Marc Darrow MD,JD

I see many people with finger problems. This includes “trigger finger.” For some people they have been to other doctors and have been diagnosed with the more technical term, “stenosing tenosynovitis.” Whether a trigger finger or stenosing tenosynovitis diagnosis, you have been to the doctor because your finger is stuck or locked in a bent position and it is making a loud popping noise that you know is not right.

Over the course of time people try to manage trigger finger on their own. Many go online and look for quick remedies and suggestions.

Many people will:

  • Rest their fingers or avoid activities that irritate the situation. This is particular tough on a musician or someone who does a lot of dexterity work with their hands. So these people look for other things that may help.
  • They may alternate heat and ice therapy depending on whether they have inflammation or puffiness.
  • Sometimes they walk around with their hand a container of warm water to try to get the finger to relax and loosen up.
  • Add to this anti-inflammatories.
  • Some may also purchase a finger splint at the pharmacy and try to keep their finger extended with the splint and tape.

For those who did not find relief with these remedies, they sought out a doctor. At the doctors they got:

  • Stronger medications than the one they were taking: ibuprofen, naproxen or acetaminophen to help manage the pain.
  • A better splint

The A1 pulley

Doctors tend to get more technical when the patient is progressing their way towards surgery. Here a doctor may explain to the patient that they have a problem with their A1 pulley and their  flexor tendon. The flexor tendon attaches the muscles of the forearm to the bones of the fingers. In its path from forearm to finger, the flexor tendons passes through a band of tissue that holds it is place along the finger bones called the A1 pulley. When this tendon does not slide properly within the A1 pulley and it becomes irritated and inflamed. If the flexor tendon becomes too enlarged and swells up to the point that it can no longer glide back and forth within the A1 pulley. It gets stuck and so does your finger.

Is there a connection between carpal tunnel syndrome and trigger finger?

A May 2020 study (1) reviewed the connection between Carpal tunnel release and trigger finger. They wrote: “Carpal tunnel release is acknowledged as a predisposing factor for the development of the trigger finger. However, the incidence of new-onset trigger finger after Carpal tunnel release surgery has been inconsistently reported. In this study, we aimed to evaluate the prevalence of Carpal tunnel release as a risk factor of the development of the trigger finger.”

  • Post-Carpal tunnel release trigger finger was detected in 26.3% of the 57 patients of this study
  • The trigger finger occurred approximately six months after Carpal tunnel release surgery. The thumb and ring fingers were the most commonly involved fingers.
  • Ten out of 15 (66.7%) patients who developed a post-Carpal tunnel release trigger finger had mild-to-moderate Carpal tunnel syndrome, and five (33.3%) patients had severe Carpal tunnel syndrome. No significant difference was found between the patients who did and did not develop a trigger finger after Carpal tunnel release surgery.

“The rate of developing a post-Carpal tunnel syndrome trigger finger was remarkable in our study.” The authors of this study suggested that patients under going Carpal tunnel release be advised of the potential of developing trigger finger.

Non-Surgical options : Cortisone, PRP and Stem Cell Therapy

Since trigger finger is considered a problem of inflammation some will think that the obvious treatment should be a strong anti-inflammatory, such as a cortisone injection. Others would rather not go down the cortisone route because of the well known side-effects and the simple fact that cortisone is not a healing treatment, it is a symptom suppression treatment.

PRP vs cortisone

A research team in November 2020 (2) announced that they would conduct a study to compare PRP injections to cortisone injections for trigger finger. There is limited research on PRP effectiveness for trigger finger outside of research that suggests “Platelet-rich plasma (PRP) has been shown to be safe and to reduce symptoms in different tendon pathologies, such as DeQuervain’s disease (painful thumb tendons).”

Further they write:

“PRP has been shown to reduce symptoms in different tendon pathologies with the rationale to potentially accelerate the healing process. PRP has positive effects on both short-term and long-term pain on tendon and ligament healing. PRP contains various growth factors that have potential tendon-healing properties. PRP has been previously used in hand pathologies such as osteoarthrosis.

Injection of corticosteroids in the vicinity of the A1 pulley is generally accepted as a first-line therapy, although recurrence rates up to 33% have been reported. Moreover, up to 5.8% of major adverse events have been reported in soft-tissue injections of cortisone (defined as those needing intervention or not disappearing). As some authors have stated superiority of PRP compared to cortisone in select musculoskeletal disorders,, investigating the clinical efficacy of PRP in treating trigger finger is warranted.”

We have seen many people with problems of trigger finger. We have helped many with PRP treatments. Equally we have helped a lot of people with stem cell therapy for their trigger finger problems.

