Clinical Review

Management and referral for trigger finger/thumb

BMJ 2005; 331 doi: http://dx.doi.org/10.1136/bmj.331.7507.30 (Published 30 June 2005) Cite this as: BMJ 2005;331:30
  1. Sohail Akhtar ([email protected]), clinical/research fellow1,
  2. Mary J Bradley, research and postgraduate manager2,
  3. David N Quinton, consultant hand surgeon2,
  4. Frank D Burke, professor of hand surgery2
  1. 1 27 Belle Vue Avenue, Oakwood, Leeds LS8 2NN
  2. 2 Pulvertaft Hand Centre, Derbyshire Royal Infirmary, Derby
  1. Correspondence to: S Akhtar

    Introduction

    Trigger finger is a common cause of pain and disability in the hand. It is also the fourth most common reason for referral to the hand outpatient clinic and accounts for 1 in 18 of all referrals to our unit. The condition is, however, not solely managed by hand surgeons as it is often treated in the community and by specialist practitioners such as rheumatologists and endocrinologists who encounter it as a secondary manifestation of a primary systemic disorder. From a review of the literature we highlight the presentation of trigger finger, describe the processes involved in developing the condition, and rationalise the treatment options available. We have suggested guidelines and key points of note to aid practitioners in the management and referral of trigger finger and thumb in adults.

    Sources and search criteria

    We searched Medline and PubMed for relevant English language literature. We used the search terms “trigger finger” and “stenosing tenosynovitis.” We identified additional literature from the references of these papers.

    Presentation and progression

    Trigger finger presents with discomfort in the palm during movement of the involved digits. Gradually, or in some cases acutely, the flexor tendon causes a painful click as the patient flexes and extends the digit. The patient may present with a digit locked in a particular position, usually in flexion, which may need gentle passive manipulation into full extension. Spontaneous resolution of symptoms can occur in patients with trigger thumb.w1

    Epidemiology

    The condition has a reported incidence of 28 cases per 100 000 population per year, or a lifetime risk of 2.6% in the general population.1 This rises to 10% in patients with diabetes. Two peaks in incidence occur—the first under the age of eight and the second (more common) in the fifth and sixth decades of life. This bimodal distribution represents two different clinical groups, not only for …

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