Trigger Finger

Most common cause of hand pain and disability

Flexor tendon causes painful popping or snapping as digit is flexed and extended

Etiology and Pathogenesis:

Thickening of flexor tendon within distal aspect of the palm; causing abnormal gliding and locking of tendon within
tendon sheath (Specifically at the edge of A1 pulley)

Sign and Symptoms:

1. Locking during active flexion – extension

2. Stiff digit (Especially in neglected case)
3. Pain over distal palm
4. Pain radiating along the digit
5. Palpable snapping sensation / crepitus over A1 pulley
6. Tenderness over A1 pulley
7. Palpable nodule in the line of flexor digitorum superficialis (FDS), just distal to the metacarpophalangeal
(MCP) joint in the palm
8. Fixed-flexion deformity in late presentations (Especially in proximal interphalangeal (PIP) joint)
9. Evidence of associated conditions (RA / Gout)
10. Early signs of triggering in other digits

Diagnosis:

 Clinical examination is adequate

 No lab test needed
 Radiography rarely indicated
o (Only if abnormal pathology is suspected)

Management:

 Conservative
o Corticosteroid injection in thickened tendon sheath
o Custom MCP splint (MCP joint at 10⁰-15⁰ flexion; PIP & DIP
joints free)
 Surgical
o Fail to respond to 2-3 injections
o Surgical release of A1 pulley with local anaesthesia