General Guideline Principles for Flexor Tendon

Entrapment (Tenosynovitis and Trigger Digit)

for workers compensation patients

The New York State workers compensation board has developed these guidelines to help physicians, podiatrists, and other healthcare professionals provide appropriate treatment for Flexor Tendon Entrapment (Tenosynovitis and Trigger Digit).

These Workers Compensation Board guidelines are intended to assist healthcare professionals in making decisions regarding the appropriate level of care for their patients with ankle and foot disorders.

The guidelines are not a substitute for clinical judgement or professional experience. The ultimate decision regarding care must be made by the patient in consultation with his or her healthcare provider.

Flexor Tendon Entrapment (Tenosynovitis and Trigger Digit) of Hand, Wrist and Forearm Injuries

Flexor tendon entrapment of the digits is a condition that causes the thumb or fingers to snap or lock (with or without pain). The majority of cases are caused by thickening of the digit’s A1 pulley, but other pathogeneses are possible.

Diagnostic Studies of Flexor Tendon Entrapment (Tenosynovitis and Trigger Digit)

There are no special tests that are usually administered. X-rays are rarely useful. The threshold for testing for confounding conditions like diabetes, hypothyroidism, and connective tissue disorders should be low in order to avoid other morbidities..

Medications of Flexor Tendon Entrapment (Tenosynovitis and Trigger Digit)

For the majority of patients, ibuprofen, naproxen, or other older generation NSAIDs are recommended as first-line medications. Although the majority of evidence suggests that acetaminophen (or its analogue paracetamol) is marginally less effective than NSAIDs, it may be a viable option for patients who are not candidates for NSAIDs.

There is evidence that NSAIDs are as effective at relieving pain as opioids (including tramadol). less harmful.

  1. Non-Steroidal Anti-inflammatory Drugs (NSAIDs)

    Non-Steroidal Anti-inflammatory Drugs (NSAIDs) is recommended for the treatment of flexor tendon entrapment, whether acute, subacute, or chronic

    Indications – NSAIDs are recommended for the treatment of acute, subacute, or chronic flexor tendon entrapment. Over-the-counter (OTC) medications may be adequate and should be tried first.

    Frequency/Duration: For many patients, using it as needed may be appropriate. Suggestions for

    Discontinuation: Symptom relief, ineffectiveness, or the emergence of adverse effects necessitates discontinuation.


  2. NSAIDs for Patients at High Risk of Gastrointestinal Bleeding

    NSAIDs for Patients at High Risk of Gastrointestinal Bleeding is recommended Misoprostol, sucralfate, histamine Type 2 receptor blockers, and proton pump inhibitors should be used concurrently in patients at high risk of gastrointestinal bleeding.

    Indications: Cytoprotective medications should be considered for patients with a high-risk factor profile who also have indications for NSAIDs, especially if longer-term treatment is planned. Patients at risk include those with a history of gastrointestinal bleeding, the elderly, diabetics, and cigarette smokers..

    Frequency/Dose/Duration: Misoprostol, sucralfate, and H2 blockers are all recommended. Dose and frequency are determined by the manufacturer. There are no significant differences in efficacy for preventing gastrointestinal bleeding, according to most experts.

    Indications for Discontinuation: Intolerance, adverse effects, or discontinuation of an NSAID.


  3. NSAIDs for Patients at Risk for Cardiovascular Adverse Effects

    Patients with known cardiovascular disease or multiple risk factors for cardiovascular disease should have the risks and benefits of NSAID therapy for pain discussed.


  4. NSAIDs for Patients at Risk for Cardiovascular Adverse Effects


    • NSAIDs for Patients at Risk for Cardiovascular Adverse Effects

      NSAIDs for Patients at Risk for Cardiovascular Adverse Effects is recommended Acetaminophen or aspirin as first-line therapy appears to be the least risky in terms of cardiovascular side effects.


