Stenosing tenosynovitis, or otherwise known as “Trigger Finger”, occurs when thickening or nodule formation prevents the flexor tendon from gliding within its sheath, catching at the site of the first annular pulley.
The grading of trigger finger includes:
- Grade 1: Pretriggering – there is pain and catching and tenderness over the first annular pulley.
- Grade 2: Active – there is catching, but full active range of motion (ROM)
- Grade 3: Passive
- 3A: locking with passive ROM
- 3B: unable to actively flex
- Grade 4: Contracture – demonstrates catching and a fixed flexion deformity of PIP joint
Trigger finger occurs more commonly in persons with repetitive use injuries, diabetes, rheumatoid arthritis, carpal tunnel syndrome, dupuytren disease, amyloidosis, hypothyroidism, mucopolysaccharide storage disorders, and congestive heart failure.
Patients with this condition may present with palmar pain and difficulty with finger flexion and extension, with a locking, popping sensation as the tendon slides through the tight area
Conservative management options include rest, nonsteroidal antiinflammatory medications for pain and inflammation, splinting, and injection therapy with corticosteroids or PRP.
If conservative management fails, surgical management could be an option. Surgery includes a small incision in the palm where the first annular pulley is incised.