Stem Cell therapy

In our practice, Stem Cell Therapy is a treatment for musculoskeletal disorders. We treat degenerative joint disease, degenerative disc disease of the spine, and tendon and ligament injury. We offer stem cells drawn from patient’s own bone marrow. Stem cells are “de-differentiated pluripotent” cells, which means that they continue to divide to create more stem cells; these eventually “morph” into the tissue needing repair — for our purposes, collagen, bone, and cartilage.

There is no direct study on the effect of stem cell therapy on trigger finger. Like PRP above there is an expectation that the treatment would be beneficial based on successful treatments documented in the medical literature on other types of tendinopathies.

More recently a January 2020 study (3) suggested: “there have been over 100 studies using MSCs for tendon healing, and the majority of these studies has been published in the last 5 years. These studies have used the traditional bone marrow derived stromal cells (BMSCs), adipose derived stem cells (ASCs), endogenous ligament derived stem cells (LDSCs) or tendon derived stem cells (TDSCs), and MSCs from other sources, such as synovial fluid. MSC-based therapies have been applied to augment tendon and ligament healing in several different ways.” What we see is an explosion in research based on the concept that stem cell therapy may be very beneficial for tendon injuries such as those found in a trigger finger.

Doctors writing in the medical journal Hand Surgery suggested that bone-marrow derived stem cells accelerate tendon healing in animal studies.(4) Doctors know that chronic tendon injuries present unique management challenges because of the long-held belief that they result from ongoing inflammation. This thinking has caused physicians to rely on treatments demonstrated to be ineffective in the long term—e.g., anti-inflammatory medications and cortisone shots.

Published in the Journal of Muscles Ligaments Tendons, researchers from Italy wrote: “Tendon injuries represent, even today, a challenge, as repair may be exceedingly slow and incomplete. Regenerative medicine and stem cell technology have shown to be of great promise.” (5)

Most recently, a study from the Feinstein Institute for Medical Research indicated the potential effectiveness of bone marrow (stem cells) for Achilles tendon healing, particularly during the early phases.(6)

Do you have questions? Ask Dr. Darrow

Over the years we have seen many people with various finger and hand problems and we have helped many people.

A leading provider of stem cell therapy, platelet rich plasma and prolotherapy
11645 WILSHIRE BOULEVARD SUITE 120, LOS ANGELES, CA 90025

PHONE: (800) 300-9300 or 310-231-7000

Stem cell and PRP injections for musculoskeletal conditions are not FDA approved. We do not treat disease. We do not offer IV treatments. There are no guarantees that this treatment will help you. Prior to our treatment, seek advice from your medical physician. Neither Dr. Darrow, nor any associate, offer medical advice from this transmission. This information is offered for educational purposes only. The transmission of this information does not create a physician-patient relationship between you and Dr. Darrow or any associate. We do not guarantee the accuracy, completeness, usefulness or adequacy of any resource, information, product, or process available from this transmission. We cannot be responsible for the receipt of your email since spam filters and servers often block their receipt. If you have a medical issue, please call our office. If you have a medical emergency, please call 911.

1 Aspinen S, Nordback PH, Anttila T, Stjernberg-Salmela S, Ryhänen J, Kosola J. Platelet-rich plasma versus corticosteroid injection for treatment of trigger finger: study protocol for a prospective randomized triple-blind placebo-controlled trial. Trials. 2020 Dec;21(1):1-9.
2 Shafaee-Khanghah Y, Akbari H, Bagheri N. Prevalence of Carpal Tunnel Release as a Risk Factor of Trigger Finger. World Journal of Plastic Surgery. 2020 May;9(2):174.
3 Leong NL, Kator JL, Clemens TL, James A, Enamoto‐Iwamoto M, Jiang J. Tendon and ligament healing and current approaches to tendon and ligament regeneration. Journal of Orthopaedic Research®. 2020 Jan;38(1):7-12.
4 He M, Gan AW, Lim AY, Goh JC, Hui JH, Chong AK. Bone marrow derived mesenchymal stem cell augmentation of rabbit flexor tendon healing. Hand Surg. 2015 Oct;20(3):421-9. doi: 10.1142/S0218810415500343.
5 Tetta C, Consiglio AL, Bruno S, Tetta E, Gatti E, Dobreva M, Cremonesi F, Camussi G. Muscles: the role of microvesicles derived from mesenchymal stem cells in tissue regeneration; a dream for tendon repair? Ligaments Tendons J. 2012 Oct 16;2(3):212-21. Print 2012 Jul.
6 Shapiro E, Grande D, Drakos M. Biologics in Achilles tendon healing and  repair: a review. Curr Rev Musculoskelet Med. 2015 Feb 6. PubMed. 1376

 

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