Trigger Fingers, Painful Fixation Of Joints Of Fingers
Trigger finger is a condition that makes your fingers or thumb difficult to move. It can “freeze” them in a flexed position. It affects the tendons in your fingers and thumbs. Read the article to know more.
Nivedita Dar17 Jul, 2024
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Stenosing Tenosynovitis (Trigger Finger)
Stenosing tenosynovitis, also known as trigger finger, is a condition characterized by the painful locking of a finger or thumb in a bent position. Inflammation and constriction of the sheath surrounding the flexor tendons impede smooth tendon movement. Although it is a benign condition, it can significantly impact hand function and quality of life.
Pathophysiology
Flexor tendons are responsible for bending the fingers. These tendons run through a series of pulleys (fibrous rings that keep the tendons close to the bone). The first annular pulley (A1 pulley) at the base of the finger is the most common site of problems in trigger finger. Inflammation of the tendon and its sheath (tenosynovium) leads to the development of a nodule and swelling. This nodule can catch on the A1 pulley during finger movement, causing the characteristic catching or locking. Histologically, trigger finger occurs due to fibrocartilaginous metaplasia of the tendon and/or pulley, proliferation of chondrocytes, increased type III collagen, and hyperglycemia, which can cause collagen cross-linking by impairing collagen degradation.Clinical Presentation and Physical Examination
Patients usually present with progressive symptoms like pain at the level of the A1 pulley (at the base of the finger), clicking, catching, and the finger might become “locked” in a flexed position at the proximal interphalangeal joint. Palpation of the hand reveals tenderness at the level of the A1 pulley (at the base of the finger) and a palpable nodule of the flexor tendon.Etiology
The etiology, which simply means the causes of trigger finger, is multifaceted and can be associated with specific comorbid diseases such as diabetes, rheumatoid arthritis, gout, thyroid disease, and carpal tunnel syndrome. Traumatic forces lead to hypertrophy (increase in cell size) and inflammation of the tendon and sheath, resulting in a catching and locking sensation due to the tendon’s inability to slide smoothly within its sheath.Treatment
Trigger finger can be managed in two ways—either by nonsurgical approaches, which involve steroid injection and splinting, or surgical interventions.Nonsurgical Procedures
1.Steroid Injections: Administering steroids into the tendon sheath is frequently an effective initial treatment approach for patients with trigger finger. This method is cost-effective, easily executed, and less invasive than surgery. While many patients may find relief with a steroid injection, there is a potential for symptom recurrence. Adverse effects of steroid injections may include tissue atrophy, skin discoloration, hypopigmentation, or infection. Prolonged symptoms are associated with a lower likelihood of resolution. 2.Splinting: Splinting is intended to limit tendon gliding and reduce inflammation. Utilizing a metacarpophalangeal (MCP) blocking splint set at 10° to 15° of flexion for a duration of 6 to 10 weeks is a common approach. However, its effectiveness is diminished for patients with severe or prolonged symptoms.Trigger Fingers FAQs
What is carpal tunnel syndrome?
Carpal tunnel syndrome is a condition caused by compression of the median nerve as it travels through the carpal tunnel in the wrist, leading to symptoms such as numbness, tingling, and weakness in the hand and fingers.
What is metaplasia of tendons?
Metaplasia of tendons refers to the abnormal transformation of tendon cells into a different type of tissue, often leading to dysfunction and pathological changes such as those seen in trigger finger.
What are flexor tendons of the hand?
Flexor tendons of the hand are tendons that connect the muscles of the forearm to the bones of the fingers and thumb, allowing for the bending and flexing of the fingers.
Why do steroids reduce inflammation?
Steroids reduce inflammation by inhibiting the immune system’s response to injury and decreasing the production of inflammatory chemicals. This helps to reduce swelling, pain, and tissue damage in conditions like trigger finger.
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