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Extensor digitorum tendon
1%
41/5003
Grayson's ligament
2%
102/5003
Oblique retinacular ligament
52/5003
A1 pulley
95%
4769/5003
Transverse carpal ligament
0%
11/5003
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The scenario listed above points to a diagnosis of trigger finger. In this condition, the disparity in size between the flexor tendon and the surrounding retinacular pulley system, most commonly at the level of the first annular (A1) pulley, results in difficulty flexing or extending the finger and the “triggering” phenomenon. Metacarpophalangeal locking should be included in the differential, where the collateral ligament or volar plate tethers on a prominent metacarpal head or osteophyte. The referenced text notes that a series of two corticosteroid injections should be given before surgery is considered for A1 pulley release. Mention is also made of the possibility of diabetics being more resistant to injections, with surgical release being a cost-effective treatment for this patient population. Illustration A shows the clinical appearance of this disorder.
3.8
(32)
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