Trigger Finger Injection – Technique and Tips

By Chris Faubel, MD —

aka “trigger thumb injection”, “trigger digit injection”

Indications

• Trigger Finger
  • ICD-9 code:
    • 727.03 “trigger finger” (acquired)
  • ICD-10 code:
    • M65.3 “trigger finger“ nodular tendinous disease

CPT code: 20550 “Injection(s); single tendon sheath, or ligament, aponeurosis”

Materials Needed

• Pen – clicking type
• Gloves – non-sterile
• Alcohol swabs (or povidone-iodine)
• Band-aid
• Tuberculin needle/syringe (27-gauge, o.5″ needle with 1-ml syringe)
• Injectate
  • 0.3-0.4-ml of 40mg/ml Depo-Medrol or Kenalog
  • 0.3-0.4-ml of 1% lidocaine

Technique / Procedure Steps

1. Always start with informed consent from the patient, and then a time-out to verify correct patient and injection site.
2. Mark the injection site with the pen tip in order to leave an impression in the skin.
3. Clean the skin thoroughly with as many alcohol swabs as needed (usually only 1-2 are needed).
4. Patient position: Perform lying supine or seated with the hand supinated.
5. With the tuberculin needle/syringe, enter the skin a few millimeters either distally or proximally to the nodule (triggering site) at about a 30-degree angle.
6. Aspirate to make sure you’re not in any vessel.
7. After negative aspiration, inject the full contents of the syringe, unless lots of resistance is met (means intratendinous needle tip position).  Withdraw very slightly, or reposition completely, and try again.
8. Withdraw the needle after syringe if fully empty, and apply band-aid.

Tips

• Finding the injection site
  • Palpate the volar flexor tendon sheath and tendon in the distal palm, feeling for a nodule.
  • Finger/extend the triggering digit to find the triggering site and nodule.
• Numbing the skin
  • Find out all about “Taking the Sting Out” (of injections) by going here.
  • Since I use a tiny tuberculin needle, most patients have no problem with the injection and don’t need any extra lidocaine skin wheal, although some freezing spray may help.
• After the injection
  • Have the patient move their involved digit (flex/extend) while you throw away supplies.
  • Then, re-palpate the nodule so they can see the immediate results of the lidocaine.
  • Explain to the patient that the lidocaine will wear off in an hour or so, and that they will be back to their normal pain until the steroids start kicking in (anywhere from 1-7 days).
  • May also ask the patient to not do much repetitive activity with that digit for 12-24 hours.