Quick On The Trigger: Finger Pain That Masked An Underlying Problem - Page #1

Author: Tyler Adamson, DO
Co Author #1: Michelle Mullins, MD
Senior Editor: Carolyn Landsberg, MD
Editor: Jessalynn Adam, MD

Patient Presentation:
42-year-old right handed male presented with left sided hand pain and inability to straighten his finger. Three weeks prior to presentation, the patient noted a flexion deformity of his left 4th digit. His pain progressed to the 3rd-5th digits over the subsequent 1-2 weeks. One week prior to presentation, he developed left sided medial wrist pain. The pain was described as a constant, vague, aching. The pain was localized around the metacarpophalangeal joints of digits 3-5. He has worked as a mechanic for the past 12 years and continued despite the pain. He noted limitation in his grasping ability at work.
He denied numbness or tingling, cyanosis, atrophy, swelling, warmth of the affected extremity, elbow pain, or neck pain.

Past medical history was notable for tobacco use for the past 23 years and hypertension. Surgical history was notable for left sided open reduction and internal fixation of an olecranon fracture following a motor vehicle accident 5 years prior to presentation.

Physical Exam:
General appearance: alert, well-appearing, no acute distress
Gait and station: normal.
Neck: Full range of motion. (-)Spurling's testing

Left Extremity:
Skin intact
Wrist ROM: full flexion, extension, pronation, and supination
Triggering of the 4th finger at the level of A1 pulley with palpable lump.
Triggering of the 3rd finger in the palmar aspect of the hand.
Absent ulnar pulse on the left wrist
Foveal tenderness appreciated

Special Tests(Left-sided):
(+) Tinel's sign at wrist, (+) Tinel's sign at elbow.
(-) Median nerve compression.
(+) Allen Test

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