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Digital Flexor Tendinitis and Tenosynovitis (Trigger Finger)

(Stenosing Flexor Tenosynovitis)

By

David R. Steinberg

, MD, Perelman School of Medicine at the University of Pennsylvania

Last full review/revision May 2020| Content last modified May 2020
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Digital flexor tendinitis and tenosynovitis are inflammation, sometimes with subsequent fibrosis, of tendons and tendon sheaths of the digits.

Digital flexor tendinitis and tenosynovitis are idiopathic but are common among patients with rheumatoid arthritis Rheumatoid Arthritis (RA) Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease that primarily involves the joints. RA causes damage mediated by cytokines, chemokines, and metalloproteases. Characteristically... read more Rheumatoid Arthritis (RA) or diabetes mellitus Diabetes Mellitus (DM) Diabetes mellitus is impaired insulin secretion and variable degrees of peripheral insulin resistance leading to hyperglycemia. Early symptoms are related to hyperglycemia and include polydipsia... read more . Repetitive use of the hands (as may occur when using heavy gardening shears) may contribute. In diabetes, they often coexist with carpal tunnel syndrome Carpal Tunnel Syndrome Carpal tunnel syndrome is compression of the median nerve as it passes through the carpal tunnel in the wrist. Symptoms include pain and paresthesias in the median nerve distribution. Diagnosis... read more and occasionally with fibrosis of the palmar fascia. Pathologic changes begin with a thickening or nodule within the tendon; when located at the site of the tight first annular pulley, the thickening or nodule blocks smooth extension or flexion of the finger. The finger may lock in flexion, or “trigger,” suddenly extending with a snap.

Treatment of Digital Flexor Tendinitis and Tenosynovitis

  • Conservative measures

  • Sometimes corticosteroid injection

  • Sometimes surgery

If these measures fail, injection of a corticosteroid suspension into the flexor tendon sheath, along with splinting, may provide safe, rapid relief of pain and triggering. Operative release can be done if corticosteroid therapy fails.

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