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Trigger Finger

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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


Risk Factors


Differential Diagnosis


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


References


Created by:
John Kiel on 18 June 2019 23:18:06
Authors:
Last edited:
28 October 2020 14:05:14
Categories: