Trigger Finger — SCE Rheumatology MCQ

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EasySoft Tissue RheumatologyTrigger FingerSCE Rheumatology

A 50-year-old woman reports painful clicking and catching of her ring finger during movement. The finger occasionally locks in flexion and must be straightened using her other hand. Examination reveals focal tenderness and a palpable nodule over the A1 pulley. What is the diagnosis?

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Correct answer: D — Trigger finger

The diagnosis is trigger finger, caused by impaired gliding of the flexor tendon through the A1 pulley. The combination of painful clicking or catching, locking in flexion that can be passively corrected, and focal tenderness or a palpable nodule at the A1 pulley is characteristic. The ring finger is commonly affected. Dupuytren contracture produces palmar fascial nodules and cords with a progressive, usually fixed flexion contracture rather than reproducible tendon triggering. Flexor tendon rupture causes loss of active flexion, not locking during extension. An MCP dislocation would usually follow trauma and produce joint deformity, while a swan-neck deformity consists of PIP hyperextension with DIP flexion and does not cause an A1 pulley nodule.

Reference: Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust. Trigger Finger: What is a Trigger Finger and Thumb? May 2024. https://www.rjah.nhs.uk/media/heufaqwm/trigger-finger-hand-and-upper-limb-headley-court-screen-friendly.pdf