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Excessive Decks > [21] Trigger Finger > Flashcards

[21] Trigger Finger Flashcards

1
Q

What is trigger finger also known as?

A

Stenosing flexor tenosynvoitis

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2
Q

What is trigger finger?

A

A condition in which the finger or thumb click or lock when in flexion, preventing a return to extension

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3
Q

How many of the tendons of the hand does trigger finger affect?

A

One or more

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4
Q

In whom to most cases of trigger finger occur in?

A

Occur spontaneously in otherwise healthy individuals

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5
Q

What is the prevalence of trigger finger?

A

Approximately 2 in 100

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6
Q

What other conditions can trigger finger be associated with?

A

Rheumatoid arthritis
Amyloidosis
Diabetes mellitus

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7
Q

What are most cases of trigger finger preceded by?

A

Flexor tenosynovitis

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8
Q

What causes flexor tenosynovitis?

A

Repetitive movements leading to inflammation of the tendon and sheath

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9
Q

What might happen to superficial and deep flexor tendons with local tenosynvoitis at the metacarpal head?

A

They develop localised nodal formation on the tendon, distal to the pulley

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10
Q

What is the most frequently involved ligament in trigger finger?

A

The A1 pulley

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11
Q

How does nodal formation on the tendon distal to the pulley cause trigger finger?

A

When the fingers are flexed, the node moves proximal to the pulley, however when the patient attemps to extent the digit, this node fails to pass back under the pulley. Consequently, the digit becomes locked in a flexed position

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12
Q

What is the purpose of the flexor sheath and pulley system of the digits?

A

Ensures that the flexor tendons remain in the joint’s axis of motion, and prevents bowstringing

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13
Q

What are the types of pulleys involved in the flexor sheath and pulley system of the digit?

A

Palmar aponeurosis
Annular ligaments
Cruciate ligaments

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14
Q

What is the palmar aponeurosis pulley system made up of?

A

Transverse fascicular bands

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15
Q

How many annular ligaments are there?

A

5

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16
Q

What do the 2nd and 4th annular ligaments do?

A

Prevent bowstringing

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17
Q

What do the 1st, 3rd, and 5th annular ligaments do?

A

Overlie the metacarpophalangeal (MP), proximal interphalangeal (PIP), and distal interphalangeal (DIP) joints respectively

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18
Q

How many cruciate ligaments are there?

A

3

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19
Q

What do the cruciate ligaments do?

A

Prevent collapsing and expansion of the sheath during movement of the digits

20
Q

What is the main risk factor for developing trigger finger?

A

Having an occupation or hobby that involves prolonged gripping or use of the hand

21
Q

What are the other risk factors for developing trigger finger?

A

RA
Diabetes mellitus
Female gender
Increasing age

22
Q

What are the initial symptoms of trigger finger?

A

Painless clicking/snapping/catching when trying to extend their finger

23
Q

What fingers are most commonly affected in trigger finger?

A

Middle or ring finger

24
Q

Can more than one finger be involved at a time in trigger finger?

A

Yes, and may be bilateral

25
Q

What happens to the presentation of trigger finger over time?

A

It may become painful, especially over the volar aspect of the metacarpophalangeal joint, and the digits start to lock in flexion

26
Q

What should be assessed on examination in trigger finger?

A

Should palpate the proximal aspect of the phalanx for any clicking, pain associated with movement, and any lumps/masses

27
Q

What are the differential diagnoses for trigger finger?

A

Dupuytren’s contracture
Acromegaly
Infection within tendon sheath
Ganglion involving tendon sheath

28
Q

How can a Dupuytren’s contracture be differentiated from trigger finger?

A

In Dupuytren’s contracture, the flexion is painless, fixed, and cannot be passively corrected

29
Q

How can acromegaly limit movement of the fingers?

A

Excessive growth hormone results in swelling of flexor synovium within tendon sheath due to increased extracellular volume, limiting both flexion and extension in the affected digit

30
Q

How can infection within the tendon sheath be differentiated from trigger finger?

A

It is usually preceded with trauma
The finger becomes swollen, erythematous, and tender
Passive movement of the digit causes marked pain

31
Q

How is a diagnosis of trigger finger made?

A

Clinical basis

32
Q

When may blood tests or imaging be warranted in trigger finger?

A

If any of the differentials are suspected

33
Q

When can trigger finger be managed conservatively?

A

In mild cases

34
Q

What should be involved in the conservative management of trigger finger?

A

Advice regarding activities that cause pain

Small splint to hold finger in extension at night

35
Q

What is the purpose of a splint to hold the finger in extension in trigger finger?

A

Keeps the roughened portion of the tendon in the tunnel, which makes it smoother

36
Q

What can be trialled in patients with trigger finger who do not respond to conservative management, or who’s condition is severe?

A

Steroid injections can be trialled

37
Q

How long do steroid injections take to produce improvement?

A

Improvement can be seen over a few days

38
Q

What surgical management of trigger finger can be attempted in most cases?

A

Percutaneous trigger finger release

39
Q

What does a percutaneous trigger finger release involve?

A

The release of the tunnel using a needle

40
Q

What anaesthetic is used in percutaneous trigger finger release?

A

Local

41
Q

What surgical option may be employed in severe cases of trigger finger?

A

Surgical decompression of the tendon tunnel

42
Q

What happens in surgical decompression of the tendon tunnel?

A

The roof is slit, in turn widening its mouth to release the tendon

43
Q

What anaesthetic is used in surgical compression of the tendon tunnel?

A

Either local or general

44
Q

Is recurrence following surgery for trigger finger common?

A

No, uncommon

45
Q

What can happen if the patient doesn’t begin immediate motion following surgery for trigger finger?

A

Adhesions can form

Excessive Decks (3 decks)

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