Trigger finger is one of the most common causes of hand pain. It appears six times more frequently in women than in men, usually between the ages of 40 and 60. The dominant hand is more commonly affected, and the ring finger is most often involved. Diabetes mellitus is the most significant predisposing factor, with 10% of diabetic patients developing the condition. Trigger finger often coexists with other hand pathologies, such as carpal tunnel syndrome and de Quervain’s tenosynovitis. It is also more common in patients with hypothyroidism, rheumatoid arthritis, kidney disease, and amyloidosis.
Trigger finger is also observed in children under the age of 8, occurring equally in boys and girls, and most commonly affecting the thumb.
The tendons responsible for finger flexion pass through a series of strong annular and cruciform pulleys. These pulleys keep the tendons close to the bones of the fingers, allowing smooth gliding during flexion and extension. Thickening of the tendon, caused by microtrauma from repetitive forceful movements, prevents smooth tendon motion through the pulleys. The greatest forces are exerted at the first annular pulley (A1), located at the level of the metacarpophalangeal joint at the base of the finger. This is why trigger finger most often occurs at this site. It has also been shown that tendon diameter increases during flexion, which explains why the finger frequently locks in a flexed position. In children, however, the cause is entirely different: it is a developmental disorder in which the flexor tendon of the thumb is disproportionately larger than the corresponding pulley, without the presence of inflammation.
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In the early stages, there may only be a sensation of catching in finger movement without pain. As the condition worsens, flexion and extension of the finger become more difficult and are accompanied by significant pain, often giving the impression of a joint problem. In some cases, there is a gradual inability to fully flex or extend the finger, without the classic snapping phenomenon of trigger finger. Frequently, a nodule can be palpated on the tendon at the level of the metacarpophalangeal joint. Most patients report greater stiffness in the morning and locking of the finger in flexion that requires the other hand to release it, causing sharp pain.
Diagnosis is based on the characteristic clinical presentation, and radiological testing is not necessary. In acute cases, there may be pain, swelling, and restricted finger motion without the typical snapping. In such cases, infectious inflammation or traumatic injury must be excluded.
Initial treatment is conservative, focusing on avoiding activities that heavily strain the hand. Anti-inflammatory medications can also help reduce pain.
Local corticosteroid injection into the tendon sheath is quite effective in managing trigger finger, particularly in non-diabetic patients with recent onset of symptoms. However, in cases of recurrence, the success rate of a second injection is much lower, especially in chronic cases (>6 months) or with multiple finger involvement.
Surgery is the most definitive treatment for trigger finger, with a nearly 100% success rate. It involves releasing the first annular pulley (A1). Under local anesthesia, a small incision of about one centimeter is made at the level of the metacarpophalangeal joint, and the tendon is released. The patient can use the hand immediately and return to full activity after suture removal, with no further treatment required.
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