Trigger Finger

Question 1

What is trigger finger?

Answer 1

Also called stenosing flexor tenosynovitis

Finger or thumb click or lock when in flexion preventing return to extension.

Question 2

Epidemiology

Answer 2

Can affect one or more tendons

Most cases occur spontaneously

2 in 100 people

Question 3

Pathophysiology

Answer 3

Preceded by flexor tenosynovitis from repetitive movements -> Inflammation of tendon and sheath

Superficial and deep flexor tendons will the develop nodal formation on tendon distal to the pulley. A1 pulley is most common involved ligament

When the fingers are then flexed the node moves proximal to the pulley but on extension cannot move back.

This leads to locking of finger.

Question 4

Purpose of flexor sheath and pulley system.

Answer 4

Ensures flexor tendons remain in the joint’s axis of motion

Question 5

Three types of pulleys involved in the digits.

Answer 5

Palmar aponeurosis

Annular ligaments (A1-A5 and prevents bowstringing) - A1 overlie the MCPJ

Cruciate ligaments (3 in total) that prevent collapsing and expansion of sheath during movement

Question 6

Risk factors

Answer 6

Occupation or hobby that involve prolonged gripping and use of the hand

RA

DM

Female gender

Increasing age

Question 7

Clinical features

Answer 7

Painless clicking/snapping/catching when trying to extend finger

More than one finger can be involved and it can be bilateral

Later on this will become painful over volar aspect of MCPJ and digit will start to lock in flexion.

Question 8

Examination findings

Answer 8

Proximal aspect of the digit should be palpated for clicking, pain with movement and to check for any lumps or masses

Question 9

Dx

Answer 9

Dupuytren’s contracture (painless and cannot be passively corrected)

Infection

Ganglion (involves tendon sheath)

Acromegaly

Question 10

Investigations

Answer 10

Clinical diagnosis

Blood tests and imaging might be done if dx are needed to rule out

Question 11

Conservative management

Answer 11

Lifestyle advice about activities

Small splint to hold finger in extension at night

If failing to respond to this steroid injection can be tried.

Question 12

Surgical managements

Answer 12

Percutaneous trigger finger release by a needle.
Performed under local anaesthetics

Severe cases surgical decompression can be tried.
Roof of the tunnel is slit to release the tendon.
Performed under local or general anaesthetics

Question 13

Complications

Answer 13

Recurrence (uncommon)

Adhesions if patient does not begin immediate motion following surgery