Flexor tenosynovitis

Flexor tenosynovitis, or trigger finger, results from inflammation and thickening of the tendon sheath. This prevents the tendon from moving freely, and thus limits flexion and extension.

Epidemiology

About 20% of patients with diabetes will get flexor tenosynovitis, versus 2% of the general population. It usually affects the first, third or fourth digit of the right hand. Women are more frequently affected than men.

Diagnosis and treatment

Typical for the disease is the trigger finger: a flexion posture of the finger caused by the swelling of the tendon sheath, which the patient can initially overcome with some pain and effort. The disease is painful and often disabling. First line therapy is rest, if necessary by temporary splinting of the finger, so that the inflammation and swelling can subside. Local corticosteroid injections can also help, but their detrimental effects on glycaemic control have to be taken into consideraton. Also, the combination of diabetes and poor glycaemic control seems to increase the risk of recurrence. In severe cases surgery can be neccessary to release the tendon from the pressure of the swollen sheath.

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