JOURNAL READING :

TRIGGER FINGERS

Oleh : Pembimbing :
Gabriella Dwiputri dr. Benny Murtaza
C 111 07 117 dr. Hendrian Chaniago

SUPERVISOR :
DR. HENRY YURIANTO, M.PHIL., PHD, SPOT.
Description

A trigger finger is a manifestation of stenosing

tenosynovitis that results in painful catching of the
involved flexor tendon as the patient flexes and
extends the digit.
As the affected digit is slowly flexed, it snaps or
triggers into a flexed position.
The pathological change in the flexor sheath is
fibrocartilaginous metaplasia and hypertrophy of
its A1 pulley (Sampson, 1991). This causes a
tender nodule at the base of the finger in the palm.
( adapted from 5 minutes orthopedics)
 Epidemiology

Affected digits:
all digits, (most commonly, the thumb, ring, and middle
fingers)
females more often than males.

( adapted from 5 minutes orthopedics)

Incidence and Risk Factors

Risk Factors:
Rheumatoid arthritis
Increased age
Diabetes mellitus (High incident in adult diabetic)

( adapted from 5 minutes orthopaedics)

 Fig. 1. In trigger finger, a
nodule in the tendon
sheath prevents it from
sliding under the pulley.
The finger does not
extend.

( adapted from 5 minutes orthopaedics)

Diagnosis

Signs and Symptoms

Sign: swelling in the palm of the hand
Symptom:
Painful locking or snapping of the digit into a flexed position
with flexion
Physical Exam
By gently palpating the flexor tendon sheath : nodule
sometimes may be palpated.

( adapted from 5 minutes orthopaedics)

Severity of Trigger Finger

Mild (pre-triggering)
History of: pain, catching or click
Tender A1 pulley; but fully mobile finger

Moderate
Triggering with:
A - Difficulty actively extending finger
B - Need for passive finger extension
Loss of complete active flexion

Severe
Fixed contracture

( adapted from Wolfe 2005, Greens operative hand surgery)

Test

Lab and imaging are not necessary because trigger

finger is a clinical diagnosis.

( adapted from 5 minutes orthopaedics)

Differential Diagnosis
Tendon rupture
Contracted/ankylosed joints
Absent extensor
Tumor of tendon sheath

( adapted from 5 minutes orthopaedics)

Treatment

Triggering may unlock with rest.

Corticosteroid injection is 1st line of treatment.
When nonoperative therapy fails, surgical incision of
the A1 pulley has a 98% cure rate.
No restrictions are placed on activity after injection.

( adapted from 5 minutes orthopaedics)

British Society for Surgery of the Hand
recommendations for Treatment of Trigger
Digit in Adults
Follow Up

Prognosis
The prognosis is good.
Complications:
damage to the tendon or digital nerves and vasculature
Surgical risks:
digital nerve laceration
tendon rupture
Infection

( adapted from 5 minutes orthopaedics)

THANK YOU