Trigger finger

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Obesity, Sleep & Internal medicine
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Trigger finger
File:TriggerFinger.webm
Synonyms	Stenosing tenosynovitis
Pronounce	N/A
Specialty	N/A
Symptoms	Pain, stiffness, and a sensation of locking or catching when bending and straightening the finger
Complications	Permanent contracture
Onset	Most common in people aged 40 to 60
Duration	Can be chronic if untreated
Types	N/A
Causes	Repetitive strain, rheumatoid arthritis, diabetes mellitus
Risks	Occupations involving repetitive gripping actions
Diagnosis	Based on physical examination
Differential diagnosis	Dupuytren's contracture, osteoarthritis, carpal tunnel syndrome
Prevention	Avoiding repetitive hand movements
Treatment	Splinting, NSAIDs, steroid injections, surgery
Medication	NSAIDs, corticosteroids
Prognosis	Good with treatment
Frequency	Affects 2-3% of the general population
Deaths	N/A

What is trigger finger?

Trigger finger is a disorder where a finger or thumb gets stuck in a bent position, as if you were squeezing a trigger. Also, once it gets unstuck, the finger pops straight out, like a trigger being released.

File:Post-operative photo of trigger finger release surgery.jpg

Post operative photo of trigger finger release surgery in a diabetic patient

What causes trigger finger?

• The tendons that move the finger slide through a tendon sheath and if the tunnel swells and becomes smaller, or the tendon has a bump on it, the tendon cannot slide smoothly through the tunnel.
• When it cannot slide smoothly, the tendon may become stuck when you try to straighten your finger.

Signs and symptoms

• Symptoms include catching or locking of the involved finger.
• In the ring and middle fingers, often a nodule can be felt at the area of the hand where the palm meets the finger.

Diagnosis

• Diagnosis is made almost exclusively by history and physical examination alone.
• More than one finger may be affected at a time, though it usually affects the index, thumb, middle, or ring finger.
• The triggering is usually more pronounced late at night and into the morning, or while gripping an object firmly.

Treatment

• Treatment consists of injection of a corticosteroid such as methylprednisolone often combined with a local anesthetic (lidocaine) at the site of maximal inflammation or tenderness around the A1 pulley of the finger in the palm.
• The infiltration of the affected site can be performed using standard anatomic landmarks or sonographically guided, and often needs to be repeated 2 or three times to achieve remission.
• An irreducibly locked trigger, often associated with a flexion contracture of the PIP joint, should not be treated by injections.

Surgery

For symptoms that have persisted or recurred for more than 6 months and/or have been unresponsive to conservative treatment, surgical release of the pulley may be indicated.

Prognosis

• The natural history of disease for trigger finger remains uncertain.
• There is some evidence that idiopathic trigger finger behaves differently in people with diabetes.
• Recurrent triggering is unusual after successful injection and rare after successful surgery.

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