Trigger finger

• Trigger finger is also known as stenosing tenosynovitis
• Pathophysiology:

  • The flexor tendons of fingers pass through several tunnels called sheaths along the length of the fingers
  • In trigger finger there is either a thickening of the tendon or tightening of the sheath
  • Prevents the tendon from smoothly moving through the sheath when flexing and extending the finger
  • Commonly a nodule develops on tendon around first MCP joint where there is a pulley in the sheath - nodule can get stuck at the entrance to the pulley causing the finger to get stuck in flexed position - can suddenly release with a painful pop/clock
• Risk factors:

  • Age 40-50
  • Women
  • Diabetes
• Presentation:

  • Pain and difficulty moving the affected finger
  • Pain and tenderness around MCP joint on palm side of hand
  • Finger doesn't move smoothly through flexion and extension, makes a popping or clicking sound and get stuck in flexed position
  • Symptoms are worse in the morning and improve throughout day
• Management:

  • Small number of cases resolve spontaneously
  • Rest and analgesia
  • Splinting of finger
  • Steroid injections
  • Surgery - cut/release the pulley