Utilization Review Checklist
Trigger Digit (Flexor Tendon Entrapment)
Derived from the ACOEM Hand, Wrist and Forearm Disorders Guideline, edition 14 July 2025, as adopted into the California MTUS 2 January 2026. CPT 26055. ICD-10 M65.3.
Draft — not reviewed or approved by COA. Prepared by Rette from the ACOEM guideline named above. This is not a COA document and does not reproduce COA’s own checklists.
CriteriaCheck if documented
Confirmatory Diagnosis
Any one of the following
Tenderness over the A-1 pulley and/or volar metacarpophalangeal joint area
“● tenderness over the A-1 pulley and/or volar metacarpophalangeal joint area or” — p. 191
OR
Locking/triggering of the digit
“● locking/triggering of the digit.” — p. 191
Conservative Care
Any one of the following
Failed one glucocorticosteroid injection with documented immediate improvement, absent a contraindication
“● failed one glucocorticosteroid injection for which there is documented immediate improvement in symptoms (absent a contraindication for an injection) or” — p. 191
OR
The digit locks requiring manipulation to open or extend the digit
“● the digit locks requiring manipulation to open or extend the digit.” — p. 191
Procedures — the guideline treats each separately
Open release for persistent or chronic flexor tendon entrapment
Moderately Recommended. Open release for persistent or chronic flexor tendon entrapment is moderately recommended.
Strength of Evidence — Moderately Recommended, Evidence (B) · confidence high · p. 191
Indications — required:
Open release requested for persistent or chronic flexor tendon entrapment
“Open release for persistent or chronic flexor tendon entrapment is moderately recommended.” — p. 191
Moderately Recommended on (B) evidence with high confidence — among the better-supported hand procedures in this chapter. The criteria are short: a confirmed diagnosis by either route, and either a failed injection or a digit that locks and needs manipulating.
Percutaneous release
Moderately Recommended. Percutaneous release is also a reasonable option
Strength of Evidence — Moderately Recommended, Evidence (B) · confidence high · p. 191
Indications — required:
Percutaneous release requested
“Percutaneous release is also a reasonable option” — p. 191
The guideline calls percutaneous release 'a reasonable option' and says the evidence is strong that it is as effective, if not more effective, than open release. It also records concerns about digital nerve and artery injury in inexperienced hands, with the thumb more prone — worth a sentence on why this approach suits this digit.