Flexor Stenosing Tenosynovitis Trigger Finger and Thumb

Kevin D. Plancher History and Clinical Presentation

A 45-year-old right hand dominant woman was seen in the office because her right middle finger was stuck in her palm. She reported that her family physician gave her an injection in that finger 6 months ago for her symptoms of clicking and pain over the dorsal aspect of her proximal phalanx of her middle finger. She denies any symptoms of diabetes, rheumatoid arthritis, gout, or connective tissue disorders.

Physical Examination

On examination the patient actively initiated extension of her middle finger but stopped with a short arc of motion because of pain. The patient withdrew her hand when passive extension was attempted because of pain. The hand and all digits have no signs of vascular compromise. The patient's two-point sensory discrimination, as determined by the Weber two-point discrimination test, using a dull pointed eye caliper applied in the longitudinal axis of the digit without blanching the skin, is within normal limits. A tender, palpable nodule is noted over the palmar surface of the second metacarpophalangeal (MP) joint (Fig. 29-1).

Diagnostic Studies

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