What are the typical symptoms and clinical presentation of trigger finger (stenosing flexor tenosynovitis)?

Symptoms of Trigger Finger

Trigger finger presents with painful locking or catching of the affected digit during active flexion or extension movements, often accompanied by a palpable nodule at the base of the finger and localized tenderness over the A1 pulley. 1, 2

Cardinal Clinical Features

Primary Symptom

• Finger locking or catching during active bending movement is the hallmark diagnostic feature, occurring as the flexor tendon catches on the thickened A1 pulley 2, 3
• The locking sensation may occur during either flexion or extension of the digit 4

Pain Characteristics

• Painful locking is typically present and represents the chief complaint 1, 5
• Pain localizes to the palmar aspect of the hand at the base of the affected finger, corresponding to the location of the A1 pulley 3
• Tenderness is reproducible with direct palpation over the A1 pulley region 3

Physical Examination Findings

• A palpable nodule may be felt at the base of the affected finger, representing the thickened flexor tendon or tenosynovium 3
• In advanced cases, patients may present with flexion deformity or complete inability to flex the finger 2
• The triggering phenomenon can often be reproduced during active finger flexion and extension on examination 4

Functional Impact

Progressive Nature

• Symptoms typically have an insidious onset and may progress over time 1
• Early cases may show intermittent catching, while advanced cases demonstrate persistent locking or fixed contracture 2, 4

Severity Spectrum

• Mild cases: Intermittent catching without significant functional limitation 4
• Moderate cases: Consistent triggering requiring passive manipulation to unlock the digit 4
• Severe cases: Fixed flexion contracture or inability to actively flex the finger, indicating earlier surgical consideration due to pain intensity and functional disability 2

Diagnostic Confirmation

Clinical Diagnosis

• The diagnosis is purely clinical in most cases and depends solely on the existence of finger locking during active bending movement 2
• Clinical assessment is usually adequate, though imaging may be employed when the clinical picture is uncertain 6

Imaging Considerations (When Needed)

• Ultrasound is the preferred imaging modality for confirming stenosing tenosynovitis when clinical uncertainty exists, as it allows dynamic real-time assessment of the superficially located flexor tendons 6
• Non-contrast MRI can accurately diagnose stenosing tenosynovitis when advanced imaging is required, though it is seldom necessary for uncomplicated cases 6

Common Pitfall to Avoid

• Do not confuse trigger finger with other causes of hand pain or stiffness—the specific catching or locking phenomenon during active digit movement distinguishes trigger finger from arthritis, tendinitis, or other hand pathologies 2, 3