Shima’a Jaffer Al-Amer

211504748

TRIGGER FINGER

Objectives:• Normal anatomy of region• Aetiology• Clinical presentation• Investigations• Treatment• Complications

Normal Anatomy

Flexor digitorum profundus

Flexor digitorum superficialis

Etiology• idiopathic• repetitive finger movements • local trauma • stress • degenerative force • occupations requiring extensive gripping and hand flexion

Clinical presentationHistory:

• Initially painless clicking, catching, or locking • painful episodes in which the patient has difficulty spontaneously extending the affected digits.• awaken with the finger locked in the palm, with gradual "unlocking" as the day progresses.• the finger may become locked in flexion requiring passive manipulation of the finger into extension, which can be painful

Clinical presentationPhysical examination• tenderness to palpation over A1 pulley•  tender nodule• asked the patient to fully open and close the hand

locking or clicking • Pain may be aggravated by stretching the tendon

in extension

Investigations• injection of lidocaine into the flexor sheath relieve the pain + allow the digit to become actively or passively extended. • no role for imaging • x-rays considered unnecessary in patients without history of inflammatory disease or trauma

TreatmentNonoperative•night splinting, • activity modification,•  NSAIDS• steroid injections

  

TreatmentOperative• surgical debridement and release of the A-1 pulley

• release of A1 pulley and 1 slip of FDS (usually ulnar slip) 

Complications• Joint flexion contructure• Radial digital nerve injury• During the dissection, the radial digital nerve crosses the operative field and is at risk.

References• Al Hasan Makkouk, et.al; Trigger finger: etiology, evaluation, and treatment; 2007

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2684207/

• UpToDate

http://www.uptodate.com/contents/trigger-finger-stenosing-flexor-tenosynovitis

• Orthobullet

http://www.orthobullets.com/hand/6027/trigger-finger