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Condition/Disorder Synonyms

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  • Trigger digit

  • Locked finger

  • Stenosing tenosynovitis

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ICD-9-CM Code

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  • 727.03 Trigger finger (acquired)

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ICD-10-CM Code

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  • M65.30 Trigger finger, unspecified finger

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Preferred Practice Pattern1

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Key Features

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Description

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  • Painful snapping or catching/locking of finger or thumb

  • Inflammation of the fluid-filled sheath (tenosynovitis) surrounding the flexor tendons of the phalanges

  • Painful nodule at the distal flexion crease

  • Inflammation causes interference with gliding of tendon at the location of the A1 pulleys

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Essentials of Diagnosis

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  • Thickening of sheath or tendon leads to constriction of the sliding tendon, and nodules can develop.

  • Crepitus and nodules may be palpable at location of A1 pulley.

  • Cause is typically non-specific overuse.

  • Pain with digit motion precedes triggering or locking sensations

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General Considerations

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  • Pain may precede symptoms of triggering.

  • Mechanical symptoms exacerbate condition, leading to increased pain and decreased motion of the digit.

  • Can be managed surgically or non-surgically depending upon signs and symptom severity, response to conservative treatment, and orthopedic physician recommendations.

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Demographics

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  • Unknown etiology, idiopathic

  • Middle-aged women

  • Increased incidence with diabetic population, young children, and menopausal women.

  • Associated in population with rheumatic disease/changes in the hand.

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Clinical Findings

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Signs and Symptoms

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  • Pain in palmar metacarpophalangeal (MCP) joint region with digit motion, especially flexion

  • Nodule along the A1 pulley

  • Crepitus

  • Palpable tenderness and possible swelling over palmar MCP joint

  • Palpable crepitus over the palmar MCP joint

  • Catching, locking, triggering with flexion of the digit

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Functional Implications

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  • Difficulty and or pain with opening and closing hand in preparation for grasping or reaching

  • Difficulty and/or pain with grasping dishes, utensils, or drinking cups due to pain and weakness

  • Difficulty and/or pain with grasping and turning steering wheel

  • Difficulty and/or pain with turning doorknob

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Possible Contributing Causes

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  • Rheumatoid arthritis, or other rheumatic or connective tissue disorders

  • Diabetes mellitus

  • Infection: M. Kansasii

  • Carpal tunnel syndrome

  • Psoriatic arthritis

  • Gout

  • Sarcoidosis

  • Tuberculosis

  • De Quervain's stenosing tenosynovitis

  • Overuse activity of the hand and fingers

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Differential Diagnosis

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  • Rheumatoid arthritis

  • Ganglion of tendon sheath

  • Dupuytren disease

  • Loose body in the MCP joint

  • Subluxation of the extensor digitorum communis

  • Diabetes mellitus

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Means of Confirmation or Diagnosis

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Imaging

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  • No indication. Radiographs can be taken to rule out fracture.

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Diagnostic Procedures

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  • Start with a full fist, and then ask patient to open the hand and extend the fingers.

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