Trigger Finger

Welcome to Texas State University's Evidence-based Practice project space. This is a wiki created by and for the students in the Doctor of Physical Therapy program at Texas State University - San Marcos. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!

Original and Lead Editors - Holly Pulket, Hilary Zachary, Angela Dempski, Dana Williams, Shannon Davis

Search Strategy

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Definition/Description

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Epidemiology/Etiology

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Characteristics/Clinical Presentation

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Differential Diagnosis

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Outcome Measures

NPRS, Open& Close Hand 10 Times, Stages of Stenosing Tenosynovitis, Participant Perceive Improvement in Symptoms, Grip Strength (Jamar dynameter) (Colbourn et. al) DASH
(need charts for Stages of Stenosing Tenosynovitis & Participant Perceive Improvement in Symptoms)

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Examination

Hx: recent trauma to the area may be reported (Makkouk). Job related repetitive movements. A history of locking or snapping while flexing or extending the affecter finger or thumb. (Harvard womens health watch)Patient might complain of a snapping sensation that causes pain that radiates to the palm or toward the end of the finger or thumb. (Harvard Women’s Health Watch)
     PMH: Diabetes have an almost 4-fold increased risk for developing trigger finger (Harvard Women’s Health Watch) and Rheumatoid Arthritis; Associated with disorders that cause connective tissue changes such as RA, Gout, and Diabetes (Colbourn et al).
Observation: may present with a digit locked in flexion; boney proliferative changes could be seen in the subadjacent distal phalangeal joint (Howitt et al)
Palpation: painful nodule in the palmar MCP area as a result of intratendinous swelling (Makkouk et al)
ROM: Loss of motion should be seen in the affected finger with patient unable to fully extend finger.
MMT: Muscles involved are Flexor Digitorum Profundus and Flexor Digitorum Superficialis, if the finger is locked in place it would be impossible to test. Gripe strength may be measured utilizing the Jamar Dynameter. (Colbourn et al)
Joint Accessory Mobilization: Secondary to the development of PIP contracture and digital stiffness, joint mobility of all the effecting digits should be assessed, especially PIP joint (Makkouk et al). Most cases are secondary to thickening of the digits A-1 pulley but other pulley sights , the MCP joint or the Carpal Tunnel can be involved. As a result a consideration of these areas and surrounding tissues is reasonable and should be considered in a complete assessment.(Howitt et al) Wrist joint accessory mobilization can be beneficial for digit pathologies. (Boucher)
Special Test:
Open and Close hand 10x- Ask patient to actively make ten fists. The number of triggering events in ten active full fists was then scored out of 10. If participant’s finger remained locked at any time they were to stop and given a score of 10/10. (Colbourn et al)

Medical Management

Video courtesy of the American Society for Surgery of the Hand

Physical Therapy Management

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Key Research

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Resources

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Clinical Bottom Line

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Recent Related Research (from Pubmed)

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References

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