Trigger finger

• Trigger digit
• Locked finger
• Stenosing tenosynovitis

• 727.03 Trigger finger (acquired)

• M65.30 Trigger finger, unspecified finger

• 4D: Impaired joint mobility, motor function, muscle performance, and range of motion associated with connective tissue dysfunction

Description

• 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

Essentials of Diagnosis

• 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

General Considerations

• 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.

Demographics

• 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.

Signs and Symptoms

• 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

Functional Implications

• 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

Possible Contributing Causes

• 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

Differential Diagnosis

• Rheumatoid arthritis
• Ganglion of tendon sheath
• Dupuytren disease
• Loose body in the MCP joint
• Subluxation of the extensor digitorum communis
• Diabetes mellitus

Imaging

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

Diagnostic Procedures

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

Medication

• NSAIDs
• Corticosteroid injection into flexor sheath

Medical Procedures

• Surgical release possible after failed conservative care

• Radiologist for imaging, x-ray ...