ePlasty: Vol. 18
Acute Trigger Finger Presenting as an Extensor Lag
Stephen R. Ali, BM MMedSc (Hons), PGCME, MRCS(Eng), and Hussein Mohamedbahi, BM, MMedSc(Hons), MRCS(Eng)

Department of Plastic, Reconstructive and Burns Surgery, North Bristol NHS Trust, Bristol, United Kingdom

Correspondence: Stephen.Ali@nbt.nhs.uk
Keywords: stenosing tenosynovitis, trigger finger, extensor lag, steroid injection, management


A 75-year-old right-hand–dominant woman presented with pain and swelling of the left index finger and was unable to straighten the digit after forcibly turning the garden tap on. There was no history of triggering. On examination, there was a palpable nodule proximal to the A1 pulley and no active or passive extension at the metacarpophalangeal (MCP) joint. There was full extension at the proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints. X-ray study was unremarkable. She was managed with triamcinolone injection, which she responded to.


1. What is the anatomy of the digital pulley system?

2. What are the differential diagnoses of an extensor lag to a digit?

3. How are trigger fingers assessed and classified?

4. What non-surgical and surgical treatment options exist for a trigger finger?