    • NSAIDs for Patients at Risk for Cardiovascular Adverse Effects

      NSAIDs for Patients at Risk for Cardiovascular Adverse Effects is recommended If necessary, non-selective NSAIDs are preferred over COX-2 specific drugs. To reduce the possibility of the NSAID counteracting the beneficial effects of aspirin in patients receiving low-dose aspirin for primary or secondary cardiovascular disease prevention, the NSAID should be taken at least 30 minutes after or 8 hours before the daily aspirin.


  5. Acetaminophen for Treatment of Flexor Tendon Entrapment Pain

    Acetaminophen for Treatment of Flexor Tendon Entrapment Pain is recommended for the treatment of flexor tendon entrapment pain, especially in patients who cannot take NSAIDs.

    Indications: All patients suffering from flexor tendon entrapment pain, whether acute, subacute, chronic, or post-operative.

    Dose/Frequency: According to the manufacturer’s recommendations; may be used as needed. When taken in excess of four grammes per day, there is evidence of hepatic toxicity. Suggestions for


  6. Opioids of Flexor Tendon Entrapment (Tenosynovitis and Trigger Digit)


    • Opioids of Hand, Wrist and Forearm Injuries are not recommended for acute, subacute, or chronic flexor tendon entrapment.


    • Opioids of Hand, Wrist and Forearm Injuries are recommended for short-term (no more than seven days) use as an adjunctive therapy to more effective treatments for postoperative pain management.

      Indications: For post-operative pain management, a brief prescription of opioids as an adjunct to more effective treatments (particularly NSAIDs and acetaminophen) is frequently required, particularly at night.

      Frequency/Duration: Prescribed as needed during the day, then only at night until completely weaned off.

      Rationale for Recommendation: Because NSAIDs do not provide adequate pain relief for some patients, judicious use of opioids, particularly at night, may be beneficial.

      Opioids are only recommended for short-term, selective use in postoperative patients, with the primary use being at night to achieve postoperative sleep.


  7. Treatments of Flexor Tendon Entrapment (Tenosynovitis and Trigger Digit)


    • Glucocorticosteroid Injections

      Glucocorticosteroid Injections is recommended for the treatment of flexor tendon entrapment, whether acute, subacute, or chronic

      Indications – The presence of a triggering digit or symptoms of pain over the A1 pulley is thought to be indicative of stenosing tenosynovitis. Injection may be the best first line of defence.

      Frequency/Duration – A single injection with results evaluated to demonstrate progress


    • Glucocorticosteroid Injections

      Glucocorticosteroid Injections are not recommended Ultrasound-guided glucocorticosteroid injections for acute, subacute, or chronic flexor tendon entrapment.

      Splint of Flexor Tendon Entrapment (Tenosynovitis and Trigger Digit)

      Splint of Flexor Tendon Entrapment (Tenosynovitis and Trigger Digit) is recommended for the treatment of select cases of acute, subacute, or chronic flexor tendon entrapment (i.e., patients who refuse injection).


  8. Rehabilitation of Flexor Tendon Entrapment (Tenosynovitis and Trigger Digit)

    Rehabilitation (supervised formal therapy) required as a result of a work-related injury should focus on restoring functional ability required to meet the patient’s daily and work activities and return to work, with the goal of restoring the injured worker to pre-injury status to the greatest extent possible.

    Active therapy necessitates a patient’s internal effort to complete a specific exercise or task. Passive therapy refers to interventions that do not require the patient to exert any effort, but instead rely on modalities provided by a therapist.

    In general, passive interventions are viewed as a means of facilitating progress in an active therapy programme while also achieving objective functional gains. The importance of active interventions should be emphasised over passive interventions.

    In order to maintain improvement levels, the patient should be instructed to continue both active and passive therapies at home as an extension of the treatment process.

    To facilitate functional gains, assistive devices may be included as an adjunctive measure in the rehabilitation plan.


    • Therapy: Active


      • Therapeutic Exercise

        Therapeutic Exercise is not recommended for acute cases and the vast majority of patients with flexor tendon entrapment


      • Therapeutic Exercise – Patients with Residual Deficits

        Therapeutic Exercise – Patients with Residual Deficits is recommended especially post-operatively,

        Frequency/Dose/Duration – Total visits may be as few as two to three for patients with mild functional deficits or as many as 12 to 15 for patients with more severe deficits who have documented ongoing objective functional improvement.

