History and exam

Key diagnostic factors

common

location over and around a retinacular sheath

Locations of symptoms and signs of pain not directly over a retinacular sheath should direct attention to alternative diagnoses.[1][2]

pain increased with motion

Pain may be present without motion, but it should increase with active and passive motion. Motion is frequently restricted because of pain and/or locking.[1][2]

response to anesthetic injection

Appropriately placed anesthetic injection combined with corticosteroid should dramatically improve symptoms. If not, other diagnoses should be considered, including another stenosing tendinopathy in the area (de Quervain versus intersection syndrome/flexor carpi radialis tenosynovitis/trigger thumb/basilar thumb arthritis; extensor carpi ulnaris tenosynovitis versus triangular fibrocartilage complex).[1][2]

painful popping sensation with finger flexion and extension (trigger finger)

Trigger finger presents with painful catching or popping of the flexor tendon, which occurs as the patient flexes and extends the digit. The digit may be locked in flexion. Passive manipulation into extension may release the locking. Prolonged neglect can result in flexion contracture of the finger at the proximal interphalangeal joint.[3][6][7][8][10][11][12]

palpable nodule at the level of the metacarpal head (trigger finger)

A tender nodule or mass may be palpable at the level of the metacarpal head in the palm.[3][6][7][8][10][11][12]

pain, tenderness, and swelling localized to radial side of wrist (de Quervain disease)

de Quervain disease presents with pain, tenderness, and swelling localized to the radial side of the wrist 1 to 2 cm proximal to the radial styloid. It is aggravated by thumb movement. Pain is exacerbated by ulnar deviation of the wrist when the thumb is clasped in the palm (Finkelstein test).[2][5][9]​​[14][17][22]

pain and swelling proximal to wrist joint (intersection syndrome)

Intersection syndrome presents as pain and swelling 4 cm proximal to the wrist joint. In severe cases, redness and palpable crepitus ( that may sometimes be audible) are noted on exam. Pain is greatly increased by resisted wrist extension.[34]

pain, swelling, tenderness at Lister tubercle (extensor pollicis longus tenosynovitis)

Presenting features of extensor pollicis longus tenosynovitis. Thumb interphalangeal joint motion causes pain at Lister tubercle.[27][28]

ulnar-sided wrist pain (extensor carpi ulnaris tenosynovitis)

Ulnar-sided wrist pain, increased with all motions of the wrist, is suggestive of extensor carpi ulnaris tenosynovitis. Pain with extension/ulnar deviation against resistance is suggestive.[40][41]

pain at palmar wrist crease over scaphoid tubercle and along length of tendon (flexor carpi radialis tenosynovitis)

Suggestive of flexor carpi radialis tenosynovitis. Increased pain with resisted wrist flexion and radial deviation is pathognomonic. Localized swelling and a ganglion cyst may be present.[29]

Other diagnostic factors

common

symptom duration over weeks to months

Symptoms develop over weeks to months. Acute presentation should direct attention to other possible diagnoses.[1][2]

Risk factors

strong

age 50 to 60 years

Possible relationship to degenerative changes.[2][10][11]​​​[12][13]

female sex

Stenosing tendonopathies are far more common in women than in men.[3][5][6][7]​​[15][18]

history of current concomitant conditions with similar pathology (stenosing tendinopathy or neuropathy)

The same basic pathophysiology can present at the same or at different times, in different locations, with stenosing tendinopathy or neuropathy.[2][7][9]​​[12][21][22]

involvement of dominant hand

Possible relationship to degenerative changes.[2][3][7]​​[16]

insulin-dependent diabetes mellitus

For reasons that are not fully understood, the risk of trigger digit may be up to 5 times higher in people with insulin-dependent diabetes mellitus than in the general population.[23][24]​

pregnancy and lactation

Risk factor for de Quervain syndrome. Thought to be related to fluid shifts and increased demands with newborn care.[14]

weak

degenerative joint disease or trauma

Especially in extensor pollicis longus tenosynovitis (related to blunt trauma or nondisplaced distal radius fracture) and flexor carpi radialis tenosynovitis (related to basilar thumb arthritis).[25][26][27][28][29]

hyperlipidemia

One large population-based study identified hyperlipidemia as a potential risk factor for trigger digit.[30]

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