Stenosing tenosynovitis (also known as trigger finger or trigger thumb) is a painful condition caused by the inflammation (tenosynovitis) and progressive restriction of the superficial and deep flexors fibrous. Repetitive forceful compression, tensile stress, and resistive flexion, causes inflammation, swelling, and microtrauma, that results in thickening and stenosis (commonly a nodular formation) of the tendon distal to the pulley leading to a painful digital base, limitation of finger movements, triggering, snapping, locking, and deformity progressively.
Patients report a popping sound at the proximal interphalangeal joint (PIP), morning stiffness with/without triggering, delayed and sometimes painful extension of the digit, and when more advanced, a locking position that requires manipulation to extend the affected finger. This condition more commonly affects the middle and ring fingers (occasionally the thumb), and the flexor rather than extensor tendons in the hand.
In rheumatic trigger finger (or in diabetes), more than one finger may be involved. Cases of stenosing peroneal tenosynovitis, have been reported where the patient presents with pain over the lateral malleolus, both with active and passive range of motion and no physical of radiographic evidence of instability.
Stenosing tenosynovitis often presents with a painful and swollen thumb with limited range of motion, or a ring finger or middle finger with similarly limited motion. There is often a feeling of catching when the thumb is flexed. In the ring and middle fingers, often a nodule can be felt when you press the area of the hand where the palm meets the finger.
Stenosing tenosynovitis is most common caused by overuse from chronic repetitive activities using the hand or the involved finger. Examples include work activities (e.g., computer use, materials handling, hand surgeons) or recreational activities (e.g., knitting, golf, racket sports). Carpenters who use hammers suffer from this as well as those who continuously grip wood or other materials when cutting them due to having to use your hands as a clamp to hold things in place.
Primary stenosing tenosynovitis can be idiopathic, occurring in middle age women more frequently than in men, but can present also in infancy.
Secondary stenosing tenosynovitis can be caused by disease or entities that cause connective tissue disorders including the following:
Rheumatoid arthritis & psoriatic arthritis-therefore the clinician must assess the hands for rheumatologic deformities.
Systemic Lupus Erythematosus
Others causes may include the following:
Direct trauma to the site
During the postpartum period
Splinting, Non-steroidal anti inflammatory drugs (NSAIDs), and corticosteroid injections are regarded as conservative first-line treatments for stenosing tenosynovitis. However, NSAIDs have been found to be ineffective as a mono therapy. Early treatment of trigger thumb has been associated with better treatment outcomes. Surgical treatment of trigger thumb can be complicated by injury to the digital nerves, scarring, tenderness, or a contracture of the joint. A significantly higher rate of symptom improvement has been observed when surgical management is paired with corticosteroid injections when compared to corticosteroid injections alone.