gms | German Medical Science

68. Jahrestagung der Deutschen Gesellschaft für Unfallchirurgie
90. Tagung der Deutschen Gesellschaft für Orthopädie und Orthopädische Chirurgie
45. Tagung des Berufsverbandes der Fachärzte für Orthopädie in Zusammenarbeit mit dem Deutschen Verband für Physiotherapie – Zentralverband der Physiotherapeuten/Krankengymnasten

19. bis 23.10.2004, Berlin

Trigger wrist phenomenon: Why it is so rare? Presentation of 4 cases and Literature review

Meeting Abstract (DGOOC 2004)

  • presenting/speaker D. Giannikas - Uni Klinik, Orthopaedische, Patra Griechenland
  • A. Papadopoulos - Uni Klinik, Orthopaedische, Patra Griechenland
  • A. Karabasi - Uni Klinik, Orthopaedische, Patra Griechenland
  • M. Tyllianakis - Uni Klinik, Orthopaedische, Patra Griechenland

Deutsche Gesellschaft für Unfallchirurgie. Deutsche Gesellschaft für Orthopädie und orthopädische Chirurgie. Berufsverband der Fachärzte für Orthopädie. 68. Jahrestagung der Deutschen Gesellschaft für Unfallchirurgie, 90. Tagung der Deutschen Gesellschaft für Orthopädie und Orthopädische Chirurgie und 45. Tagung des Berufsverbandes der Fachärzte für Orthopädie. Berlin, 19.-23.10.2004. Düsseldorf, Köln: German Medical Science; 2004. Doc04dguO7-1918

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgu2004/04dgu0845.shtml

Published: October 19, 2004

© 2004 Giannikas et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

Text

Introduction

The presentation of this rare phenomenon, and a new classification of its forms

Methods

Between 1998-2004, four patients were surgically treated for triggering of their wrists which was associated with median nerve pathology. All cases were Suematsu type I. The triggering was caused in 3 cases by a mass entering the carpal tunnel. The fourth case was a partial laceration of the profundus tendon of the little finger which had formed a fibrous nodule blocking its movement through the carpal tunnel.

There were all surgically removed and the tendons were repaired by tendon graft. Synovial tissue around median nerve was carefully removed. Physiotherapy followed for 6-10 weeks).

Results

The mean follow-up time was 3 years.No residual triggering or clicking was found so far. Median EMG studies were almost restored to normal. Range of motion of the affected fingers was finally satisfactory. Although rheumatic diseases can reform nodules or produce tendon ruptures, no recurrences were presented so far.

Conclusions

Triggering of the wrist can be eliminated in most cases by surgical means without any recurrence. Suematsu's classification is based on the implication of flexor compartment pathology in the triggering mechanism. We have found that literature reports indicate that more complex forms implicating extensor compartment pathology and carpal instability are also generating triggering mechanisms. We present our suggestion for a new classification which integrates all forms based on a case which was analyzed with radiocinematography.