Skip to main content
SpringerLink
Log in

MR imaging findings of trigger thumb

  • Case Report
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

Abstract

Trigger finger (or trigger thumb), also known as sclerosing tenosynovitis, is a common clinical diagnosis that rarely presents for imaging. Because of this selection bias, many radiologists may not be familiar with the process. Furthermore, patients who do present for imaging frequently have misleading examination indications. To our knowledge, magnetic resonance (MR) imaging findings of trigger thumb have not been previously reported in the literature. In this article, we review the entity of trigger thumb, the anatomy involved, and associated imaging findings, which include flexor pollicis longus tendinosis with a distinct nodule, A1 pulley thickening, and tenosynovitis. In addition, in some cases, an abnormal Av pulley is apparent. In the rare cases of trigger finger that present for MR imaging, accurate diagnosis by the radiologist can allow initiation of treatment and avoid further unnecessary workup.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

References

  1. Ryzewicz M, Wolf JM. Trigger digits: principles, management, and complications. J Hand Surg. 2006;31(1):135–46.

    Article  Google Scholar 

  2. Gorsche R, Wiley JP, Renger R, Brant R, Gemer TY, Sasyniuk TM. Prevalence and incidence of stenosing flexor tenosynovitis (trigger finger) in a meat-packing plant. J Occup Environ Med Am Coll Occup Environ Med. 1998;40(6):556–60.

    Article  CAS  Google Scholar 

  3. Ferree S, Neuhaus V, Becker SJ, Jupiter JB, Mudgal CS, Ring DC. Risk factors for return with a second trigger digit. J Hand Surg Eur Vol. 2014;39(7):704–7.

    Article  CAS  PubMed  Google Scholar 

  4. Guerini H, Pessis E, Theumann N, Le Quintrec JS, Campagna R, Chevrot A, et al. Sonographic appearance of trigger fingers. J Ultrasound Med Off J Am Inst Ultrasound Med. 2008;27(10):1407–13.

    Google Scholar 

  5. Makkouk AH, Oetgen ME, Swigart CR, Dodds SD. Trigger finger: etiology, evaluation, and treatment. Curr Rev Musculoskelet Med. 2008;1(2):92–6.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Saldana MJ. Trigger digits: diagnosis and treatment. J Am Acad Orthop Surg. 2001;9(4):246–52.

    CAS  PubMed  Google Scholar 

  7. Kapellusch JM, Garg A, Hegmann KT, Thiese MS, Malloy EJ. The strain index and ACGIH TLV for HAL: risk of trigger digit in the WISTAH prospective cohort. Hum Factors. 2014;56(1):98–111.

    Article  PubMed  Google Scholar 

  8. De la Parra-Marquez ML, Tamez-Cavazos R, Zertuche-Cedillo L, Martinez-Perez JJ, Velasco-Rodriguez V, Cisneros-Perez V. Risk factors associated with trigger finger. Case-control study. Cir Cir. 2008;76(4):323–7.

    PubMed  Google Scholar 

  9. Flatt AE. Notta’s nodules and trigger digits. Proc Bayl Univ Med Cent. 2007;20(2):143–5.

    PubMed Central  PubMed  Google Scholar 

  10. Clapham PJ, Chung KC. A historical perspective of the Notta’s node in trigger fingers. J Hand Surg. 2009;34(8):1518–22.

    Article  Google Scholar 

  11. Katzman BM, Steinberg DR, Bozentka DJ, Cain E, Caligiuri DA, Geller J. Utility of obtaining radiographs in patients with trigger finger. Am J Orthop. 1999;28(12):703–5.

    CAS  PubMed  Google Scholar 

  12. Gulabi D, Cecen GS, Bekler HI, Saglam F, Tanju N. A study of 60 patients with percutaneous trigger finger releases: clinical and ultrasonographic findings. J Hand Surg Eur Vol. 2014;39(7):699–703.

    Article  CAS  PubMed  Google Scholar 

  13. Vijayan R, Re ND, Gulabi D, Cecen GS, Bekler HI, Saglam F, et al. A study of 60 patients with percutaneous trigger finger releases: clinical and ultrasonographic findings. J Hand Surg Eur. 2014;39:699–703. J Hand Surg Eur Vol. 2015; 40(1):103.

    Article  Google Scholar 

  14. Zhao JG, Kan SL, Zhao L, Wang ZL, Long L, Wang J, et al. Percutaneous first annular pulley release for trigger digits: a systematic review and meta-analysis of current evidence. J Hand Surg. 2014;39(11):2192–202.

    Article  Google Scholar 

  15. Evans RB, Hunter JM, Burkhalter WE. Conservative management of the trigger finger: a new approach. J Hand Ther. 1988;1(2):59–68.

