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Practice 10-Minute Consultation

Adult trigger finger

BMJ 2012; 345 doi: (Published 12 October 2012) Cite this as: BMJ 2012;345:e5743
  1. John Henton, clinical research fellow, plastic surgery1,
  2. Abhilash Jain, clinical senior lecturer and consultant plastic surgeon12,
  3. Claire Medhurst, general practitioner3,
  4. Shehan Hettiaratchy, consultant plastic surgeon and lead clinician1
  1. 1Hand and Extremity Reconstruction Service, Department of Plastic and Reconstructive Surgery, Imperial College Healthcare NHS Trust, London W6 8RF, UK
  2. 2Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
  3. 3Baddow Village Surgery, Chelmsford CM2 7EZ, UK
  1. Correspondence to: J Henton johnhenton{at}
  • Accepted 2 August 2012

A 62 year old diabetic woman complains of pain in the palm of her hand at the base of her ring finger, which is held in flexion. Extension is painful, produces an audible click, and often requires the assistance of the other hand.

What you should cover

Trigger finger is caused by inflammation and constriction of the retinacular sheath through which the flexor tendons run as they pass from the palm of the hand into the finger. This causes irritation of the tendon, sometimes resulting in the formation of a nodule, which impinges on the pulley, causing pain and restricting movement.

The retinacular sheath is composed of five annular “pulleys” which hold the tendon close to the bone and are integral to the biomechanics of finger flexion (figure). The A1 pulley, at the level of the metacarpal head, is the first part of the sheath and is subject to the highest force. Consequently, triggering usually occurs at this level.

Fig 1 Lateral view of a digit showing a simplified view the annular pulley system (A1-5), the flexor tendons with inflammatory nodule, and the passage of the needle for corticosteroid injection

The cause is often multifactorial. Trigger finger is most common in the sixth decade, women, people with diabetes, and the dominant hand.1


  • Symptom duration, frequency, and severity

  • Which digit(s) affected? Handedness?

  • Triggering is exacerbated by occupation, repetitive …

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