Updated: 12/18/2016

Trigger Finger

Topic
Review Topic
0
0
Questions
5
0
0
Evidence
9
0
0
Videos
1
Techniques
1
https://upload.orthobullets.com/topic/6027/images/trigger finger.jpg
https://upload.orthobullets.com/topic/6027/images/finger_pulleys_2.jpg
Introduction
  • Stenosing tenosynovitis caused by inflammation of the flexor tendon sheath
  • Epidemiology
    • more common in diabetics
    • ring finger most commonly involved
  • Mechanism
    • caused by entrapment of the flexor tendons at the level of the A1 pulley
    • fibrocartilaginous metaplasia of tendon and pulley found in pathology
  • Associated conditions
    • diabetes mellitus
    • rheumatoid arthritis
    • amyloidosis
Anatomy
  • Flexor pulleys of finger 
    • A1 overlie the MP joints
  • Muscles
    • FDP 
    • FDS 
Classification
 
Green Classification
Grade I Palm pain and tenderness at A-1 pulley
Grade II Catching of digit
Grade III Locking of digit, passively correctable
Grade IV Fixed, locked digit
 
Imaging
  • Radiographs
    • not required in diagnosis and treatment
Presentation
  • Symptoms
    • finger clicking
    • pain at distal palm near A1 pulley
    • finger becoming "locked in flexed position
  • Physical exam
    • tenderness to palpation over A1 pulley 
    • a palpable bump may be present near the same location
Treatment
  • Nonoperative
    • night splinting, activity modification, NSAIDS
      • indications
        • first line of treatment
    • steroid injections
      • indications
        • best initial treatment for fingers, not for thumb
      • technique
        • give 1 to 3 injections in flexor tendon sheath
        • diabetics do not respond as well as non-diabetics
  • Operative
    • surgical debridement and release of the A-1 pulley
      • indications
        •  in cases that fail nonoperative treatment
    • release of A1 pulley and 1 slip of FDS (usually ulnar slip)  
      • indications
        • pediatric trigger finger
          • presents with Notta's nodule (proximal to A1 pulley), flexion contracture and triggering
          • may need to release remaining FDS slip and A3 pulley as well
Techniques
  • Surgical debridement and release of the A-1 pulley
    • approach
      • longitudinal or transverse incision
    • release technique
      • in children, in addition to A-1 pulley release, may also need to release
        • one or both limbs of the sublimus tendon
        • A-2 pulley
        • A-3 pulley 
    • postoperative
      • early passive and active ROM 4 times a day
      • if patient does not have FROM at first post-op visit then send to PT
Complications
  • Radial digital nerve injury 
 

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Technique Guides (1)
Questions (5)

(OBQ05.164) A 64-year-old diabetic female presents with sudden catching and locking of her ring finger when trying to extend it. Attempts at finger extension are painful, and she notes tenderness in her distal palm. A clinical photo is shown in Figure A. Which of the following structures are implicated in the pathogenesis of this condition? Review Topic

QID: 1050
FIGURES:
1

Extensor digitorum tendon

1%

(23/3130)

2

Grayson's ligament

2%

(59/3130)

3

Oblique retinacular ligament

1%

(34/3130)

4

A1 pulley

96%

(2992/3130)

5

Transverse carpal ligament

0%

(7/3130)

ML 1

Select Answer to see Preferred Response

PREFERRED RESPONSE 4
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(OBQ10.113) When surgically treating a trigger finger in a child, what structure may need to be released in addition to the A-1 pulley? Review Topic

QID: 3207
1

One or both limbs of the sublimis tendon

69%

(2267/3295)

2

A-4 pulley

6%

(188/3295)

3

Lumbrical origin

6%

(192/3295)

4

Dorsal interosseous insertion

2%

(55/3295)

5

Anomalous insertion of the MCP joint collateral ligament

17%

(573/3295)

ML 3

Select Answer to see Preferred Response

PREFERRED RESPONSE 1

(OBQ11.56) A 2-year-old child has a flexion deformity of the interphalangeal joint of his thumb as seen in Figure A. Surgical correction of this deformity places what structure most at risk as it crosses the surgical field? Review Topic

QID: 3479
FIGURES:
1

Princeps pollicis artery

6%

(166/2617)

2

Ulnar digital nerve

9%

(242/2617)

3

Oblique pulley

6%

(168/2617)

4

Ulnar digital artery

2%

(57/2617)

5

Radial digital nerve

75%

(1972/2617)

ML 2

Select Answer to see Preferred Response

PREFERRED RESPONSE 5
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VIDEOS (1)
Topic COMMENTS (8)
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