gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

Trigger finger at the distal A2 pulley with extension locking of proximal interphalangeal joint: category of the idiopathic trigger finger

Meeting Abstract

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  • Chul-Hyung Lee - Daejeon Sun Hospital, Daejeon, South Korea
  • presenting/speaker Cheol-U Kim - Daejeon Sun Hospital, Daejeon, South Korea

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-1683

doi: 10.3205/19ifssh0272, urn:nbn:de:0183-19ifssh02722

Published: February 6, 2020

© 2020 Lee et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objectives/Interrogation: Trigger fingers are known to be caused by volume mismatching of th A1 pulley and flexor tendon. We experienced a A2 trigger finger with extension locking of the proximal interphalangeal joint.

Methods: A 44 year old man came to our hand clinic because of the triggering of the right ring finger, which began five years ago.Except triggering, the patient could not fully extension of the proximal interphalangeal joint, and flexion contracture of about five degrees was observed. On physical examination, the nodule was not obvious on the A1 pulley, but there was tenderness. We planned A1 pulley release. After axillary brachial plexus block, a tourniquet was applied and a 2 cm longitudinal skin incision was made on the A1 pulley area. Degenerative changes and abnormal findings of the A1 pulley, abnormal findings of the flexor tendon like nodule were not evident. Despite performing A1 pulley release, the flexion contracture was still observed. Full extension was possible only after giving excessive force, and it was kept locked in a state of hyperextension of two to three degrees of the proximal interphalangeal joint. When compressing the musculotendinous junction of the forearm, other fingers were naturally flexed, but the metacarpophalangeal joint of ring finger was flexed with locking on the proximal interphalangeal joint. In the hyperextension state, the proximal interphalangeal joint was manually flexed, and locking was released with snapping at about 90 degrees. Hyperextension locking was reproduced without improvement. In the operating room, we found a nodule like lesion moving along the flexor tendon during flexion-extension on the A2 pulley area. We explained to the patient that there may be a cause other than A1 pulley like A2 pulley or proximal interphalangeal joint problems. Additional incision was performed on the proximal interphalangeal joint area. When passive flexion of hyperextended finger was performed, the flexor digitorum profundus did not glide into the pulley at distal part of the A2 pulley and became bulged. We concluded that the triggering occur between the both slips of flexor digitorum superfisialis and the flexor digitorum profundus exiting the Camper's chiasm at the distal part of the A2 pulley.

Results and Conclusions: The hyperextension locking of proximal interphalangeal joint was disappeared after releasing distal 4mm of A2 pulley. There were no significant enlargement of flexor tendons and inflammatory findings around A2 pulley.