Trigger Finger (Digital Stenosing Tenosynovitis)



Trigger finger, also known as stenosing flexor tenosynovitis, is disruption of smooth tendon gliding in the fingers/thumb that causes clicking, locking, catching, and pain with flexion and extension.



  • Adult population: 2–3% of adults
    • Typically presents in the 5th and 6th decades of life
    • Female > male (6:1)
  • Rare in children
    • Associated with mucopolysaccharidoses (MPS)
    • Female = male
  • 10% of diabetic population
  • Thumb is predominant digit

Lifetime prevalence in the general population is 2.6%.

Pediatric Considerations

  • Successful treatment using nonoperative methods such as casting and splinting
  • Surgical methods provided satisfactory resolution with those who failed conservative measures and are also used as initial therapy as well.

Etiology and Pathophysiology

  • The result of fibrocartilaginous metaplasia of the tendon and/or pulley from prolonged inflammation causing narrowing around the pulley
  • This can occur at any of the five pulleys along the flexor tendon—A1 pulley is the most common.
  • 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 get stuck 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.
  • No clear association with occupational-related or repetitive activities

Commonly Associated Conditions

  • Orthopedic conditions:
    • Rheumatoid arthritis
    • Calcific tendinitis
    • Septic tenosynovitis
    • Carpal tunnel syndrome
    • Congenital trigger thumb
  • Medical conditions:
    • Diabetes
    • Amyloidosis
    • Hypothyroidism
    • Sarcoidosis
    • Gout
    • Pseudogout

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