Trigger finger is inflammation, sometimes with subsequent fibrosis, of tendons and tendon sheaths of the digits.
(See also Overview and Evaluation of Hand Disorders.)
DR P. MARAZZI/SCIENCE PHOTO LIBRARY
Trigger finger is idiopathic but is common among patients with rheumatoid arthritis or diabetes mellitus. Repetitive use of the hands (as may occur when using heavy gardening shears) may contribute. In patients with diabetes, trigger finger often coexists with carpal tunnel syndrome and occasionally with fibrosis of the palmar fascia. Pathologic changes begin with a thickening or nodule within the tendon; when located at the site of the tight first annular pulley, the thickening or nodule blocks smooth extension or flexion of the finger. The nodules are frequently tender to touch. The finger may lock in flexion, or “trigger,” suddenly extending with a snap.
Diagnosis of Trigger Finger
Clinical evaluation
The diagnosis of trigger finger is largely based on a description by the patient of painful snapping or locking of the affected finger during flexion and extension movements. It may be observed on physical examination if the patient is asked to open and close the hand. Tenderness, with or without a nodule, may be present at the base of the finger. Imaging is not necessary for the diagnosis.
Treatment of Trigger Finger
Conservative measures
Sometimes corticosteroid injection
Sometimes surgery
Treatment of acute inflammation and pain includes splinting, moist heat, and nonsteroidal anti-inflammatory drugs (NSAIDs).
If these measures fail, injection of a corticosteroid suspension into the flexor tendon sheath, along with splinting, may provide safe, rapid relief of pain and triggering (1). Operative release can be done if corticosteroid therapy fails.
Treatment reference
1. Giugale JM, Fowler JR: Trigger Finger: Adult and Pediatric Treatment Strategies. Orthop Clin North Am. 2015;46(4):561-569. doi:10.1016/j.ocl.2015.06.014
