Trigger finger / thumb
- Inflammation of the flexor sheath or tendon resulting in entrapment at the A1 pulley.
- Associated with diabetes, rheumatoid arthritis and amyloidosis.
- Patients typically complain of finger clicking, pain at the base of the finger and catching or locking of the finger.
- Examination may reveal a palpable nodule in the palm overlying the MPCJ with a catching sensation as the nodule enters the pulley, or a finger locked in flexion.
- Investigations are not required for treatment or prior to referral.
- Initial management is conservative.
- Explanation and advice.
- Up to 3 steroid injections 1 month apart may be given into the flexor sheath at the A1 pulley if skilled (50% success in diabetics and not recommended in the thumb due to risk of damage to digital nerves).
- Referral indications: Diagnostic uncertainty, referral for steroid injection, failure to respond to steroid injection, surgery required.