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