MANUAL MINORS
Trigger finger (stenosing tenosynovitis) is a condition in which the flexor tendons of the fingers become inflamed or irritated, causing the finger to lock in a flexed position or making it difficult to extend. This occurs because the tendons cannot slide freely through the tendon sheath due to inflammation, nodule formation, or narrowing of the sheath. It is common in individuals who perform repetitive gripping movements.
Diagnosis
The diagnosis is clinical and characterised by:
Difficulty extending the affected finger, which may become “locked” in flexion.
Pain and tenderness at the base of the finger or the palm, in the area of the tendon sheath.
Clicking or “locking” sensation when attempting to move the finger.
In severe cases, the finger may become completely locked in a flexed position.
Diagnosis is confirmed by physical examination, and in some cases, a nodule can be palpated in the affected area.
Differential Diagnosis
Condition | Key Differences |
|---|---|
De Quervain’s Tenosynovitis | Pain on the radial side of the wrist, affecting the thumb tendons, without finger locking. |
Flexor Tendon Rupture | Inability to actively flex the finger, without locking or “triggering” sensation. |
Osteoarthritis of the Interphalangeal Joints | Chronic pain and stiffness, but without sudden finger locking. |
Dupuytren’s Contracture | Progressive finger flexion without clicking, associated with thickening of the palmar tissue. |
Emergency Management
Immobilisation of the affected finger to reduce pain and inflammation.
Administration of non-steroidal anti-inflammatory drugs (NSAIDs) to control pain and inflammation.
Application of ice to the base of the finger to reduce swelling.
If severe pain or persistent locking occurs, a steroid injection into the tendon sheath may be considered to reduce inflammation.
Definitive Treatment
Initial treatment is conservative, involving rest of the affected finger, anti-inflammatory medication, and sometimes corticosteroid injections. If the locking persists or worsens, surgery (tendon release) may be required to enlarge the tendon sheath and allow free tendon movement. After surgery, rehabilitation is crucial to restore full finger mobility and prevent recurrence.
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