Trigger wrist in adult. A case report.

Abstract

Background: One of common disorders in hand is trigger finger, but trigger wrist is an uncommon condition. Eibel in 1961 reported the trigger wrist. This condition gets obvious with finger or wrist flexion and extension and painful clicking or triggering of finger around carpal tunnel and can be associated with neuropathy and space occupying lesion or any other underlying condition the Objective of treatment is to achieve complete cure with surgical treatment in terms of functional and aesthetic improvement. Case: A 35 years old right handed housewife, presented to us in OPD with 1 year history of triggering at left wrist level. She had history of pain; with off and on clicking during flexion/extension of index finger of left hand. Pain had been increasing over the last 6 months. She underwent standard trigger finger surgery and release of left index finger A1 pulley four month ago but symptom was still present. Pre-operative ultrasonography showed irregular hypo echo mass at wrist that caused adhesion and inflammation at this area. After detail discussion, written informed consent was obtained and she underwent surgical treatment with zigzag incision under axillary block. Median never and all flexor tendons were identified. We found mass over FDP of left index finger that was stuck in carpal tunnel and caused snapping and clicking of left index finger. The other tendons were normal. After resection of occupying lesion of left index finger FDP and carpal tunnel release, there was free gliding of tendons at wrist level. Histopathological evaluation of the lesion turned out as fibroma of tendon sheath without evidence of inflammation and malignancy. After the discharge, physiotherapy was advised and patient was followed-up on weekly basis for 1st month then 2 weekly for 6 months. After the surgical treatment, there was free gliding of tendons at wrist level, under carpal tunnel, with complete functional and aesthetic improvement. Conclusion: Trigger wrist is an uncommon condition caused by space occupying lesion or any other associated pathology. Surgery is the mainstay of treatment that provides complete resolution of symptoms with functional and aesthetic improvement.