Trigger Finger Clinical Presentation

Updated: Apr 26, 2021
  • Author: Satishchandra Kale, MD, MBBS, MBA, MCh(Orth), FRCS(Edin), FRCS(Tr&Orth); Chief Editor: Harris Gellman, MD  more...
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Presentation

History

Patients with trigger finger (TF) may have a history of diabetes mellitus (DM) or rheumatoid arthritis (RA). In these individuals, multiple digits may be involved in TF.

Some patients will have a history of repetitive trauma to the affected area, while others may have occupational duties requiring repetitive use of the involved tendons. [31]

Signs and symptoms of TF are as follows:

  • Locking or catching during active flexion-extension activity (passive manipulation may be needed to extend the digit in the later stages)
  • Stiff digit, especially in long-standing or neglected cases
  • Pain over the distal palm
  • Pain radiating along the digit
  • Triggering on active or passive extension by the patient
  • Palpable snapping sensation or crepitus over the A1 pulley
  • Tenderness over the A1 pulley
  • Palpable nodule in the line of the flexor digitorum superficialis (FDS), just distal to the metacarpophalangeal (MCP) joint in the palm
  • Fixed-flexion deformity in late presentations, especially in the proximal interphalangeal (PIP) joint
  • Evidence of associated conditions (eg, RA, gout)
  • Early signs of triggering in other digits (may be bilateral)

A classic complaint is difficulty in achieving full extension of a single digit, which eventually releases or snaps open with pain at the distal palm and into the digit.

Some patients have difficulty with finger flexion rather than extension, though the former is less common. Other patients may have a painful nodule in the distal palm without any catching or triggering.

Some patients report stiffness in the fingers, especially after they have been asleep or following other periods of inactivity.

Some patients report swelling of the affected digit, particularly at the digit's base or proximal aspect.

Pediatric

Children with trigger thumb rarely complain of pain. They usually are brought in for evaluation when aged 1-4 years, when the parent first notices a flexed posture of the thumb’s interphalangeal (IP) joint. These children often demonstrate bilateral fixed flexion contractures of the thumb by the time they present to the physician. [4]

Next:

Physical Examination

At the level of the distal palmar crease, a tender nodule can be palpated, usually overlying the MCP joint.

The affected digit may lock in a flexed or (less commonly) extended position. When the patient attempts to move the digit more forcefully beyond the restriction, the digit may snap or trigger beyond the restriction. The triggering movement is very painful for the patient. (See the image below.)

Trigger finger often results in difficulty flexing Trigger finger often results in difficulty flexing or (in this case) extending metacarpophalangeal joint of involved digit.

In severe cases, the patient is unable to move the digit beyond the restriction, and thus no triggering occurs.

With a trigger thumb, the tenderness to palpation is found at the palmar aspect of the first MCP joints rather than over the distal palmar crease.

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