Trigger Finger

Inhibition of smooth tendon gliding due to mechanical impingement at the level of the A1 pulley that causes progressive pain, clicking catching and locking of the affected finger

Aetiology

  • More common in females
  • Typically age 50+ (but can occur at any age)
  • More common in diabetics

Pathophysiology

  • Tendons run within flexor tendon sheath
  • Stenosing tenosynovitis (tendon swelling) → irritation → fibrocartilaginaginous metaplasia (more swelling) → nodule on FDS tendon
  • The nodule results in the loss of smooth gliding of the finger flexor tendons under the annular pully, so finger gets locked in flexed position

Clinical presentation

Symptoms

  • Pain over A1 pulley (MC head)
  • Sticking of finger, usually in flexion
    • May need other hand to extend
    • May not be able to extend at all
notion image

Signs

  • Demonstrate triggering
  • Tenderness over A1 pulley
  • Feel nodule pass beneath pulley
  • Distinguish between Dupuytrens

Investigations

  • Clinical dianosis

Management

Conservative

  • Often resolves spontaneously
  • Splint to prevent flexion

Tendon sheath injection

  • Steriod + LA
  • Often curative
  • May be repeated 2x

Surgical release

  • Division of the A1 pulley under general or local anaethetic