COVID-19 Adjusted Treatment Pathways
Community Physiotherapy are now injecting all patients, both high and low risk with the only caveat is that we will leave 2 weeks prior or after vaccination to inject (June 2021)
Steroid joint injections are not currently being performed at UHCW in Musculo-Skeletal / Orthopaedics / Radiology. Please do not currently refer to UHCW for this purpose.
Prior approval from the Clinical Commissioning Group will be required before any treatment proceeds in secondary care.
Management should be in accordance with British Society for Surgery of the Hand recommendations1:
- History of pain or of catching or “click”
- Tender A1 pulley; but fully mobile finger
- Difficulty actively extending finger
- Need for passive finger extension
- Loss of complete active flexion
- Fixed contracture
Prior approval from the CCG will be required before any treatment proceeds in secondary care.
Refer to Secondary Care provider via RSS using the appropriate Prior Approval Referral Form.
Mild cases which cause no loss of function require no treatment or avoidance of activities which precipitate triggering and may resolve spontaneously.
Cases interfering with activities or causing pain should first be treated with:
- One or two steroid injections which are typically successful (strong evidence), but the problem may recur, especially in diabetics;
- Splinting of the affected finger for 3-12 weeks (weak evidence)
Surgery will be funded if:
- Triggering persists or recurs after one of the above measures (particularly steroid injections);
- Finger is permanently locked in the palm;
- Patient has previously had 2 other trigger digits unsuccessfully treated with appropriate non-operative methods;
- Surgery is usually effective and requires a small skin incision in the palm, but can be done with a needle through a puncture wound (percutaneous release)
Refer to Adult Physiotherapy Service – Coventry
If patients have triggering of one or several of the digits refer for a steroid injection using the normal Adult Physiotherapy pathway via the ‘NHS eReferral Service’.
Here they will be triaged into an appropriate injection slot by the clinician.
Splints or Physiotherapy are not provided for triggering of digits.
If patient have had > 2 injections into the same digit with no improvement please send to Orthopaedics for consideration of a release.