When should I consider referring a patient with trigger finger to a specialist?

Consider referring a patient with trigger finger to a specialist if:

• There is significant loss of function or contracture affecting the finger.
• Symptoms are persistent and refractory to initial conservative management in primary care.
• There is diagnostic uncertainty requiring specialist assessment.
• There are painful nodules without contracture, depending on clinical judgement.

Referral is typically to a hand surgeon or a specialist in plastic or orthopaedic surgery for assessment and possible surgical management.

This approach is analogous to the management principles for similar hand conditions such as Dupuytren's disease, where referral is recommended for contracture or significant functional loss, and consideration is given for painful nodules without contracture ².