        More than 12 to 15 visits may be indicated if there is documentation of functional improvement toward specific objective functional goals when there are ongoing functional deficits (e.g., increased grip strength, key pinch strength, range of motion, advancing ability to perform work activities).

        A home exercise programme should be developed and performed in conjunction with therapy as part of the rehabilitation plan.


  9. Surgery of Flexor Tendon Entrapment (Tenosynovitis and Trigger Digit)

    Surgery of Flexor Tendon Entrapment (Tenosynovitis and Trigger Digit) is recommended in patients who have been partially or temporarily responsive to two glucocorticosteroid injections for persistent or chronic flexor tendon entrapment (Trigger Finger).

    Those who do not respond should be carefully evaluated for possible alternate conditions. If two glucocorticosteroid injections fail to produce a therapeutic response in the presence of an obvious trigger finger, surgery may be necessary.

What our office can do if you have Flexor Tendon Entrapment (Tenosynovitis and Trigger Digit)

We have the experience to help you with their workers compensation injuries. We understand what you are going through and will meet your medical needs and follow the guidelines set by the New York State Workers Compensation Board.

We understand the importance of your workers compensation cases. Let us help you navigate through the maze of dealing with the workers compensation insurance company and your employer.

We understand that this is a stressful time for you and your family. If you would like to schedule an appointment, please contact us so we will do everything we can to make it as easy on you as possible.

