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
• Patients 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

• Radiograph positive
  • Hand and finger fractures
  • Hand and finger dislocations
  • Triquetrolunate ligament instability
• Radiograph negative
  • Dupeytren contracture
  • Boutonniere deformity
  • Hand and finger tendon injuries
  • Ganglion cyst
  • De Quervain tenosynovitis
  • Intersection syndrome
  • Drummer's wrist
  • Extensor digitorum tenosynovitis
  • Vaughn Jackson syndrome
  • Snapping Extensor Carpi Ulnaris
  • Compressive neuropathy, "bracelet syndrome"
  • Scaphoid fracture
  • Osteoarthritis
  • Infiltrative tenosynovitis
  • Gout
  • Rheumatoid arthritis
  • Trigger finger
  • Mallet finger
    • Swan neck deformity
  • Jersey finger
  • Jammed finger
  • Subungual hematoma
  • Fingertip laceration
  • Metacarpophalangeal (MCP) ulnar ligament rupture (Gamekeeper's thumb)
  • Nail avulsion
  • High-pressure injection injury

Evaluation

• Clinical diagnosis, radiographs not indicated
• Most commonly ring finger
• Finger clicking
• Palpable fibrous nodule
• Tenderness 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.

Authors

Kevin Lu, Ross Donaldson, Claire, Daniel Ostermayer, Neil Young