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]
  • Thumb is predominant digit.
  • Predominant age
    • Adult form typically presents in the 5th and 6th decades of life.
  • Predominant sex
    • Children: female = male
    • Adults: female > male (6:1)

Prevalence
Lifetime prevalence in the general population is 2.6%.
Pediatric Considerations
  • 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 flexor tendon becomes 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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