Digital Flexor Tenosynovitis

Tenosynovitis of a digital flexor tendon, also called "trigger finger," is quite common. Patients present with the complaint of a finger that "sticks" with motion, primarily flexion, and they must painfully force the finger back into extension. Usually, a painful palpable nodule on the flexor tendon is present along the distal palmar crease or at the base of the thumb, at the level of the metacarpophalangeal (MCP) joint (Fig. 30-20). Motion and activities may be associated with pain. Radiographs and other diagnostic tests are not needed to make an accurate diagnosis.

Treatment options for digital flexor tenosynovitis include anti-inflammatory medications, modification of activities, ice, massage, stretching of the flexor tendons, and gentle-grip strength exercises, although these usually provide little relief. Corticosteroid injections are often used to relieve pain and triggering symptoms (Marks and Gunther , Peters-Veluthamaningal et al., 2009b). Symptoms may return, and repeat injections are considered if the first injection provided reasonable pain relief. However, surgery may be needed in patients with frequent recurrence.

Figure 30-21 A, Disruption of scapholunate and radiocarpal ligaments leads to progressive dissociation between scaphoid and rest of carpal bones. This injury is frequently mistaken for a persistent wrist sprain. B, Chronic dissociation of scapholunate joint allows scaphoid to rotate downward toward the palm. This increases the angle between scaphoid axis and radiolunate-capitate axis. The capitate then slowly migrates toward the radius, and osteoarthritis rapidly develops.

(From Connolly JF: DePalma's The Management of Fractures and Dislocations: an Atlas, 3rd ed. Philadelphia, Saunders, 1981.)

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