CASE DISCUSSION

By : Chathiya Banu
49 Y/O INDIAN MALE, U/L
DM FOR 6 YEARS
Presented with swelling on right ring
finger for 1 month
HISTORY OF PRESENTING ILLNESS

Swelling
 Progressive

 No skin discoloration/bleeding/pus

 + tenderness along finger & palm of hand (extension)

 P/s : 3/10

 Aggravated while lifting objects

 Slightly affected his daily activities : Lorry driver,

unable to grasp objects (pain)

 Right hand dominant
Patient also complains of :
 Locking of fingers in bent position

 Stiffness of fingers, worsens in morning

Otherwise,

 No hx of trauma to finger
 Other fingers are normal
 No numbness/weakness of hand
 No knee/wrist/back afdpin
 No mass noted
PAST MEDICAL HISTORY
 DM for 6 years, under metformin

PAST SURGICAL HISTORY,

ALLERGY
Irrelevant
FAMILY HISTORY
 No hx of rheumatoid arthritis

SOCIAL HISTORY
Irrelevant
 PHYSICAL EXAMINATION : HAND

LOOK

 Slight swelling of 4th digit

 No deformities, not in fixed flexed position
 No skin/nail bed changes, no discoloration
 No hypothenar/thenar wasting
 No contracture
 No nodules
FEEL

 Normal temperature of both hands, equally warm

 Normal muscle bulk of thenar & hypothenar
 No palmar thickening
 Radial pulse present, 80 bpm
 CRT < 2 sec
 No tenderness at 4th MCP / Dip, wrist joints,
anatomical snuffbox
 Sensory of C6, C7, C8, T1 : intact
MOVE

 Normal active and passive ROM wrist extension & flexion

 No crepitus
 Finger locking upon active flexion, requires passive extension
 Tenderness upon passive extension noted
 Normal abduction & adduction against resistance
 Normal thumb abduction
 Power : 5/5 both hands
 Pincer grip : Normal
 Tinel’s sign : - ve
 Phalanx sign : - ve
 DIAGNOSIS
Trigger finger

INVESTIGATIONS

NIL
MANAGEMENT PLANS
 1st line : Physiotherapy exercises, rest& splint (6
weeks)  Follow up in 3 months
- Splintage (MCP) : allow synovitis resolve (Akhtar
et.al, 2005)
 No evidence proved the benefit of NSAID (except
for temporary ain relief)
 Steroid injection : high efficacy (nodule), reduced

to 50% of efficacy in recurrring cases (BMJ, 2005)

 Percutaneous trigger finger release (daycare
OT)
 Success rate 90%

 Rare complications : infection, hematoma,

persistent pain, digital nerve injury

 Recurrence/ recalcitrant  open surgery ( high

complication risks ; nerve injury, tendon sheath

infection, inadequate release)
DISCHARGE PLAN

 From ward : on the day of procedure

 From clinic : patients ROM improved, no post op
side effects like contracture.