Trigger Finger Differential Diagnoses

Updated: Aug 27, 2018
  • Author: Satishchandra Kale, MD, MBBS, MBA, MCh(Orth), FRCS(Edin), FRCS(Tr&Orth); Chief Editor: Harris Gellman, MD  more...
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DDx

Diagnostic Considerations

The following situations can simulate the locking found in trigger finger (TF):

  • Collateral ligaments of the metacarpophalangeal (MCP) joint catch on a bony prominence on the side of the metatarsal head (osteophyte)
  • Localized swelling in the flexor digitorum profundus (FDP) gets entrapped at the decussation of the FDS
  • A partially lacerated flexor tendon catches against the A1 pulley or the FDS decussation
  • A nodule in the FDS catches against the A3 pulley
  • Locking is simulated by abnormal sesamoids
  • A loose body is present in the MCP joint
  • Snapping or subluxation of the extensor digitorum communis (EPC) occurs

Other problems to consider in patients who may have FT include the following:

  • Ganglion involving the tendon sheath
  • Infection within the tendon sheaths
  • Ganglion cyst of the wrist
  • Acromegaly - Increased growth hormone stimulates sodium reabsorption in the distal nephron, increasing extracellular volume and leading to swelling of the flexor synovium within the digital sheath [32]

Perhaps the most important differential diagnosis is infection, such as suppurative tenosynovitis. Any such infection requires immediate referral to a hand surgeon or plastic surgeon for aggressive management, which includes antibiotics and local procedures.

Differential Diagnoses