Acquired triggering of the fingers and thumb in adults

#### What you need to know #### Search and selection criteria Articles and published textbooks were used based on the recommended reading list for the UK Diploma in Hand Surgery, which is run by the University of Manchester and the British Society of Surgery of the Hand. An additional PubMed search was performed to identify relevant articles based around the keywords “trigger finger,” “trigger thumb,” and “stenosing tenovaginitis,” filtering articles based on full text availability and English language. Search date 21 Dec 2016. Trigger finger and trigger thumb are common conditions presenting to primary care and specialist hand surgery clinics. This article seeks to explain the causes and clinical features of acquired triggering of the digit, and to describe the options and techniques for its management while discussing the evidence base behind them. The acquired trigger digit has a lifetime prevalence of 2%,1 requiring approximately 13 533 day case admissions for surgical release over a 12 month period in England.2 Primary care attendances are common, and incidence is estimated at 28 per 100 000 in the adult population.3 Trigger finger is synonymous with “tenosynovitis” and “tenovaginitis” in medical texts. Patients present with jerky movements, or visible “triggering” or “catching” of the digit. There might be painful crepitus over the flexor tendons in the distal palm, which is worse during movement. Early disease can present with a painful nodule at the base of the finger (Notta’s nodule)4 or isolated morning stiffness of an individual digit, while a locked digit …