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  • Trigger digit
  • Locked finger
  • Stenosing tenosynovitis

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  • 727.03 Trigger finger (acquired)

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  • M65.30 Trigger finger, unspecified finger

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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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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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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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Medication

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  • NSAIDs
  • Corticosteroid injection into flexor sheath

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Medical Procedures

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  • Surgical release possible after failed conservative care

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  • Radiologist for imaging, x-ray to rule out other pathology
  • Primary care to rule our rheumatic causes ...

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