Trigger finger (stenosing flexor tenosynovitis)
- Philip E Blazar, MD
Philip E Blazar, MD
- Assistant Professor of Orthopedic Surgery
- Harvard Medical School
- Rohit Aggarwal, MD, MSc
Rohit Aggarwal, MD, MSc
- Assistant Professor of Medicine, Division of Rheumatology and Clinical Immunology
- University of Pittsburgh
Trigger finger (also called stenosing flexor tenosynovitis) is caused by a disparity in the size of the flexor tendons and the surrounding retinacular pulley system at the first annular (A1) pulley (figure 1) which overlies the metacarpophalangeal (MCP) joint (figure 2). The flexor tendon catches when it attempts to glide through a relatively stenotic sheath, resulting in an inability to smoothly flex or extend the finger. In severe cases, the finger may become locked in flexion requiring passive manipulation of the finger into extension. The cause of trigger finger is most frequently unclear, although patients often attribute it overuse or repetitive movements. (See "Musculoskeletal complications in diabetes mellitus", section on 'Flexor tenosynovitis'.)
The pathogenesis, clinical manifestations, diagnosis and treatment of trigger finger are discussed here. The anatomy of the finger flexion and pulley system is reviewed separately. (See "Finger and thumb anatomy", section on 'Finger flexion and pulley system'.)
Trigger finger is one of the most common causes of hand pain in adults. The reported prevalence is roughly 2 percent in the general population, and is more common among women than men in the fifth or sixth decade of life . It can occur in one or many fingers in each hand and can be bilateral. The prevalence of trigger finger is also higher among patients with diabetes mellitus, rheumatoid arthritis, or conditions that cause systemic deposition of protein such as amyloidosis [1,2]. Trigger finger is occasionally observed in children . (See "Mucopolysaccharidoses: Complications and management", section on 'Carpal tunnel syndrome'.)
The majority of trigger fingers are idiopathic . Symptoms usually begin spontaneously, without a prior history of trauma or change in activity level. There are some observational reports suggesting an association with occupational or repetitive activities, but this is somewhat controversial .
The main histopathological change is fibrocartilagenous metaplasia of the ligamentous layer of the tendon sheath at the first annular (A1) pulley with secondary reduction in the cross-sectional area of the fibro-osseous canal [1,4]. Functional impairment in finger flexion and extension is primarily a result of mechanical impingement leading to tendon entrapment.
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- DIFFERENTIAL DIAGNOSIS
- Dupuytren’s contracture
- Diabetic cheiroarthropathy
- Metacarpophalangeal joint sprain
- Infection within the tendon sheath
- Calcific peritendinitis or periarthritis
- Tenosynovitis (non-infectious)
- Overall approach
- Acute symptoms
- Persistent symptoms
- - Glucocorticoid injection
- - Surgery
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS