Practice Clinical Updates

Acquired triggering of the fingers and thumb in adults

BMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j5285 (Published 30 November 2017) Cite this as: BMJ 2017;359:j5285
  1. Michael David, post-CCT senior fellow in hand surgery1,
  2. Madhav Rangaraju, general practitioner2,
  3. Andrew Raine, consultant orthopaedic surgeon3
  1. 1The Royal Orthopaedic Hospital, Birmingham, UK
  2. 2Princess Road Surgery, Withington, Manchester, UK
  3. 3The Royal Wolverhampton Hospitals Trust, New Cross Hospital, Wolverhampton, UK
  1. Correspondence to Michael David michaeldavid{at}nhs.net

What you need to know

  • The acquired trigger digit is a frequently presented upper limb pathology

  • Painful triggering might represent coexisting flexor synovitis (inflammation of the tendon)

  • A steroid injection is considered a first line treatment, and can be delivered in the primary care setting

  • Injections can be repeated, but surgical release is more reliable (particularly in those with diabetes)—prompting referral to a hand surgery service

Search and selection criteria

Articles and published textbooks were used based on the recommended reading list for the UK Diploma in Hand Surgery, which is run by the University of Manchester and the British Society of Surgery of the Hand. An additional PubMed search was performed to identify relevant articles based around the keywords “trigger finger,” “trigger thumb,” and “stenosing tenovaginitis,” filtering articles based on full text availability and English language. Search date 21 Dec 2016.

Trigger finger and trigger thumb are common conditions presenting to primary care and specialist hand surgery clinics. This article seeks to explain the causes and clinical features of acquired triggering of the digit, and to describe the options and techniques for its management while discussing the evidence base behind them.

The acquired trigger digit has a lifetime prevalence of 2%,1 requiring approximately 13 533 day case admissions for surgical release over a 12 month period in England.2 Primary care attendances are common, and incidence is estimated at 28 per 100 000 in the adult population.3 Trigger finger is synonymous with “tenosynovitis” and “tenovaginitis” in medical texts.

How does it present?

Patients present with jerky movements, or visible “triggering” or “catching” of the digit. There might be painful crepitus over the flexor tendons in the distal palm, which is worse during movement. Early disease can present with a painful nodule at the base of the finger (Notta’s nodule)4 or isolated morning stiffness of an individual digit, while a locked digit …

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