Finger in spring

Specialty: Musculoskeletal.

• finger on trigger
• stenosing tenosynovitis of the flexor tendons
• nodular tenosynovitis

Why it occurs

• Thickening of the A1 hand pulley due to repetitive mechanical friction
• Diabetes mellitus (associated with collagen glycation)
• Rheumatoid arthritis (inflammation of the synovial sheath of the flexors)
• Occupational activities that require the use of tools with a sustained grip
• Hypothyroidism or systemic amyloidosis

Initial workup

Physical examination (palpation of a painful nodule on the A1 pulley that moves during movement) | Musculoskeletal ultrasound of the hand (assesses thickening of the A1 pulley and tendon slippage).

Standard management

• Naproxen — 250-500 mg every 12 hours orally for initial analgesic control
• Ultrasound-guided local infiltration of methylprednisolone — 10-20 mg directed to the peritendinous space under the A1 pulley; avoids surgery in a high percentage of cases
• Paracetamol (500 mg combined with 37.5 mg tramadol for severe pain during block).