Question
A 56 year old diabetic woman,presented with pain in the distal palm and snapping sensation during flexion and extension of the ring finger.On examination,following picture is seen.Identify this condition.
A. Trigger finger
B. Carpal tunnel syndrome
C. Compound palmar ganglion
D. Compound palmar ganglion
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Correct Answer » A Explanation |
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Ans: A. Trigger finger
Trigger finger (stenosing tenosynovitis)
- The flexor tendon causes painful popping or snapping as the patient flexes and extends the digit.
- The patient may present with a digit locked in a particular position, most often flexion, which may require gentle, passive manipulation into full extension.
- TF results from thickening of the flexor tendon within the distal aspect of the palm.
- This thickening causes abnormal gliding and locking of the tendon within the tendon sheath.
- Specifically, the affected tendon is caught at the edge of the first annular (A1) pulley.
Etiology:
The exact etiology is still unknown, but it is thought that DM or autoimmune conditions may contribute to morphological changes in the pulley and/or the tendon sheath to cause triggering.
Systemic causes of TF are collagen-vascular diseases, including the following:
- RA
- DM
- Psoriatic arthritis
- Amyloidosis
- Hypothyroidism
- Sarcoidosis
- Pigmented villonodular synovitis
Septic causes of TF are secondary infections (eg, tuberculosis)
Signs and symptoms :
- Occurs two to six times more frequently in women than in men.
- Peak incidence of trigger digit to be in individuals aged 55-60 years.
- Locking during active flexion-extension activity (passive manipulation may be needed to extend the digit in the later stages)
- Stiff digit, especially in long-standing or neglected cases
- Pain over the distal palm
- Pain radiating along the digit
- Triggering on active or passive extension by the patient
- Palpable snapping sensation or crepitus over the A1 pulley
- Tenderness over the A1 pulley
- Palpable nodule in the line of the flexor digitorum superficialis (FDS), just distal to the metacarpophalangeal (MCP) joint in the palm
- Fixed-flexion deformity in late presentations, especially in the proximal interphalangeal (PIP) joint.
Treatment:
- Corticosteroid injection in the area of tendon sheath thickening.
- Custom-made splinting of the MCP joint.
- Surgical release of the A1 pulley, under local anesthesia.
