Trigger finger is caused by inflammation or irritation of the tendon sheath that causes the finger to get stuck in a bent position. It presents with painless clicking or locking of the finger initially, progressing to painful episodes where the finger cannot straighten. Examination reveals tenderness over the tendon sheath and difficulty straightening the finger. Non-operative treatments include splinting and injections, while surgery involves releasing the tendon sheath. Complications can include limited finger movement or nerve injury.

1. Shima’a Jaffer Al-Amer
211504748
TRIGGER FINGER

2. Objectives:
• Normal anatomy of region
• Aetiology
• Clinical presentation
• Investigations
• Treatment
• Complications

3. Normal Anatomy
Flexor
digitorum
profundus
Flexor
digitorum
superficialis

8. Etiology
• idiopathic
• repetitive finger movements
• local trauma
• stress
• degenerative force
• occupations requiring extensive gripping and hand flexion

10. Clinical presentation
History:
• Initially painless clicking, catching, or locking
• painful episodes in which the patient has difficulty spontaneously
extending the affected digits.
• awaken with the finger locked in the palm, with gradual
"unlocking" as the day progresses.
• the finger may become locked in flexion requiring passive
manipulation of the finger into extension, which can be painful

11. Clinical presentation
Physical examination
• tenderness to palpation over A1 pulley
• tender nodule
• asked the patient to fully open and close the hand  locking
or clicking
• Pain may be aggravated by stretching the tendon in
extension

12. Investigations
• injection of lidocaine into the flexor sheath relieve the pain +
allow the digit to become actively or passively extended.
• no role for imaging
• x-rays considered unnecessary in patients without history of
inflammatory disease or trauma

13. Treatment
Nonoperative
• night splinting,
• activity modification,
• NSAIDS
• steroid injections

14. Treatment
Operative
• surgical debridement and release of the A-1 pulley
• release of A1 pulley and 1 slip of FDS (usually ulnar slip)

15. Complications
• Joint flexion contructure
• Radial digital nerve injury
• During the dissection, the radial digital nerve crosses the operative
field and is at risk.

16. References
• Al Hasan Makkouk, et.al; Trigger finger: etiology, evaluation, and
treatment; 2007
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2684207/
• UpToDate
http://www.uptodate.com/contents/trigger-finger-stenosing-flexor-
tenosynovitis
• Orthobullet
http://www.orthobullets.com/hand/6027/trigger-finger