II. Epidemiology

  1. Prevalence: 2% of adults in U.S.
  2. Age: Peaks age 50 to 60 years old
  3. Gender: Female predomince

III. Pathophysiology

  1. Congenital form seen in some children
  2. Inflammation and narrowing of the A1 Pulley (or swelling of flexor tendon and sheath)
    1. Difficult passage of flexor tendon through A1 pulley
    2. Analogous to knotted fishing line in pole eyes

IV. Risk Factors

  1. Diabetes Mellitus
  2. Rheumatoid Arthritis
  3. Amyloid deposition diseases (see Amyloidosis)
  4. Anatomic variants (esp. children)

V. Findings: Signs and Symptoms

  1. Snapping or triggering of affected finger at the flexor MCP joint
    1. Worse after rest
    2. Improves with active finger use
  2. Triggering transmitted to DIP joint
    1. Entire finger may lock in position
  3. Proximal flexor pulley swelling
    1. Tenderness to palpation
    2. Swollen, firm mass palpable at pulley

VI. Imaging

  1. Bedside soft tissue Ultrasound (optional)
    1. May demonstrate flexor tendon thickening pr palmar Nodule
  2. XRay
    1. Not typically indicated

VII. Differential Diagnosis

  1. Suppurative Tenosynovitis
    1. Severe, finger-threatening infection that rapidly spreads along the flexor surface of the finger

VIII. Management

  1. Similar approach as for De Quervain's Tenosynovitis
  2. Conservative Therapy (effective in most cases)
    1. NSAIDs
    2. Immobilization
    3. Avoid offending activity
    4. Moist heat as needed
  3. Digital Flexor Tenosynovitis Injection
    1. Consider for lack of improvement after 4 to 6 weeks of conservative therapy
    2. May consider for first-line management in more severe presentations (severe locking, reduced range of motion)
  4. Hand Surgery referral
    1. Indicated in Trigger Finger refractory to above management
    2. Consider for endoscopic or percutaneous release

IX. Complications

  1. Proximal interphalangeal joint contracture

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Related Studies

Ontology: Trigger Finger Disorder (C0158328)

Definition (NCI) A painful hand deformity affecting the fingers. It is due to damage of the finger flexor tendons, causing the finger to remain in a locked position.
Definition (MSH) A painful disability in the hand affecting the finger or thumb. It is caused by mechanical impingement of the digital flexor tendons as they pass through a narrowed retinacular pulley at the level of the metacarpal head. Thickening of the sheath and fibrocartilaginous metaplasia can occur, and nodules can form. (From Green's Operative Hand Surgery, 5th ed, p2137-58).
Concepts Acquired Abnormality (T020)
MSH D052582
ICD9 727.03
ICD10 M65.3
SnomedCT 202904003, 156671002, 268095007, 1539003
English Trigger finger (acquired), Nodular tendin dis of finger, Snapping finger, Digit, Trigger, Digits, Trigger, Entrapment, Flexor Tendon, Entrapments, Flexor Tendon, Finger, Snapping, Fingers, Snapping, Flexor Tendon Entrapments, Flexor Tendon Entrapment, Snapping Fingers, Tendon Entrapment, Flexor, Tendon Entrapments, Flexor, Trigger Digits, Trigger Digit, Snapping Finger, Trigger finger - acquired, acquired trigger finger (diagnosis), trigger finger, acquired trigger finger, trigger finger (physical finding), trigger finger (acquired), Trigger Finger Disorder [Disease/Finding], finger trigger, finger triggered, snapping finger, fingers trigger, snap finger, Trigger Finger Disorder, Snapping fingers, Finger snapping, Finger trigger, Trigger finger, Acquired trigger finger, Nodular tendinous disease of finger, Triggering of finger, Acquired trigger finger (disorder), finger; snapping, snapping; finger
Italian Dito a scatto, Dito a scatto (acquisito), Disturbo del dito a scatto, Difficoltà di scorrimento del tendine flessore, Dita a scatto
Dutch trigger finger of hokkende vinger (verworven), finger; snapping, snapping; finger, Trigger finger, trigger finger of hokkende vinger
French Doigt à ressort (acquis), Doigt à ressaut, Doigt à ressort, Doigt en gachette, Blocage du tendon fléchisseur
German Trigger-Finger (erworben), Schnellender Finger, Digitus saltans, Schnappfinger, Springender Finger, Tendovaginitis stenosans, Trigger-Finger
Portuguese Dedo em gatilho (adquirido), Encarceramento do Tendão Flexor, Dedo em Gatilho, Compressão do Tendão Flexor, Transtorno do Dedo em Gatilho, Aprisionamento do Tendão Flexor, Dedo em mola
Spanish Dedo en resorte (adquirido), Atrapamiento del Tendón Flexor, Trastorno del Dedo en Gatillo, dedo de la mano en gatillo adquirido, dedo de la mano en gatillo adquirido (trastorno), dedo en resorte adquirido (trastorno), dedo en resorte adquirido, enfermedad tendinosa nodular de dedo de la mano, Dedo en gatillo
Russian "ЗАЩЕЛКИВАЮЩИЕСЯ ПАЛЬЦЫ", "ПРУЖИНЯЩИЕ ПАЛЬЦЫ", TRIGGER FINGER РАССТРОЙСТВО, СВЯЗКОСГИБАТЕЛЯ УЩЕМЛЕНИЕ, ЛИГАМЕНТИТ СТЕНОЗИРУЮЩИЙ КОЛЬЦЕВИДНОЙ СВЯЗКИ, "ЩЕЛКАЮЩИЙ ПАЛЕЦ", "SHCHELKAIUSHCHII PALETS", TRIGGER FINGER RASSTROISTVO, "PRUZHINIASHCHIE PAL'TSY", LIGAMENTIT STENOZIRUIUSHCHII KOL'TSEVIDNOI SVIAZKI, "ZASHCHELKIVAIUSHCHIESIA PAL'TSY", SVIAZKOSGIBATELIA USHCHEMLENIE
Japanese 弾発指(後天性), ダンパツシ, ダンパツシコウテンセイ, ばね指, バネ指, 弾発指, 弾撥指
Finnish Napsusormihäiriö
Czech skákavé prsty, skákavý prst, lupavý prst, Lupavý prst (získaný), Lupavý prst
Swedish Triggertumme
Korean 방아쇠 손가락증
Polish Palec przeskakujący, Palec trzaskający
Hungarian Pattanó ujj, Pattanó ujj (szerzett)
Norwegian Triggerfinger, Tendovaginitis stenosans, Digitus saltans, Springfinger