Hand

Trigger Finger

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Trigger Finger, Stenosing Flexor Tenosynovitis, Flexor Tendon Entrapment

  • See Also
  1. Overuse Syndromes of the Hand and Wrist
  2. De Quervain's Tenosynovitis
  3. Suppurative Tenosynovitis
  • Epidemiology
  1. Prevalence: 2% of adults in U.S.
  2. Age: Peaks age 50 to 60 years old
  3. Gender: Female predomince
  • Pathophysiology
  1. Congenital form seen in some children
  2. Inflammation and narrowing of the A1 Pulley (or swelling of flexor tendon and sheath)
    1. Difficult passage of flexor tendon through A1 pulley
    2. Analogous to knotted fishing line in pole eyes
  • Risk Factors
  1. Diabetes Mellitus
  2. Rheumatoid Arthritis
  3. Amyloid deposition diseases (see Amyloidosis)
  4. Anatomic variants (esp. children)
  • Findings
  • Signs and Symptoms
  1. Snapping or triggering of affected finger at the flexor MCP joint
    1. Worse after rest
    2. Improves with active finger use
  2. Triggering transmitted to DIP joint
    1. Entire finger may lock in position
  3. Proximal flexor pulley swelling
    1. Tenderness to palpation
    2. Swollen, firm mass palpable at pulley
  • Imaging
  1. Bedside soft tissue Ultrasound (optional)
    1. May demonstrate flexor tendon thickening pr palmar Nodule
  2. XRay
    1. Not typically indicated
  • Differential Diagnosis
  1. Suppurative Tenosynovitis
    1. Severe, finger-threatening infection that rapidly spreads along the flexor surface of the finger
  • Management
  1. Similar approach as for De Quervain's Tenosynovitis
  2. Conservative Therapy (effective in most cases)
    1. NSAIDs
    2. Immobilization
    3. Avoid offending activity
    4. Moist heat as needed
  3. Digital Flexor Tenosynovitis Injection
    1. Consider for lack of improvement after 4 to 6 weeks of conservative therapy
    2. May consider for first-line management in more severe presentations (severe locking, reduced range of motion)
  4. Hand Surgery referral
    1. Indicated in Trigger Finger refractory to above management
    2. Consider for endoscopic or percutaneous release
  • Complications
  1. Proximal interphalangeal joint contracture
  • References
  1. Johnson (2021) J Fam Pract 70(7): 334-40 [PubMed]
  2. Pujalte (2024) Am Fam Physician 110(4): 395-401 [PubMed]