A very common hand condition.
Caused by a nodule over the flexor tendon, which catches at the entrance of the flexor pulleys (A1 pulley).
Patients initially complain of a painful click at the base of the finger or thumb on the palm, which ultimately leads to the finger being “stuck” in a flexed position at the PIP Jt, most commonly in the morning. They have to push it out straight, which is painful..
Trigger finger is more common in diabetics, who often have multiple fingers affected.
Often a painful nodule can be felt under the distal palmer crease, which moves when the finger moves.
There are no specific investigations needed for simple trigger finger.
If however there is a concern that there may be tenosynovitis, then an ultrasound scan can be helpful.
When to refer
If you are happy to carry out injections, then I think this should be the first treatment option in symptomatic trigger finger. If this fails then refer on. If the injection works fully or partly and then the triggering returns, than a second injection is warranted if clinically required.
Please refer to section on steroid injections for further information.
What’s the Evidence ?
Marks et al JHS 1989. 84% success rate of trigger fingers and 92% trigger thumbs after single injection of Kenalog at 3.5 yrs
How to Inject