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Stenosing flexor tenosynovitis is a debilitating, common condition affecting both the adult and pediatric populations, causing catching, clicking, and locking of the digits.
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Several nonsurgical options are used, including anti-inflammatory medications, splinting, and/or local corticosteroid injections.
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Open A1 pulley release remains the gold standard of treatment, but percutaneous, in-office techniques have been established with similar success rates.
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Pediatric trigger finger and thumb have a
Trigger Finger: Adult and Pediatric Treatment Strategies
Section snippets
Key points
Adult trigger digit
Stenosing flexor tenosynovitis of the hand, commonly known as trigger finger, is a potentially debilitating condition characterized by catching, clicking, or locking of the fingers. The etiology is any pathology between the flexor sheath and the underlying tendons that impedes smooth gliding during flexion. Early epidemiologic studies found a 2.6% lifetime risk of developing trigger finger, with an increased incidence in certain systemic conditions, such as diabetes mellitus and inflammatory
Nonsurgical treatment
Noninvasive treatment modalities are used for mild or early cases of triggering and in patients who are opposed to injections. Activity modification, especially symptom-provoking activities, should be avoided. Although there is no scientific evidence to support the use of nonsteroidal anti-inflammatory drugs (NSAIDs), this drug class is commonly recommended to alleviate the local inflammatory response secondary to triggering. Prolonged use, however, may contribute to peptic ulcer disease and
Surgical treatment
Open release of the A1 pulley is the gold standard for surgical treatment of trigger finger. Longitudinal, oblique, or transverse incisions are made over the A1 pulley of the involved digit. Blunt dissection is carried down to the tendon sheath and care is taken to protect the neurovascular bundles that travel on the ulnar and radial side of the tendon. When incising the A1 pulley, care must be exercised to avoid extension into the A2 pulley, because there is a theoretic risk of tendon
Pediatric trigger digit
The pathology, natural progression, and management of pediatric trigger fingers and trigger thumbs differ significantly from their adult counterparts. Commonly, children are brought in by their parents, at approximately 2 years of age, with the observation that a child has a flexed posture of the thumb or an inability to extend the thumb at the interphalangeal joint. Careful examination of the contralateral hand should be performed because 25% of children have bilateral involvement.45 A nodule
Summary
Trigger finger is a common condition affecting both the adult and pediatric populations. A mismatch between the flexor tendons and the overlying tendon sheath causes a spectrum of symptoms from painful catching to fixed flexion contractures. Treatment differs between the 2 age groups. In adults, surgical intervention is usually recommended after a failure of conservative measures, including corticosteroid injections. Surgical intervention can be performed open or percutaneously, with similar
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Cited by (38)
Adult presentation of locked ‘congenital’ trigger thumb: A case report
2023, International Journal of Surgery Case ReportsOrthotic intervention options to non-surgically manage adult and pediatric trigger finger: A systematic review
2023, Journal of Hand TherapyA Simple Splint for Trigger Finger
2022, Journal of Hand and MicrosurgeryA1 pulley stretching treats trigger finger: A1 pulley luminal region under digital flexor tendon traction
2020, Clinical BiomechanicsCitation Excerpt :Trigger finger is one of the most common hand disorders treated by hand surgeons and the lifetime risk is estimated at 2% to 3% in the general population (Ballard and Kozlow, 2016; Griggs et al., 1995). Conservative management approaches for trigger finger include activity modification, splinting, corticosteroid injection, and other adjuvant modalities (Giugale and Fowler, 2015; Patel and Bassini, 1992; Ryzewicz and Wolf, 2006). By contrast, physiotherapy is partially accepted as a treatment for trigger finger (Lee et al., 2002).
Effectiveness of proximal interphalangeal joint–blocking orthosis vs metacarpophalangeal joint–blocking orthosis in trigger digit management: A randomized clinical trial
2019, Journal of Hand TherapyCitation Excerpt :It is diagnosed when an individual presents with a symptomatic clicking or locking of a finger or the thumb. The etiology involves pathological thickening of the flexor sheath, the annular pulley system, and intrasubstance changes within the flexor tendons.1-5 These changes, which can be felt as a palpable nodule, resulted in the inability of the affected digit to flex or extend smoothly.