Fact-sheet: Trigger finger - stenosing tenosynovitis
Updated on 08/26/2020 at 4:05 PM
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Definition
Locking or snapping during finger flexion resulting from a mismatch between the diameter of the flexor tendons and that of the pulley, generally A1.
Common condition, with a main peak during the 5th and 6th decades.
Clinical features
Painful discomfort in the palm, worse in the morning, during flexion and extension movements of a finger.
Typically, when the patient extends the finger, a snap occurs that abruptly releases the extension (snapping once the obstacle is overcome). At a later stage, the patient must use the other hand to fully straighten the finger, with the maneuver often being very painful.
Finally, the finger may sometimes remain completely locked in flexion.
Frequent location: thumb, ring finger, middle finger.
Ultrasound
- Diffuse hypoechoic thickening of the A1 pulley
- Doppler: +/- hyperemia of the pulley
- Tenosynovitis
- Tendinosis: thickening and heterogeneous appearance of the flexor tendons
- Intratendinous tear
- Gruber's dark tendon sign: anisotropy with focal loss of the fibrillar appearance of the tendon, replaced by a "dark" area that does not move with the tendon.
Management
- Resting splint
- Percutaneous tenotomy and ultrasound-guided corticosteroid injection, which is more effective than injection into the pulley and tendon sheath (palmar approach)