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Trigger Finger (Digital Stenosing Tenosynovitis)

Trigger Finger (Digital Stenosing Tenosynovitis) is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

A clicking, snapping, or locking of a finger/thumb with extension movement (after flexion) ± associated pain

Epidemiology

Incidence
  • Adult population: 28/100,000/year
    • Rare in children
  • 4 times increased risk in diabetics (1)[B]
  • Predominant age
    • Childhood form typically involves thumb.
    • Adult form typically presents in the 5th and 6th decades of life and involves thumb/digits.
  • Predominant sex
    • Children: female = male
    • Adults: female > male (6:1)

Prevalence
Lifetime prevalence in the general population is 2.6%.
Pediatric Considerations
  • The thumb is more commonly involved in children.
  • Surgery is often more complicated for children with a trigger finger (as opposed to a trigger thumb).
  • Release of the A1 pulley alone is often insufficient, other procedures may be necessary.

Etiology and Pathophysiology

  • Narrowing around the A1 pulley from inflammation, protein deposition, or thickening of the tendon itself. Prolonged inflammation leads to fibrocartilaginous metaplasia of the tendon sheath.
  • If the flexor tendon become nodular, the triggering phenomenon is worse because the nodule has difficulty passing under the A1 pulley.
  • Because intrinsic flexor muscles are stronger than extensors, the finger can stick in the flexed position.
  • No clear association with repetitive movements

Risk Factors

  • Diabetes mellitus
  • Rheumatoid arthritis
  • Hypothyroidism
  • Mucopolysaccharide disorders
  • Amyloidosis

General Prevention

Most cases are idiopathic, and no known prevention exists; no clear association with repetitive movements

Commonly Associated Conditions

  • De Quervain tenosynovitis
  • Carpal tunnel syndrome
  • Dupuytren contracture
  • Diabetes mellitus
  • Rheumatoid arthritis
  • Hypothyroidism
  • Amyloidosis

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Citation

Stephens, Mark B., et al., editors. "Trigger Finger (Digital Stenosing Tenosynovitis)." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116890/all/Trigger_Finger__Digital_Stenosing_Tenosynovitis_.
Trigger Finger (Digital Stenosing Tenosynovitis). In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116890/all/Trigger_Finger__Digital_Stenosing_Tenosynovitis_. Accessed April 26, 2019.
Trigger Finger (Digital Stenosing Tenosynovitis). (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116890/all/Trigger_Finger__Digital_Stenosing_Tenosynovitis_
Trigger Finger (Digital Stenosing Tenosynovitis) [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 26]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116890/all/Trigger_Finger__Digital_Stenosing_Tenosynovitis_.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Trigger Finger (Digital Stenosing Tenosynovitis) ID - 116890 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116890/all/Trigger_Finger__Digital_Stenosing_Tenosynovitis_ PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -