Red flags for elbows, wrists & hands

Prior to referral consider / screen to exclude:

Key Clinical Observations of concern:

  • Hot / red / swollen joint with raised body temperature
  • Rapidly worsening deformity
  • Neuro-vascular compromise
Urgent elbow / wrist / hand referral

Patients with any of the following suspected should be sent to A&E:

  • Fracture or dislocation
  • Suspected infection
  • Recent tendon or ligament rupture

Urgent appointments can be made in elective Hand Clinics for patients with:

  • Rapidly worsening symptoms
  • Hand pain with confirmed presence of cancer on imaging.
  • Constant unrelenting hand or forearm pain / especially unrelenting night pain in presence of cancer
  • Progressive or significant neurological loss suggestive of acute peripheral nerve compression
GP / Primary Clinician

Consider diagnosis (discuss within peer review).

In most cases, trigger finger is a nuisance rather than a serious condition and can be managed using conservative options.


Mild “pre-triggering”:

  • possible history of pain.
  • stiffness and clicking when the finger is moved, especially first thing in the morning.
  • tender A1 pulley; but fully mobile finger.
  • spontaneous recovery may occur with time.


Triggering with:

  • difficulty extending finger:  the finger may get stuck in a bent
  • position, then suddenly pop straight.
  • loss of complete active flexion.


  • fixed contracture.


  • Rest from activities that cause locking / avoid strong or repeated gripping.
  • Optimal analgesia/ NSAIDS.
  • Exercise/massage finger(s) to relieve pain.
  • Corticosteroid injection.
  • Consider refer to Physiotherapy/ Occupational Therapy if mild or moderate.


Not indicated.

Physiotherapist / Occupational Therapist
  • Advice / exercise/massage finger(s) to relieve pain.
  • Splint to limit motion causing triggering.
Interface Team
  • Consider previous assessment and management.
  • For appropriate patients, corticosteroid injection in the area of tendon sheath thickening. If not already undertaken.

If surgical criteria applicable refer directly to surgeon especially if significant pain present.


Not indicated.

Surgical Criteria

Trigger finger release is listed on Gloucestershire CCG's Effective Clinical Commissioning Policy.  Please the attached link for details of access criteria and funding arrangements.


  • Trigger finger release:
    • return to driving; 2 weeks.
    • retrun to function; 3-6 weeks.
  • Fo patients with IJD division of A1 pulley and synovectomy +/- debulking of flexor sheath may be indicated.