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15:02 02 Mar 23
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21:23 25 Feb 23
Dr Vaksha was so kind and helpful. He took extra time with us and explained things so thoroughly. Highly recommend. Office very clean.
Susan Bosinius
20:20 19 Feb 23
Dr Vaksha, is a great doctor very professional knows what he talking about. Treat patient with upmost respect. Thank You
Troy Spencer
16:46 19 Jan 23
Dr. Karkare is an amazing doctor, very caring and attentive, the girl at the front desk is very kind and helpful. .elizabeth .thank you so much .
blanca ventura
21:32 26 Oct 22
Been going to this place before my accident and after I had my knee surgery. So happy how I been treated and how well I am getting. Thank you all and specially Dr. VAKSHA for everything and getting back on track.
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19:01 25 Oct 22
Love this place From the minute I called I was treated kindly. When I arrived The Dr saw me right away he was compassionate and ordered the appropriate tests for me. I came back in for my follow up and had the same great experience.
Christine Rostock
21:28 23 May 22
Dr Vaksha and Dr karkare are 2 of the best orthopedic doctors around my wife Susan had a very serious broken ankle in March of 2019 she didn't think she was going to walk again Dr vaksha did an excellent surgery on her ankle he said it was his toughest he ever did he put a lot of hardware in her ankle and told her she would be alright she made remarkable recovery thanks to his surgery as of now she regained 100 percent use of her ankle she would highly recommend him to anyone. My own experience with Dr karkare has been wonderful he takes his time with you listens to what you have to say and prescribes various treatments and is very caring I would highly recommend him to anyone I would give both doctors a 10 plus rating we are very happy with them the best.
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23:31 19 May 22
Complete orthopedics is a wonderful place to go when you hurt or injured a great staff and wonderful doctors very knowledgeable and helpful I would recommend this place to all of my family and friends that is in me of orthopedic care I give them 10 thumbs up
Wayne Pemberton
17:39 18 May 22
The staff is very professional and helpful. Dr. Vaksha is excellent. He takes time to listen and offer suggestions to help you get better. I’m very thankful and happy to be a patient here at Complete Orthopedics.
Phoenix Rising
19:54 16 May 22
Dr.Karkare is the best. He listens to everything and explains everything I recommend him to everyone. I am so happy he is my doctor.
Myrna James
00:48 13 May 22
Dr.Kuo is amazing very attentive,caring,and passionate and staff is awsome too.Thank you for everything Dr.kuo.
Erick Murillo
23:17 12 May 22
I was in a car accident November 1 I was referred to Dr. Vaksha For shoulder surgery . I he was amazing he made me feel very comfortable and explained everything that was going to happen from surgery all the way through my physical therapy highly recommend Dr. Vaksha
Yolanda Ojeda
19:37 09 May 22
My appointment with Dr. Vaksha was amazing. Dr. Vaksha was very thorough and kind. I would refer this office to anyone who needs a great orthopedic doctor.
John Senechal
19:54 05 May 22
Scheduling my appointment was quick and easy. The staff was super friendly and down to earth. I was seen on time. The appropriate test, “x-rays” were taken before the conversation with doctor, something I really liked, test for analysis and conversation was done upfront. Dr. V had a great personality and was no BS, straight forward diagnosis and a play on next steps. I am happy I found them and would refer them to friends and family.
00:46 03 May 22
I have seen Dr. Kuo two times already and he's awesome along with his staff. Very friendly office and I'm glad to be a patient here.
Camaris A
20:01 28 Apr 22
Amazing team!! Very caring, profesional, and friendly!! Dr. Kevin Kuo, you are the best, very passionate, caring, and helping thank you for getting me better and being so kind to me! Elizabeth you the best thank you for you help always and you big smile and positive actitud❤️🙏🏼
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19:01 22 Apr 22
The staff is truly exceptional, they make you feel comfortable and welcomed. The doctors are amazing,always professional, compassionate and great listeners.
Elizabeth Collado
03:25 09 Apr 22
What a great place! The place is clean and organized.The staff is wonderful. Setting up physical therapy is right there as well.I'm so glad I found this place.
Donna Anne
22:45 05 Apr 22
This was my 1st time breaking something in my 27 years on this planet. I was recommended here by a friend Dr. Vashka helped me from day 1 and still continues to check in on me and my healing ankle. Would highly recommend
tyron davis
16:06 01 Apr 22
Brand new office, same great doctors! Rooms are clean, plenty of parking, physical therapy attached, Dr. Karkare and his staff are awesome. Thank you!
Emily B
02:49 24 Mar 22
Dr.VAksha is the best, I love the way he treats me as his patient, he is caring,understanding and very attentive to my needs
Mirna Caballero
14:53 03 Mar 22
Great staff. Dr. Vaksha is awesome and takes the time to listen to his patients. He is very compassionate. I would highly recommend this office.
Bebe Doyle
01:24 23 Feb 22
After suffering from a severe ankle injury Dr. V was able to help me heal and return back to work completely to a job where I stand for 12 hours a day. The office is very clean and I appreciated the reminders of my appointments via phone call and through text. The patient portal made it easy for me to access all my documents including work notes. The office staff is wonderful and Rebecca was able to schedule me with a busy schedule and awesome at answering all of my questions including referring me to a great physical therapy office. I highly recommend this office to anyone who’s looking for knowledgeable and kind orthopedic office.
