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trigger finger/thumb

Inability to re-extend the finger (generally 2nd or 3rd finger) after flexion, due to sticking of tendon in the metacarpal tendon sheath. Etiology: 1) direct mechanical trauma to the joints of the fingers 2) repetitive grasping action involving the fingers &/or thumb Epidemiology: - 3% in the general population - up to 10% in patients with diabetes mellitus Pathology: 1) inflammation due to overuse of the superficial finger flexor tendons 2) tendon nodules at the A1 pulley site (distal palmar area over the distal metacarpal head) 3) sticking of tendon in the metacarpal tendon sheath Clinical manifestations: 1) inability to re-extend the finger (generally 2nd or 3rd finger) after flexion 2) making a fist may be difficult/painful 3) the digit may finally extend with a painful click 4) a nodule may be felt over the A1 pulley Management: 1) steroid injection: 0.5 cc Kenalog (40 mg/mL) [3] - 45% of patients with sustained benefit from a single injection after 10 years [5] - women more likely to benefit than men - age & diabetes mellitus not factors in benefit [5] 2) surgical release

General

repetitive strain disorder; repetitive motion disorder; cumulative trauma disorder; overuse syndrome

References

  1. Contribution from Dr. M. Fung, Kaiser Permanente, Fresno CA
  2. Clyman B, in: UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
  3. Rozental TD et al. Trigger finger: Prognostic indicators of recurrence following corticosteroid injection. J Bone Joint Surg Am 2008 Aug; 90:1665. PMID: 18676896
  4. OrthoInfo: Trigger Finger http://orthoinfo.aaos.org/topic.cfm?topic=a00024
  5. Wojahn RD et al. Long-term outcomes following a single corticosteroid injection for trigger finger. J Bone Joint Surg Am 2014 Nov 19; 96:1849 PMID: 25410501 http://jbjs.org/content/96/22/1849