Wrist & Hand: Trigger Finger Flashcards Preview

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Flashcards in Wrist & Hand: Trigger Finger Deck (16)
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what is trigger finger?

stenosing flexor tenosynovitis
a condition in which the finger or thumb click or lock when in flexion - preventing return to extension
can affect 1 or more tendon(s)


what is the cause of trigger finger?

often occurs spontaneously in otherwise healthy individuals


what the prevalence of trigger finger?

2 in 100 people


what conditions is trigger finger associated with?

diabetes mellitus


what often precedes trigger finger?

flexor tenosynovitis - often from repetitive movements leading to inflammation of the tendon and sheath


what develops on the superficial and deep tendons with local tenosynovitis at the metacarpal head?

localised nodal formation on the tendon distal to the pulley


which pulley is most frequently involved ligament in trigger finger?

the A1 pulley


explain how the digit becomes locked in place

when the fingers are flexed the node moves proximal to the pulley. when the patient attempts to extend the digit this node fails to pass back under the pulley = locked in flexion


risk factors for trigger finger

- occupation/hobby that involves prolonged gripping and use of the hand
- RA
- DM
- female
- increasing age


clinical features

painless clicking (snapping or catching) when trying to extend the finger (most common middle and ring) more that 1 finger can be involved at a time and it may be bilateral
over time - painful - on volar aspect of the MCP joint


what part of the phalanx should be palpated on examination of suspected trigger finger?

proximal aspect of phalanx - palpated to asses for clicking, pain with movement and any lumps of masses


DDx for trigger finger

Dupuytren's contractrure - flexion is painless, fixed and cannot be passively corrected
infection - preceded with trauma, finger swollen, erythematous, tender, passive movement of digit causes pain
ganglion - involving tendon sheath
acromegaly - excessive growth results in swelling of flexor synovium within tendon sheath due to increased extracellular volume, limiting both flexion and extension in the affected digit


how is trigger finger diagnosed?

diagnosis is clinical
blood tests or imaging may be warranted to exclude any differentials


how is trigger finger managed?

mild - conservatively
splint to keep finger extended at night
steroid injections can be trialled for those who didn't respond to conservative management


surgical management of trigger finger

a percutaneous trigger finger release via a needle can be attempted in most cases involving the release of the tunnel using a needle performed under local anaesthetic
for severe cases - surgical decompression of tendon tunnel can be trialled - where roof of tunnel is slit in turn widening its mouth to release the tendon - LA or GA


complications of trigger finger

recurrence is uncommon
adhesions can form if patient does not begin immediate motion following surgery