Elizabeth Birchwell
21:31 28 Jan 21
The staff here are great, I was seen at the time of my appointment and was well taken care of!
Shaun Berry
18:14 07 Jan 21
They are an excellent practice. The front and back office people are amazing and so helpful. Rebecca is such a kind and understanding person. I had an issue with paperwork and she cleared it right up. Dr. Karkare is very knowledgeable, helpful, and caring.
Matt S.
19:31 18 Nov 20
Rebecca K. - What a true burst of sunshine. Very friendly and definitely an asset to the practice!
Laura Aston
18:17 17 Nov 20
Great experience, the Doctor is nice but the staff is incredible. I worked with Linda, who was profession and assisted me beyond what any person has done at other practices. Complete Ortho should be complimented for having such a person on their staff.I highly recommend this place!!!
Joe Allen
17:26 17 Nov 20
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Barbara Victor
16:45 17 Nov 20
I was rear ended in an auto accident , Dr Vashka was recommended by a friend of mine .I was experiencing Back , neck , and shoulder pain . After a thorough examination and given exercises to do at home , I am feeling much better , and I ended up avoiding surgery . The staff at Complete Ortho is extremely attentive and show great care when making an appointment and are very friendly and i never waited more than 5 minutes for my appointment . So I would strongly recommend Complete Orthopedics for any aches and pains that one might be experiencing.....
Bill Becht
04:44 17 Nov 20
It was the afternoon of Friday Sept. 24. We were in Pt. Jefferson and my wife, Mary Ann, broke her hip. We went to Mather Hospital and it was determined that she would have to have an operation to have it repaired. This would be her third time under the knife in the past year. It just so happened that we were very fortunate enough to have Dr. Karkare, who was on standby, perform the surgery. He put in a rod and two screws in her hip. She spent a few days in the hospital and then went to Gurwin rehabilitee for another few weeks.It has now been almost six weeks and we both worked the election the other day. If it wasn’t for Dr. Karkare’s expertise she never would have been able to work. She is able to walk with a walker and is doing physical therapy three times a week.We can not thank the doctor enough for the compassion and dedication that he puts into his work. It allows Mary Ann do the things that she likes to do, even on a limited basis for a while. I know that with her will, perseverance and the great work that the surgeon performed she will be back on her feet in no time.Sincerely:John V. PlumpEast Northport, NY 11731
Jack Harris
14:36 06 Nov 20
In the year of 2018 I was referred to Dr. Karkare because I was experiencing severe knee joint pain. After exhausting physical therapy and trying to labor through the pain, I had to make a quality of life decision. Total knee replacement was the only viable option. Dr. Karkare made my decision easy as he walked me through the whole process from surgery to recovery.On 12/13/19 ( Friday the 13th) I enter Lenox Hill Hospital in great hands. From the time I entered Dr. Karkare’s office for the first time until now, his staff has been amazing. Andrea the medical coordinator walked me through all the paper work and necessary preparations for the surgery. Courtesy and kind would be an understatement. Dr. Karkare went over and beyond from the wellness checks and phone calls all to assure me that I was important to him. This was the right decision no pain and no limp. Complete Orthopedics should be your choice!
Kenneth Randolph
22:18 25 Sep 20
Dr. Vadshka has a great bedside manner. He really takes his time and explains treatment options.
T Lee
12:33 09 Sep 20
I suffered with pain in both knees for years. My orthopedic doctor kept recommending knee replacement . I fought it for years, as I was just afraid. When I had no choice and could barely walk , it was recommended I see Dr. Karkare. We set up a consultation and my wife and I left his office feeling totally confident and comfortable with moving ahead with the surgery. He explained everything to us, and the office staff set everything up for us and made the process easy. So about one month after our initial meeting I had the first knee done. I was up walking mere hours after the surgery, and on the workout machines the next morning. I went home two days after the surgery, and yes walked my daughter down the aisle at her wedding only one week after the surgery without even a cane! Three months later I had the other knee done and went home the very next day. Dr. Karkare put my fears to rest . I would highly recommend him. His expertise gave me my life back. Thank you Dr. Karkare.SincerelyVito Congro
Ethel Congo
23:58 12 Aug 20
Dr Rhodin really cares for his patients. When I see him he makes sure to review my progress in detail.
Micki Cahill
15:03 08 Feb 20
My mom had a total hip replacement by dr karkare. He is the BEST orthopedic doctor.Her incision is almost invisable.She is going back for her other hip next week. The office staff is the best, love Andrea.You wont find a better doctor.
Ryan Brigandi
21:06 13 Jul 18
There is no better Orthopedic doctor you will find. Broke my ankle three places on a Saturday. Called Dr. Karkare. He had is team ready at the hospital and operated on me within 6 hours after my injury. Now After 3 months of great care by him and his staff, I am walking to normalcy.
Spacecom Tel
04:13 23 Mar 18


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I am fellowship trained in joint replacement surgery, metabolic bone disorders, sports medicine and trauma. I specialize in total hip and knee replacements, and I have personally written most of the content on this page.

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