II. Pathophysiology

  1. Swelling of flexor tendon and sheath
    1. Difficult passage of swollen tendon through pulley
    2. Analogous to knotted fishing line in pole eyes
  2. Congenital form seen in some children

III. Findings: Signs and symptoms

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

IV. Differential Diagnosis

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

V. Management

  1. Similar approach as for De Quervain's Tenosynovitis
  2. NSAIDs
  3. Immobilization
  4. Avoid offending activity
  5. Moist heat as needed
  6. Digital Flexor Tenosynovitis Injection
  7. Surgical correction if refractory to above management

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