By :

Nadia H. Djibran
12.16.777.14.134

Pembimbing :
Dr. Muh. Ardi Munir, Sp. OT

KEPANITRAAN KLINIK ILMU BEDAH

FAKULTAS KEDOKTERAN UNIVERSITAS ALKHAIRAAT PALU
 Triggier Finger is..
 Tenosynovitis is characterized by inflammation
involving the synovial sheath of a tendon.

 Stenosing forms of tenosynovitis are peculiar entities

influenced by various factors, anatomical, mechanical,
and in some cases hormonal.

 Characterized by sometimes painful snapping or

locking when flexing the finger.
Anatomy
 Epidemiology
 Primary trigger finger occurs most commonly in the
middle fifth to sixth decades of life and up to 6 times
more frequently in women than men
 The lifetime risk of trigger finger development is
between 2 and 3%, but increases to up to 10% in
diabetics
 The ring finger is most commonly affected, followed by
the thumb (trigger thumb), long, index, and small
fingers in patients with multiple trigger digits
 Etiology
 Repetitive finger movements and local trauma are
possibilities with such stress and degenerative force also
accounting for an increased incidence of trigger finger in
the dominant hand
 There are reports linking trigger finger to occupations
requiring extensive gripping and hand flexion, such as
use of shears or hand held tools
 Higher risk group: carpal tunnel syndrome, de
Quervain’s disease, hypothyroidism, rheumatoid
arthritis, renal disease, and amyloidosis.
Patophysiology

 Schematic of osseofibrous tunnels. Thickening of the

retinaculum or the pulley exerts a constrictive effect on the
tendon.
 Nodule found at
the distal of A1
pulley, so the
finger is locked at
extension
position

Nodule found at
the proximal of A1
pulley, so the
finger is locked at
flexion position
Classification
Clinical presentation
 The initial complaint: a painless clicking with digital
manipulation.
 Further development of the condition: catching or
popping to become painful with both flexion and
extension, and be related as occurring at either the
metacarpophalangeal (MCP) or PIP joints.
 Feeling of stiffness and then progressive loss of full
flexion and/or extension of the affected digit without
ever developing the catching and locking of a ‘‘typical’’
trigger finger.
 Prompt examination

 A, B. Longitudinal (A) and transverse (B) sonograms of the first finger show
hypoechoic thickening of the A1 pulley (arrows). The underlying flexor
tendon is typically swollen and has a more rounded appearance when viewed
in a cross-section. C. Longitudinal sonogram of the third finger shows the A1
pulley (arrows) with diffuse hypoechoic thickening and flexor tendon
abnormalities, including fluid collection (arrowheads) along the tendon
sheath. MC, metacarpal bone; MP, middle phalanx; PP, proximal phalanx.
 USG findings may show diffuse hypoechoic thickening
of the A1 pulley and underlying flexor tendon
abnormalities suggestive of tenosynovitis. The affected
tendons are typically swollen and appear rounder in
cross-sectional views under the thickened pulley than
the other fingers. In addition, dynamic US can
visualize the locking and snapping of the flexor
tendon at the MCP level
Treatment
Clinical photograph demonstrating the proper site for a trigger
finger injection. (A1: location of the A1 pulley, NV: location of
the neurovascular bundle flanking the A1 pulley).
(a) Intra-operative photo showing a thickened A1 pulley
prior to release. (b) Once the A1 pulley is released the
flexor tendons can be lifted out of the wound
Complication
The complications are painful and functional
disturbance of the affected finger such as holding a
thing, typing, writing, and etc.
Prognosis
 The prognosis is very good, most of the patients have
good respond towards corticosteroid injection with or
without splinting. In some cases, it can heal
spontaneously and recurrent without any clear
corelation with treatment or risk factors.