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Trigger Finger
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Contents
Other Names
- Stenosing Tenosynovitis
- Trigger Digit
Background
- This page refers to trigger finger or stenosing tenosynovitis of the fingers of the hand
- This pathology is characterized by hypertrophy and inflammation of the tendon resulting in 'triggering' or catching on the A1 pulley
Epidemiology
- Bimodal incidence (need citation)
- First peak is before 8 years of age
- Second is patients in their 40s-50s
Pathophysiology
- General
- Narrowing of flexor pulley sheath combined with hypertrophy, inflammation of the tendon resulting in "triggering"
- Trigger sensation is catching of the tendon at the A1 pulley sheath located at the base of the MCPJ
- Note can occur at A2 (PIPJ) or A3 (DIPJ)
- Typically due to repetitive microtrauma resulting in inflammation of flexor tendon sheath complex
- Over time, fibrocartilaginous metaplasia of the tendon sheath occurs
- Ringer finger most common
Pathoanatomy
- Muscles involved
Risk Factors
- Women > Men
- Dominant Hand > Off Hand
- Chronic Diseases
- Diabetes Mellitus
- Amyloidosis
- Carpal Tunnel Syndrome
- Gout
- Thyroid Dysfunction
- Rheumatoid Arthritis
- Children:
- Developmental
Differential Diagnosis
- Fractures
- Dislocations
- Tendinopathies
- Ligament Injuries
- Neuropathies
- Arthropathies
- Nail Bed Injuries
- Pediatric Considerations
- Other
Clinical Features
- General: Physical Examination Hand
- Primarily a clinical diagnosis based on history
- Patients will report locking or catching of digits
- Can be in flexion or extension, although extension typically worse
- On physical exam
- There may be swelling, palpable nodule
- Locking/ clicking may or may not be reproducible
Evaluation
- Standard Radiographs Hand
- Typically normal, screen for other diseases
- Ultrasound
- May demonstrate thickening of the pulley
- Inflammation of underlying flexor tendon
- MRI not typically required
Classification
Green Classification
- Grade 1: Palm pain, tenderness at A1 pulley
- Grade 2: Catching of digit
- Grade 3: Locking of digit, passively correctable
- Grade 4: Fixed, locked digit
Management
Nonoperative
- Activity modification
- NSAIDS
- Corticosteroid Injection
- Often first line treatment in patients with trigger finger
- Splinting with MCP extension splint at 10-15° of flexion for 6-8 week
Operative
- Release of A1 pulley
- If no improvement with splinting, corticosteroid injection
- Grade 4 (fixed and locked digit)
- In kids, often surgical to prevent developmental issues with flexor tendons
Return to Play
- Needs to be updated
Complications
- Radial Digital Nerve Injury
- "Bowstringing" phenomenon
See Also
External
- Sports Med Review Hand Pain: https://www.sportsmedreview.com/by-joint/hand/
References
Created by:
John Kiel on 18 June 2019 23:18:06
Authors:
Last edited:
16 October 2022 00:19:16
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