Trigger finger

Background

• Tenosynovitis of the flexor sheath of the finger or thumb as a result of repetitive use
• Also known as stenosing tenosynovitis
• Associated with:
  • DM
  • RA
  • Amyloidosis
  • Repetitive strain
  • "Texting tendonitis"

Clinical Features

• Delayed, painful extension of digit
• Pts need to manually straighten finger with other hand
• Contrast with Dupuytren’s contracture, which is not usually associated with pain or history of repetitive overuse

Differential Diagnosis

Hand and finger injuries

• Distal finger
  • Finger amputation
  • Fingertip laceration
  • Nail avulsion
  • Nailbed laceration
  • Subungual hematoma
• Other finger/thumb
  • Boutonniere deformity
  • Mallet finger
    • Swan neck deformity
  • Jammed finger
  • Jersey finger
  • Trigger finger
  • Ring avulsion injury
  • De Quervain tenosynovitis
  • Infiltrative tenosynovitis
  • Metacarpophalangeal ulnar ligament rupture (Gamekeeper's thumb)
• Hand
  • Dupuytren contracture
• Wrist
  • Drummer's wrist
  • Ganglion cyst
  • Lunotriquetral ligament instability
  • Scaphoid fracture
  • Extensor digitorum tenosynovitis
  • Compressive neuropathy ("bracelet syndrome")
  • Intersection syndrome
  • Snapping Extensor Carpi Ulnaris
  • Vaughn Jackson syndrome
• General
  • Hand and finger dislocations
  • Hand and finger fractures
  • Hand and finger infections
  • Gout and pseudogout
  • Hand and finger tendon injuries
  • High-pressure injection injury
  • Osteoarthritis
  • Rheumatoid arthritis
  • Ring removal

Diagnosis

• Clinical dx, radiographs not indicated
• Most commonly ring finger
• Finger clicking
• Palpation of fibrous nodule
• TTP at A1 pulley (distal palm)

Management

• Conservative therapy
  • Rest
  • NSAIDs
  • Immobilization (buddy tape or finger splint)

Refractory cases may require steroid injection or surgery

See Also

• Hand and finger diagnoses

References

• Ifeacho SN and Brar R. Stenosing Tenosynovitis (Trigger Finger and Trigger Thumb). Ann R Coll Surg Engl. 2007 Apr; 89(3): 326–327.