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Trigger finger -Quick revision card

Common condition – can cause sig functional impairment prevalence may be > 3 % in the general population 4th finger/ thumb- the most commonly affected by it can affect any finger Typically develops in 5th or 6th decade of life , women affected more than men ( 5-6 times ) Dominant hand is more commonly affected Diabetic patients are at greater risk ( nearing 10 % ) 4th most common reason for referral to hand surgeons

 

etiology is poorly understood pulleys hold the flexor tendons close to the finger bones inflammation & subsequent narrowing of the A1 pulley -starts to jam –> leading to bunching of the synovium ie the gliding movement is blocked by the osteofibrous canal of the A1 pulley preventing the tendon from gliding result is that the pulley is inflamed or thickened & the flexor tendon finds it harder to glide as the finger bends may also happen at A2 ( PIP jt ) or A3 ( DIP jt )

 

repetitive finger movements local trauma increased risk has been reported in patients suffering with carpal tunnel syndrome , de Quervain’s disease , hypothyroidism , rheumatoid arthritis , renal disease & amyloidosis

 

finger gets locked / catches when flexed ( can be painful ) and would not move tendon blockage may be more noticeable in the morning – difficulty extending, the finger may remain in flexed position ( may also report metacarpophalangeal stiffness or swelling when they wake up ) diagnosis generally easy as most patients c/o clicking or locking-imaging is not needed a painful nodule ( flexor tendon also becomes inflamed ) in the tendon can some times be palpable when the finger moves

 

steroid injection within the osteofibrous canal usual 1st line and may improve symptoms but recurrence can be seen decreases the thickness of the A1 pulley steroid injections are less successful in diabetic patients splinting is an option for those who do not wish steroid inj ( limiting tendon gliding allows for inflammation to improve )

 

when conservative management fails approach can be open or percutaneous open approach considered gold standard successful and ultimate treatment.

 

Locking of digit can also be seen in other conditions as dislocations , Dupuytren’s contracture , focal dystonia , flexor tendon sheath tumour , seasamois bone abnormalities , post-traumatic tendon entrapment & even hysteria

Patient Information 

Excellent information with video and anatomy images from Ortho Info- good read for both the patients and clincians https://orthoinfo.aaos.org/en/diseases–conditions/trigger-finger/

Exercises for trigger finger – a useful printable leaflet from County Durham and Darlington NHS Trust https://www.cddft.nhs.uk/media/795788/trigger%20finger.pdf

A useful synopsis from BUPA  https://www.bupa.co.uk/health-information/muscles-bones-joints/trigger-finger

Printable information from NHS Greater Glasgow and Clyde – explains about the condition and treatment options https://www.nhsggc.org.uk/media/267571/329257_1_0-trigger-finger-patient-info-leaflet_s.pdf

A useful presentation from The Royal Orthopaedic Hospital – focusing on treatment pdf printable https://www.roh.nhs.uk/patient-information/hands/1445-treatment-for-trigger-finger/file

 

References

  1. Makkouk, Al Hasan et al. “Trigger finger: etiology, evaluation, and treatment.” Current reviews in musculoskeletal medicine vol. 1,2 (2008): 92-6. doi:10.1007/s12178-007-9012-1
  2. Trigger Finger – Trigger Thumb – OrthoInfo – AAOS
  3. Brozovich, Nikolas MD; Agrawal, Devandra PhD, MBA; Reddy, Gangadasu MD, MS, FACS A Critical Appraisal of Adult Trigger Finger: Pathophysiology, Treatment, and Future Outlook, Plastic and Reconstructive Surgery – Global Open: August 2019 – Volume 7 – Issue 8 – p e2360 doi: 10.1097/GOX.0000000000002360
  4. N JHS, L AHAF, R GVG, da Silveira DCEC, B PN, Almeida SF. Epidemiology of Trigger Finger: Metabolic Syndrome as a New Perspective of Associated Disease. Hand (N Y). 2021 Jul;16(4):542-545. doi: 10.1177/1558944719867135. Epub 2019 Aug 28. PMID: 31456430; PMCID: PMC8283119. ( Abstract )

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