By Marc Darrow, MD, JD
An active 85-year-old caller to my September 12 radio show had triggering in both hands. A corticosteroid injection had helped for only a few months. When a finger catches or locks, the flexor tendon often cannot glide smoothly beneath the A1 pulley near the base of the finger. Bilateral symptoms do not by themselves show that the tendon is torn; diabetes and inflammatory disease are among the issues to consider.
I would first establish whether this is truly trigger finger rather than arthritis, another tendon problem, or nerve-related weakness. Changes in activity, a night splint, and hand therapy can be reasonable early steps. Warm water may make motion more comfortable, but it has not been shown to reverse A1-pulley thickening.
What do injections offer?
Corticosteroid is a conventional injection that may relieve symptoms, although recurrence occurs. A systematic review of randomized trials examined different corticosteroid injection approaches; the available evidence does not justify telling every patient to avoid a repeat injection because rupture is inevitable. Repeated injections and individual risk deserve a specific discussion. (1)
PRP comes from the patient’s blood; it contains platelets, not stem cells. Small studies of PRP for trigger finger exist, but there is not enough strong comparative evidence to claim that PRP reliably frees a locked tendon or outperforms standard care. Ultrasound can help confirm pulley thickening and guide placement when an injection is chosen.
Bone marrow concentrate contains mixed cells from the patient’s marrow, including a small progenitor-cell population. Adipose-derived preparations and umbilical-cord or Wharton’s-jelly products are distinct approaches. None has convincing clinical trial evidence establishing an effective dose, target, or durable benefit for trigger finger. None is FDA-approved for this orthopedic indication. (2)
When a finger remains locked, significantly limits use, or repeatedly returns after conservative treatment, a hand surgeon can discuss A1-pulley release. A small procedure may be the most predictable way to restore gliding in some patients. My goal is to give patients a clear picture of what is known about each option, including where injection evidence is thin.
References
- Kuper G, et al. Comparative effectiveness of corticosteroid injections for trigger finger: a systematic review of randomized controlled trials. 2025. PMID: 41352303.
- US Food and Drug Administration. Consumer Alert on Regenerative Medicine Products Including Stem Cells and Exosomes.
