Trigger Finger (Digital Stenosing Tenosynovitis)
Basics
Description
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.
Epidemiology
Incidence
- 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
Prevalence
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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Citation
Domino, Frank J., et al., editors. "Trigger Finger (Digital Stenosing Tenosynovitis)." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2020. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688771/all/Trigger_Finger__Digital_Stenosing_Tenosynovitis_.
Trigger Finger (Digital Stenosing Tenosynovitis). In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2020. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688771/all/Trigger_Finger__Digital_Stenosing_Tenosynovitis_. Accessed August 31, 2024.
Trigger Finger (Digital Stenosing Tenosynovitis). (2020). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (27th ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688771/all/Trigger_Finger__Digital_Stenosing_Tenosynovitis_
Trigger Finger (Digital Stenosing Tenosynovitis) [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2020. [cited 2024 August 31]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688771/all/Trigger_Finger__Digital_Stenosing_Tenosynovitis_.
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