What is trigger finger or Stenosing tenosynovitis? How to diagnose trigger finger? what are Annular pulleys? What are causes of it? How to treat trigger finger through physical therapy?

1. TRIGGER FINGER
PRESENTED BY: DR. ZUNAIRA AHMAD

2. DEFINITION
• Inflammation and subsequent narrowing of pulley of
affected digit (most commonlyA1) Typically 3rd, 4th digit
• [Annular (A1-A5) ligaments of the tendon sheath
over the flexor tendons]
• Flexor tendon / tendon sheath thickens
• The main characteristic of trigger finger is popping and
/ or catching with movement of the digit especially at
bending.

3. CLINICAL PRESENTATION
• Initially, patients may present with painless clicking during movement of the digit. This can progress to
painful catching or popping, typically at the MCP or PIP joints.
• Possible additional symptoms are:
• Stiffness and swelling (especially in the morning)
• Intermittent finger locking during active flexion that requires a passive force to extend the finger
• Finger locking or clicking in a bent position then popping straight
• Loss of full flexion / extension
• Palpable painful nodule proximal to A1, and / or finger locked into a flexed position

4. DIFFERENTIAL DIAGNOSIS
• Dupuytren's contracture
• Flexor tendon / sheath tumor.
• Sesamoid bone anomalies
• Post-traumatic tendon entrapment on the metacarpal head

5. • History
• Past Medical History
 Diabetic individuals are four times more likely to develop trigger finger
 RA and Gout are also associated with trigger finger
• Observation
 A digit locked in flexion
 Bony proliferative changes in the sub-adjacent PIP joint
• Palpation
• Range of Movement (Loss of motion, particularly in extension)
• Manual Muscle Testing
• Joint Accessory Mobility (PIP, MCP, DIP, and CMC of all affected digits)
• Special Tests (Open and Close hand)
EXAMINATION

6. Physiotherapy
1. Rest
2. Splinting
 6-10 weeks
 2 types
 At DIP joint (50% resolution of symptoms)
 At MCP joint with 15 degrees of flexion. (92.9% resolution)
3. Exercises
 AROM ( abduction, Adduction to strengthen interossei and
the lumbricals)
 Digital blocking
 Tendon glide exercise
 Duck
 Hook
 Squeeze
 Touch and Trace
 Spread wide
MANAGEMENT
4 Hot/cold
5 Massage
6 Ultrasound
7 Electrical stimulation
8 Passive therapeutic
traction
9 Extracorporeal
Shockwave Therapy
 Operative