Trigger finger: etiology, evaluation, and treatment

Abstract

Trigger finger is a common finger aliment, thought to be caused by inflammation and subsequent narrowing of the A1 pulley, which causes pain, clicking, catching, and loss of motion of the affected finger. Although it can occur in anyone, it is seen more frequently in the diabetic population and in women, typically in the fifth to sixth decade of life. The diagnosis is usually fairly straightforward, as most patients complain of clicking or locking of the finger, but other pathological processes such as fracture, tumor, or other traumatic soft tissue injuries must be excluded. Treatment modalities, including splinting, corticosteroid injection, or surgical release, are very effective and are tailored to the severity and duration of symptoms.

Fig. 1

Schematic of the fibro-osseus tunnel composed of five annular and three cruciform pulleys through which the flexor tendons run. The most common location of triggering is at the A1 pulley. (Adapted with permission from Berger RA, Weiss AC: Hand Surgery, Baltimore, MD, Lippincott, Williams, Wilkins, 2003)

Fig. 2

Clinical photograph demonstrating the proper site for a trigger finger injection. (A1: location of the A1 pulley, NV: location of the neurovascular bundle flanking the A1 pulley)

Fig. 3

(a) Intra-operative photo showing a thickened A1 pulley prior to release. (b) Once the A1 pulley is released the flexor tendons can be lifted out of the wound