Article
Trigger wrist phenomenon: Why it is so rare? Presentation of 4 cases and Literature review
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Authors
Published: | October 19, 2004 |
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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.