Trigger finger (TF) is a condition involving the flexor tendon sheath, which leads to abnormal gliding of tendon and narrowing of the first annular (A1) pulley causing pain and locking of finger during flexion. The subject experiences painful flexion and difficulty in straightening of digits. It is one of the most common problems of hands and wrist, which leads to pain, dysfunction and disability, if not treated.
The patient may complain of clicking which may further develop into catching or popping pain. This may get normalized by manual palpation of digits. Stiffness and pain of the metacarpophalangeal joint in the morning which generally eases along the day, is a common complaint .
Pain is present in the distal aspect of the palm and at the proximal end of the digit involved. A painful, swollen nodule can be palpated near the metacarpophalangeal joint, arising due to inflammation or bunching of the fibrous tissue from trauma. At a time, one or more digits can be involved.
Entire Body System
Practice Essentials In trigger finger (TF), one of the most common causes of hand pain and disability, the flexor tendon causes painful popping or snapping as the patient flexes and extends the digit. [emedicine.medscape.com]
It is hypothesised that primary section of the A1 pulley with USSR resolves both extension lack and pain in longstanding trigger fingers with a painful extension lack. [ncbi.nlm.nih.gov]
Persistent pain and inflammation in the digits indicates the diagnosis of TF, where immediate medical attention is required. [symptoma.com]
Trigger Finger Treatment Cortisone Injection Cortisone injections can be used to treat the inflammation of small areas of the body (local injections), or they can be used to treat inflammation that is widespread throughout the body (systemic injections [medicinenet.com]
Causes Trigger finger is caused by inflammation of the tenosynovium. [emog.net]
A case of a 14-year-old boy is reported, who presented with a prominent palmar nodule over a triggering middle finger and progressive flexion contracture, 6 months after a fall on the outstretched hand. [ncbi.nlm.nih.gov]
Avoiding this response to falling can prevent wrist sprains. If you fall, make sure to protect your head, bend your arms and knees, and fall on the most padded part of your body. [ibji.com]
The absorbable sutures used during surgery will fall out on their own within two weeks of surgery. Your child will need to be examined by the hand surgeon two weeks after surgery. Many children do not require any other follow-up visits. [chop.edu]
There has been a consistent reduction in military expenditure as a percentage of GDP for the majority of countries, as well as a fall in the armed services personnel rate for most countries in the world. [visionofhumanity.org]
Another common cause of the injury is a result of direct trauma such as jamming the affected finger or falling onto an outstretched hand, causing microtears in the flexor tendon(s). [flextend.com]
This extends your pain, numbness, and weakness. Trigger finger targets a sole finger or thumb, locking the joint uncomfortably into place and making even simple movements difficult. [arksurgicalhospital.com]
The majority of patients suffer no complications following trigger finger surgery; however, complications can occur and include: Infection Nerve damage causing weakness, paralysis, or loss of feeling in the hand area. [handsurgery.com.au]
[…] problems can lead to on-going health concerns, prolonged hospitalization, or rarely death The majority of patients suffer no complications following trigger finger surgery; however, complications can occur and include: Infection Nerve damage causing weakness [woodlandssportsmedicine.com]
Symptoms may include: Wrist pain that is aggravated with repeated use or irritation A slow growing, localized swelling, with mild aching and weakness in the wrist An apparent cyst that is smooth, firm, rounded, and/or tender The symptoms of ganglion cysts [lakelandhealth.org]
- Finger Pain
Finger Splint by BMBZON This sturdy finger splint provides dependable, high level support for relief from chronic pain. [vivehealth.com]
BACKGROUND: Trigger finger is a common clinical disorder, characterised by pain and catching as the patient flexes and extends digits because of disproportion between the diameter of flexor tendons and the A1 pulley. [ncbi.nlm.nih.gov]
Signs and symptoms of osteoarthritis include: Stiffness Swelling and pain Bony nodules at the middle or end joints of the finger Pain and possibly swelling at the base of the thumb Loss of strength in the fingers and the grip of the hand Treatment for [lakelandhealth.org]
Trigger Finger Trigger finger is a painful condition that causes the fingers or the thumb (then called trigger thumb) catch or lock when bent. [miamihandcenter.com]
Trigger finger Other names Historicopous, trigger digit, trigger thumb,  stenosing tenosynovitis  Specialty Plastic surgery Symptoms Catching or locking of the involved finger, pain   Usual onset 50s to 60s years old  Risk factors Repeated [en.wikipedia.org]
He took his strategy of avoiding missteps to the extreme and neglected to provide senators with the substantive answers they deserve. [nytimes.com]
Signs and symptoms Signs and symptoms of TF are as follows: Locking or catching during active flexion-extension activity (passive manipulation may be needed to extend the digit in the later stages) Stiff digit, especially in long-standing or neglected [emedicine.medscape.com]
- TF is presented as tender, easily palpable nodule with pain and click.
- No laboratory tests or imaging is necessary in the case of an obvious clinical presentation, but in systemic conditions like diabetes and rheumatoid arthritis or other autoimmune diseases, blood sugar (fasting), rheumatoid factor and glycosylated Hb tests can be performed to study the causative condition precipitating TF .
- Radiographs are indicated only in cases of local injury, trauma or foreign body entrapment.