    Article  Google Scholar 

  16. Moore JS. Flexor tendon entrapment of the digits (trigger finger and trigger thumb). J Occup Environ Med Am Coll Occup Environ Med. 2000;42(5):526–45.

    Article  CAS  Google Scholar 

  17. Lu S-C, Su F-C, Zhao C, Thoreson AR, Jou IM, An K-N. Biomechanical aspects of trigger finger—which changed first, the pulley or the tendon? J Biomed Sci Eng. 2014;9(2):13-00237-00213-00237

  18. Sampson SP, Badalamente MA, Hurst LC, Seidman J. Pathobiology of the human A1 pulley in trigger finger. J Hand Surg. 1991;16(4):714–21.

    Article  CAS  Google Scholar 

  19. Drossos K, Remmelink M, Nagy N, de Maertelaer V, Pasteels JL, Schuind F. Correlations between clinical presentations of adult trigger digits and histologic aspects of the A1 pulley. J Hand Surg. 2009;34(8):1429–35.

    Article  CAS  Google Scholar 

  20. Lundin AC, Aspenberg P, Eliasson P. Trigger finger, tendinosis, and intratendinous gene expression. Scand J Med Sci Sports. 2014;24(2):363–8.

    Article  PubMed  Google Scholar 

  21. Lundin AC, Eliasson P, Aspenberg P. Trigger finger and tendinosis. J Hand Surg Eur Vol. 2012;37(3):233–6.

    Article  PubMed  Google Scholar 

  22. Sbernardori MC, Bandiera P. Histopathology of the A1 pulley in adult trigger fingers. J Hand Surg Eur Vol. 2007;32(5):556–9.

    Article  CAS  PubMed  Google Scholar 

  23. Uchihashi K, Tsuruta T, Mine H, Aoki S, Nishijima-Matsunobu A, Yamamoto M, et al. Histopathology of tenosynovium in trigger fingers. Pathol Int. 2014;64(6):276–82.

    Article  CAS  PubMed  Google Scholar 

  24. Schubert MF, Shah VS, Craig CL, Zeller JL. Varied anatomy of the thumb pulley system: implications for successful trigger thumb release. J Hand Surg. 2012;37(11):2278–85.

    Article  Google Scholar 

  25. Doyle JR, Blythe WF. Anatomy of the flexor tendon sheath and pulleys of the thumb. J Hand Surg. 1977;2(2):149–51.

    Article  CAS  Google Scholar 

  26. Bayat A, Shaaban H, Giakas G, Lees VC. The pulley system of the thumb: anatomic and biomechanical study. J Hand Surg. 2002;27(4):628–35.

    Article  Google Scholar 

  27. van Loveren M, van der Biezen JJ. The congenital trigger thumb—is release of the first annular pulley alone sufficient to resolve the triggering? Ann Plast Surg. 2007;58(3):335–7.

    Article  PubMed  Google Scholar 

  28. Hazani R, Elston J, Wilhelmi BJ. Transverse anatomic landmarks for the A1 pulley of the thumb. Hand. 2011;6(4):416–9.

    Article  PubMed Central  PubMed  Google Scholar 

  29. Boretto J, Alfie V, Donndorff A, Gallucci G, de Carli P. A prospective clinical study of the A1 pulley in trigger thumbs. J Hand Surg Eur Vol. 2008;33(3):260–5.

    Article  CAS  PubMed  Google Scholar 

  30. Hirschmann A, Sutter R, Schweizer A, Pfirrmann CW. MRI of the thumb: anatomy and spectrum of findings in asymptomatic volunteers. AJR Am J Roentgenol. 2014;202(4):819–27.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

Eric Y. Chang, MD, gratefully acknowledges grant support from the VA Clinical Science Research and Development Career Development Award (IK2CX000749)

Conflict of interest

No conflict of interest.

Author information

Authors and Affiliations

  1. Radiology Service, VA San Diego Healthcare System, 3350 La Jolla Village Drive, MC 114, San Diego, CA, 92161, USA

    Eric Y. Chang, Karen C. Chen & Christine B. Chung

  2. Department of Radiology, University of California, San Diego Medical Center, San Diego, CA, 92103, USA

    Eric Y. Chang, Karen C. Chen & Christine B. Chung

Authors
  1. Eric Y. Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Karen C. Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Christine B. Chung
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eric Y. Chang.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chang, E.Y., Chen, K.C. & Chung, C.B. MR imaging findings of trigger thumb. Skeletal Radiol 44, 1201–1207 (2015). https://doi.org/10.1007/s00256-015-2172-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-015-2172-y

Keywords

Search

Navigation