Trigger Finger

Home
About Us
- - About Us
  - About AMSSM
  - FAMSSM Designation
  - Awards
  - Founders
  - Past Presidents
  - Board of Directors
  - Committees
  - Contact Us
  - Bylaws/Policy & Committee Handbooks
- - FAMSSM Applications
  - Application submission is now closed for the 2025 Class of AMSSM Fellows. New Fellows will be announced to the AMSSM membership after the first of the year and honored at the 2025 Annual Meeting.
    
    Applications for the FAMSSM Designation will be available on an annual basis. Please contact Ellen Glasgow with any questions regarding the FAMSSM application.
- - We Understand You

Communications
- - Online AMSSM Community for Members
  - AMSSM Collaborate online community provides a forum for year-long connection, giving members the chance to have conversations, share resources and make connections with your peers.
- - AMSSM Informational Brochures
  - Find informational brochures about sports medicine physicians geared toward coaches, parents and other healthcare professionals.
Education
- - AMSSM Sports Medcasts
  - Find all current and past AMSSM Sports Medcast episodes in one convenient location.
- - AMSSM Fellow Online Lecture Series
  - The AMSSM National Fellow Online Lecture Series features talks from national experts on fundamental sports medicine topics pertinent to fellowship training and sports medicine board certification. Go to the collaborate.amssm.org site and view the available lectures in the Upcoming Events area.
Research
Advocacy
- - Legislative and Policy Issues
  - AMSSM is the go-to organization for legislative and policy issues related to sports medicine and athlete health and safety.
- - Legislation by State
  - AMSSM offers a variety of advocacy resources, including a map that tracks legislation important to sports medicine physicians.
Sports US
- - Sports Ultrasound Online Didactics
  - These 35 educational modules cover all of the didactic instructional session topics recommended for sports medicine fellows by the AMSSM.
- - Sports Ultrasound Committee
  - Find all the resources, materials and guidelines from the AMSSM Sports Ultrasound Committee
Patients
- - Need a Sports Medicine Physician?
  - FindADoc
- - SportsMedToday.com
  - Your comprehensive sports medicine resource for athletes, coaches and parents.
Additional Information
- - Additional Information
  - Sports Med Today
  - Journals
  - Weekly Digests
  - Store
  - Careers
  - Industry
Foundation

Trigger Finger

Authors, Editors, Case Information Author: Laura Mattson, DO Affiliation: Mayo Clinic Jacksonville Co Author(s): Raul Rosario-Concepcion, MD Senior Editor: Raul Rosario-Concepcion, MD Clinical Vignette: 73yo right hand dominant female presenting for months of intermittent triggering and locking of the ring finger. Dynamic triggering of the digit is appreciated on exam with active flexion and extension. Type of Probe Used: 3-16 megahertz linear hockey-stick transducer #1 - Image Short axis view of the of the flexor digitorum superficialis and flexor digitorum profundus tendons at the level of the metacarpophalangeal joint. #2 - Image Short axis view of the of the flexor digitorum superficialis and flexor digitorum profundus tendons at the level of the metacarpophalangeal joint. The A1 pulley is seen in long axis and is indicated by the arrows; the maximal A1 pulley thickness measured 0.75mm (see measuring line for reference on where to measure). #3 - Image Long axis view of the flexor tendons, short axis view of the A1 pulley. #4 - Image Long axis view of the flexor digitorum superficialis and flexor digitorum profundus tendons at the level of the metacarpophalangeal joint. The A1 pulley is seen in short axis and is indicated by the arrows. #5 - Video View Video The flexor tendons of the fourth finger are scanned in short axis from mid palm to the level of the mid-shaft of the proximal phalanx. The flexor digitorum superficialis (FDS) begins volar to the flexor digitorum profundus (FDP) in the midpalm. Immediately distal to the MCPJ, the FDS tendon divides into two but remains volar to the FDP tendon. Thereafter, the FDS tendon slips begin to dive dorsal to the FDP tendon and finally (not pictured) attach to the middle phalanx just distal to the proximal interphalangeal joint. #6 - Video View Video The flexor tendons of the fourth finger are scanned in long axis at the level of the metacarpophalangeal joint (MCPJ). The A1 pulley lies just volar to the flexor tendons at the level of the MCPJ. A needle is seen traversing distal to proximal to penetrate the flexor tendon sheath, where a mixture of local anesthetic and corticosteroid is injected with excellent intra-sheath flow. #7 - Video View Video Dynamic imaging of the fourth digit is performed at the level of the metacarpophalangeal joint with passive flexion and extension. The flexor digitorum superficialis (volar) and flexor digitorum profundus (dorsal) tendons are seen in long axis. There is selective hypoechogenicity and thickening of the flexor digitorum superficialis tendon just distal to the region of the A1 pulley. The flexor digitorum profundus tendon appears normal. The flexor tendons have difficulty passing under the A1 pulley with dynamic motion. Interpretation Image Interpretation: The FDS and FDP tendons are intact from mid palm to distal insertion. The FDS tendon in particular is thickened and hypoechoic just distal to the A1 pulley. With dynamic imaging of flexion and extension of the digit, the tendons, in particular those of the FDS, have difficulty passing under the A1 pulley. The A1 pulley was thickened at 0.75mm. These findings are consistent with stenosing tenosynovitis. Additional dynamic imaging is seen of the therapeutic flexor tendon sheath corticosteroid injection, with excellent intra-sheath flow Teaching Pearl: Note that the maximal A1 pulley thickness can be measured and compared against a diagnostic cutoff value of 0.62mm, with anything above this being considered thickened. This dimension is best measured in a long axis view of the pulley (short axis view to the tendon). See the following reference. Spirig A, Juon B, Banz Y, Rieben R, Vögelin E. Correlation Between Sonographic and In Vivo Measurement of A1 Pulleys in Trigger Fingers. Ultrasound Med Biol. 2016 Jul;42(7):1482-90. doi: 10.1016/j.ultrasmedbio.2016.02.017. Epub 2016 Apr 26. PMID: 27126241.
NOTE: For more information, please contact the AMSSM, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.

Back		Top

© The American Medical Society for Sports Medicine
4000 W. 114th Street, Suite 100
Leawood, KS 66211
Phone: 913.327.1415

Website created by the computer geek

Authors, Editors, Case Information

#1 - Image

#2 - Image

#3 - Image

#4 - Image

#5 - Video

#6 - Video

#7 - Video

Interpretation

UPCOMING EVENTS

FIND A SPORTS DOC