- Histology shows extracellular matrix, local inflammatory cell infiltration and plasma cells. Metaplasia of tendon sheath, collagen deposits can be seen in chronic cases.
For symptomatic relief non-steroidal anti-inflammatory drugs (NSAIDs), and corticosteroids if necessary (methyprednisolone, dexamethasone acetate) may be prescribed.
Conservative release technique
“Graston technique” is the latest technique used in the treatment; this differs from the conventional approach, and aims at re-establishing the extensor strength of the digits by palpation and control of pain using cryotherapy. The second approach is splinting technique; which is done in patients not willing for corticosteroid injections. It involves reducing the friction caused by movement of flexor tendons by immobilizing or splinting them .
Involves corticosteroid injections at the area of thickening of the sheath. It is done under strict aseptic conditions where the steroid injection is given within the tendon sheath and the patient is encouraged to move the digits. A different technique is also used in which the biaxial injection is given at the level of mid proximal phalanx which is less painful .
When the conservative or conventional approach doesn’t work or in the case of a locked TF, surgical technique is opted in which a full sectioning of the A1 pulley is done. Other technique is “Kapandji enlargement plasty” of A1 pulley in which A1 pulley is surgically enlarged. Patient feels early symptomatic relief by this technique. Latest technique is accucision or TRF (Trigger finger release), a microinvasive surgery for TF. Complications of these techniques include digital nerve and artery injury. In some cases infections, bowstring, bleeding, tendon rupture, atrophy of subcutaneous fat can occur .
Prognosis of TF is good in most cases following splinting or surgery or both. Corticosteroid injections are beneficial in patients having symptoms for a short time (less than 4 months). In most cases conservative approach, along with digital palpation and cryotherapy works.
Surgical release is proved beneficial in the patients with symptoms for prolonged duration (more than 4 months). Patients are generally cured and recurrence is seen rarely .
Etiology of the condition is mostly unknown. One of the causes is using of hand held tools and repeating motions. Activities involving prolonged stress and exertion of the pulleys can lead to trigger finger. Systemic conditions like diabetes mellitus or rheumatoid arthritis may also lead to the tendon sheath inflammation.
Acute or chronic infections, either localized or systemic, may in some cases involve the tenosynovium. Few autoimmune diseases may cause changes in the structure of tendons and pulleys. Collagen vascular diseases like sarcoidosis, amyloidosis and hypothyroidism may act as an underlying factor .
Trigger finger is a relatively common problem of the hand and wrist region and is over six times more common in women than men. It commonly affects the person during fifth and sixth decade of life. TF occurs commonly in patients with systemic diseases like diabetes, carpel tunnel syndrome, autoimmune disorders, De Quervain disease, renal diseases, hypothyroidism, and amyloidosis. The sequence of digit involvement includes thumb, middle, index and little fingers .
Trigger finger arises due to repetitive movements, pressure, stress and inflammation of the tendon sheath leading to accumulation of inflammatory exudates which results in pain during movement. Histological studies have shown accumulation of inflammatory cell infiltrate in extracellular matrix in some cases, and the appearance of chondrocytes also restrict the tendon sheath movement. Repetitive forceful movements also add to the accumulation of collagen type 3 in some areas, thus contributing to the inability of movement .
If the trigger finger is not treated for long time, it results in fibrous metaplasia of the tendon sheath.
Prevention can be done by avoiding repetitive movements and over exertions of fingers. Any of the tasks involving forceful flexion movements for longer durations should be avoided. Persistent pain and inflammation in the digits indicates the diagnosis of TF, where immediate medical attention is required. In case of excessive use or forceful flexion for longer period of time, adequate rest between works should be given to the hands and digits.
In trigger finger (TF) or stenosing tenosynovitis, the pathology lies in the tendon sheath and not the synovial lining, so it is more appropriately referred as "Tendovaginitis”. Tendon sheaths comprising of annular and cruciform pulleys form the pulley system that helps in the movement, and in force distribution of the flexor tendons during different motions. Among all the pulleys A1, A2, and A3, the first annular (A1) pulley which is located near the head of metacarpal, bears the most of stress and is responsible for many actions. It is affceted the most amongst all pulleys .
- Definition: Trigger finger (TF) is a complication arising due to local inflammation of the tendon sheaths of the fingers from overuse, trauma or systemic diseases. Pain, stiffness, clicking and popping are the early signs. Patient should note for any sign of infection, tenderness, pain and bleeding.
- Cause: Local trauma or any underlying disease plays an important role, causing TF. The tendon sheath of the finger may thicken leading to difficulty in straightening of fingers. It might present as stiffness in the morning that eases as the day proceeds.
- Symptoms: One can suspect TF, if a swelling, lump or nodule is present in the palm. It can be avoided by resting fingers and hands between extensive activities, and treating the underlying causes that may increase its incidence, like diabetes and arthritis.
- Treatment: Cryotherapy along with NSAIDS is a good symptomatic and conservative approach towards the treatment. In any case, if the symptoms persist for a longer time, intervention may be required with corticosteroid injections, surgery or splinting. If numbness of the digits is present after injection, then it may be due to digital nerve injury.
- Prognosis is very good in the cases of intra sheath injections and surgical intervention. However in some cases, reappearance of the symptoms is seen for unknown reasons or as a result of systemic manifestations.
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