Is the swelling of fingers secondary to trigger finger visible?

Swelling in Trigger Finger: Clinical Manifestations and Diagnosis

Yes, swelling of fingers secondary to trigger finger is typically visible and is one of the key physical examination findings that helps establish the diagnosis.

Clinical Presentation of Trigger Finger

• Trigger finger presents with visible swelling at the base of the affected finger, particularly over the A1 pulley, which is a common finding during physical examination 1

• The swelling is due to inflammation and subsequent narrowing of the A1 pulley, causing the flexor tendon to catch or lock during finger movement 1, 2

• Ultrasonography can confirm the presence of swelling and is valuable for diagnosis, showing thickening of the tendon and surrounding tissues 3

Physical Examination Findings

• Visible nodule or swelling at the base of the finger (metacarpophalangeal joint level) that may be tender to palpation 2

• The swelling is often accompanied by other symptoms including:

  • Painful clicking or catching during finger movement 1
  • Locking of the finger in flexion, requiring passive extension 4
  • Limited range of motion in severe cases 2

Diagnostic Imaging

• Standard radiographs are typically normal in trigger finger but should be obtained to rule out fractures or other bony abnormalities 5

• MRI without IV contrast can be helpful in complex cases to evaluate both the tendon and surrounding soft tissue abnormalities 5

• Ultrasound examination using high-frequency probes has become an important part of the comprehensive assessment of trigger finger patients 2, 3

Differential Diagnosis

• When swelling occurs after injury near the base of a finger, partial laceration of the flexor tendon should be considered as a potential cause 3

• In patients with unusual demographics (e.g., younger patients), the cause may not be idiopathic, and evaluation methods such as x-rays and ultrasonography can help rule out other causes, such as tumors 6

• Other conditions to exclude include fracture, tumor, or traumatic soft tissue injuries that may present with similar symptoms 1

Clinical Pearls

• The visible swelling in trigger finger is an important diagnostic clue that helps distinguish it from other hand pathologies 1, 2

• In post-surgical cases of arteriovenous fistulas, swelling is common but typically resolves within the first week; persistent swelling requires further evaluation to exclude major outflow obstruction 7

• Ultrasound examination is particularly useful for confirming the diagnosis as it can visualize the thickened A1 pulley and any nodular changes in the flexor tendon 2, 3