Synopsis
Distinguish stenosing flexor tenosynovitis from palmar fascial contracture and other causes of a stiff or catching digit, deliver staged non-operative care, and refer functional contracture or locked disease for the appropriate hand procedure.
- Trigger finger causes painful clicking, catching or locking at the A1 pulley near the metacarpal head; a tender mobile tendon nodule may be felt during flexion and extension.
- Dupuytren disease causes a usually painless palmar nodule and cord with progressive metacarpophalangeal or proximal interphalangeal flexion contracture, commonly affecting ring and little fingers.
- The tabletop test is positive when the patient cannot place the hand and fingers flat; functional impact and measured joint contracture, not the nodule alone, guide referral.
Key red flags
Fusiform swelling, flexed resting posture, sheath-line tenderness and pain on passive extension requires immediate hand-surgical assessment for pyogenic flexor tenosynovitis.
Investigation priorities
Observe tendon catching, locate the A1 pulley and distinguish a movable tendon nodule from a fixed fascial cord.
Management branches
Painful catching is intermittent and the digit is not fixed, infected or traumatically disrupted.
- Explain the pulley-tendon mismatch and temporarily reduce repetitive forceful gripping without immobilising the whole hand.
- Trial a suitable night or task splint and preserve comfortable active tendon glide.
Key medicines
Trigger-digit corticosteroid injectionUsing an aseptic trained local protocol, inject one dose such as triamcinolone acetonide 10 mg into the flexor-sheath region at the A1 pulley, avoiding intratendinous and digital neurovascular placement, then review before considering another intervention.
Topical diclofenac for short painful flaresSpread 2–4 g of diclofenac 1.16% gel over intact painful palmar skin per application, allowing at most three or four applications daily for a short period within the label limit.