benefits of the injection outweigh any potential complications. If you have any questions or concerns please do not hesitate to speak with your doctor.

Tell the doctor before having the treatment if you:

  • Have had a steroid injection in the last few weeks—you usually need to wait at least 6 weeks between injections
  • You’ve had 3 steroid injections in the last year—doctors usually recommend no more than 3 injections in the same area in the space of 12 months
  • Have had an allergic reaction to steroid in the past
  • Have an infection (including eye infections)
  • Have recently had, or are about to have, any vaccinations
  • Are pregnant or breastfeeding
  • Have any other conditions, such as diabetes, epilepsy, high blood pressure, or problems with your liver, heart or kidneys
  • Are taking other medicines such as anticoagulants (blood thinners) or antiretrovirals. If you take any medication for the treatment of HIV it is imperative that you get in touch with your HIV team to obtain an official clearance letter to allow you to proceed with this treatment plan.
  • Are feeling unwell
  • Do not want the injection or no longer have symptoms.

Preparation

No specific preparation is required for this procedure. You may eat and drink normally.

You may need to arrange for someone to take you home or take public transport as it is not recommended to drive for 12 hours after the procedure.

On the day

Please report to the Ultrasound Reception Desk, Imaging Department, 1st Floor, Lift Bank D. Please arrive 15 minutes before your appointment to allow time for you to be booked in and relevant written consent forms to be completed. If you arrive late it may result in your appointment being rebooked for a later date.  

Who performs the procedure?

The procedure will be performed by a Radiologist trained in performing image-guided procedures. The radiologist will explain the procedure to you and answer any questions that you have. When they are sure that you understand the procedure you will be asked to sign a consent form.

What happens during the procedure?

The radiologist will perform a diagnostic ultrasound scan to confirm the location and extent of the problem as well as to check there are no other issues in the surrounding area.

The skin is cleaned with a sterile solution. Using the ultrasound probe, the needle is guided gently to the affected area and the medication is injected. The needle is removed and a plaster or dressing is applied. The procedure usually takes 20–30 minutes.

Will you feel any pain?

The injection of local anaesthetic will involve a small needle and will be similar to a blood test, if the area is very inflamed there may be more discomfort. Tell the radiologist if you are finding the discomfort difficult to tolerate.

The injection may cause stinging briefly before the area becomes numb.

What to expect afterwards

Immediately after the procedure, you may feel that your pain has gone or is significantly reduced. This is due to the local anaesthetic and the effect will last for a few hours. The effect of the trigger finger injection/release varies from person to person, and a few people may not experience any benefit. Symptoms can be relieved for a few weeks to a few months.

When can I return to work?

You can return to work as soon as you feel able to. However, it is advisable to have the rest of the day off work.

Contact information

Imaging Department

1st Floor, Lift Bank D
Chelsea and Westminster Hospital
369 Fulham Road
London
SW10 9NH

If you need to change your appointment date or time, or if require an interpreter for your examination, please contact the booking team on 020 3315 2785/3 (Mon–Fri, 9am–5pm).