In this section : Hand Pathways
Trigger Finger/Thumb
Osteoarthritis of the Hand/Thumb
Mallet Finger
Ganglion
Dupuytren’s Contracture
De Quervain’s Tenosynovitis
Carpal Tunnel Syndrome
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Trigger Finger/Thumb
Last updated 2nd December 2022
Signs/Symptoms
- Nodule at level of A1 Pulley (over Palmar MCPJ) – palpate this area and ask patient to flex – nodule usually obvious.
- Patient may feel a “CLICK”
- Locking may be actively correctable i.e. patient can force straight again, or passively correctable whereby need to pull straight with other hand.
- Nodules may be painful especially if in contact with objects in the palm as when gripping
Advice in Primary Care
- Spontaneous recovery may occur
- Try a finger splint as per information in advice sheet
- Avoid Prolonged flexion when gripping onto objects
- Try icing over nodule to reduce inflammation around tendon
- Activity modification – reduce repetitive tasks, take regular stretch breaks
Actions in Primary Care
- Issue Triggering Information Leaflet to patient and encourage to try a splint intermittently for 6 weeks
- Direct Patient to NHS Inform Website for further info
- Try steroid injection by appropriately trained Healthcare Practitioner if these skills are available in Surgery – if not refer to OT Hand clinic for injection (less successful in Diabetic Patients) Repeat only once if initial relief temporary
- Surgical release may be required if symptoms persist
Referral to Secondary Care
- If symptoms persist following 6-8 weeks of self management
- No Active Flexion / Finger completely locked in flexion or unable to initiate active flexion REFER VIA SCI GATEWAY TO OCCUPATIONAL THERAPY HAND CLINIC and INCLUDE FOLLOWING IN REFERRAL:
- Duration of symptoms
- Duration of self management inc splint
- Precipitating factors i.e. injury/trauma, occupation
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