Location via proxy:   [ UP ]  
[Report a bug]   [Manage cookies]                
Scribd Logo
Upload

Welcome to Scribd!

  • 29 views

    Trigger Finger: By:Ida Yuanita, MD

    Uploaded by

    Anang Fajar
    A 56-year-old man presented with a trigger finger in his left middle finger for 4 months. He had difficulty extending the finger and needed help to do so, with an audible clicking. He also had pain in the finger with movement. Examination found tenderness over the MCP joint of the left middle finger with difficulty extending and a snapping sensation. He was diagnosed with trigger finger of the left middle finger and planned for ultrasound therapy and a home exercise program.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd

    Trigger Finger: By:Ida Yuanita, MD

    Uploaded by

    Anang Fajar
    29 views33 pages
    A 56-year-old man presented with a trigger finger in his left middle finger for 4 months. He had difficulty extending the finger and needed help to do so, with an audible clicking. He also had pain in the finger with movement. Examination found tenderness over the MCP joint of the left middle finger with difficulty extending and a snapping sensation. He was diagnosed with trigger finger of the left middle finger and planned for ultrasound therapy and a home exercise program.

    Original Title

    TF

    Copyright

    © Attribution Non-Commercial (BY-NC)

    Available Formats

    PPT, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    A 56-year-old man presented with a trigger finger in his left middle finger for 4 months. He had difficulty extending the finger and needed help to do so, with an audible clicking. He also had pain in the finger with movement. Examination found tenderness over the MCP joint of the left middle finger with difficulty extending and a snapping sensation. He was diagnosed with trigger finger of the left middle finger and planned for ultrasound therapy and a home exercise program.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    29 views33 pages

    Trigger Finger: By:Ida Yuanita, MD

    Uploaded by

    Anang Fajar
    A 56-year-old man presented with a trigger finger in his left middle finger for 4 months. He had difficulty extending the finger and needed help to do so, with an audible clicking. He also had pain in the finger with movement. Examination found tenderness over the MCP joint of the left middle finger with difficulty extending and a snapping sensation. He was diagnosed with trigger finger of the left middle finger and planned for ultrasound therapy and a home exercise program.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 33

    TRIGGER FINGER

    By :Ida Yuanita, MD

    Background:
    TF results from thickening of the flexor tendon within the distal aspect of the palm abnormal gliding of the tendon within tendon sheath. Specifically the affected tendon is caught at the edge of the 1st Annular (A1) pulley

    Pathophysiology: Normally the tendon of the finger flexors glide back and forth under a restraining pulley Thickening of the flexor tendon sheath restriction of the normal gliding mechanism

    Flexor tendons pass within the tendon sheath and beneath the A-1 pulley at approximately the metacarpal head, beyond which they travel into the digit

    An inflamed nodule can restrict the tendon from passing smoothly beneath the A-1 pulley. If the nodule is distal to the A-1 pulley (as shown in this sketch), then the digit may get stuck in an extended position. Conversely, if the nodule is proximal to the A-1 pulley, then the patient's digit is more likely to become stuck in the flexed position.

    Etiology:
    Systemic causes of TF are collagenvascular diseases, including RA, DM, hypothyroidism Septic causes of TF are secondary infections (eg, tuberculosis). Idiopathic: nodule or pulley morphology change.

    Symptoms & Signs: Locking during active flexion-extension activity (Passive manipulation may be needed to extend the digit in the later stages.) Stiff digit, especially in long-standing or neglected cases Pain over the distal palm Pain radiating along the digit

    Palpable snapping sensation or crepitous over the A1 pulley Tenderness over the A1 pulley Palpable nodule in the line of the FDS, just distal to the MCP joint in the palm Fixed-flexion deformity in late presentations, especially in the PIP joint

    Lab & imaging studies: not needed

    Treatment: Rehabilitation program rest, physical modalities, orthesa, exercise and prevention Medical analgesic drugs, corticosteroid injection Surgical intervention excision of the nodule

    Data Base Identity


    Name Age Address Occupation Status Religion : Mr. M : 56 y.o. : Sby : pensioner of an administrative employee :married : Moslem

    Patient was referred from Neurology Outpatient clinic with Trigger Finger digiti III manus S + DM

    Chief complain : Jari tengah tangan kiri sulit diluruskan History of Present illness The middle finger of his left hand was difficult to extend after flexing of the finger for 4 months It was needed a help of the other hand to extend the affected finger and there was a clicking sound if the finger flexed

    He also complains of pain of the middle finger especially if it moved but there was no numbness, tingling sensation and weakness of her hand. He feels difficult to hold / lift with his left hand, eg : for washing clothes, lifting buckets, etc.

    History of past illness


    Diabetes melitus (+), was known 2 weeks ago, controlled. GDA=210 Hyperuricemia (+) Trauma (-)

    Physical Examination
    General Examination (10/09/09) CM, ambulatory independent, gait N, right handed BP : 120/70 mmHg, HR : 88 x/minute Weight : 61 kg ; BH : 165 cm, BMI=22,4

    Head & Neck : no anemia, icterus, cyanosis & dyspneu Thorax : Cor : S1S2 sound, murmur Pulmo : vesiculer, wheezing -/, ronchi -/ Abdomen : Meteorismus -, Hepar / Lien : unpalpable Extremities : warm acral

    Physiatric Examination
    Cervical Flexion Extension Lateral Flexion Rotation Trunk Flexion Extension Lateral Flexion Rotation ROM F (0-450) F (0-450) F/F (0-450) F/F (0-600) ROM F(0-450 ) F (0-300) F/F (0-350) F/F (0-450) MMT 5 5 5/5 5/5 MMT 5 5 5/5 5/5

    Shoulder Flexion Extension Abduction Adduction Ext. Rotation Int. Rotation Elbow Flexion Extension Forearm supination

    ROM F/F (0-1800) F/F (0-800) F/F (0-1800) F/F (0-450) F/F (0-450) F/F (0-550) ROM F/F (0-1500) F/F (1500-0) F/F (0-800)
    0

    MMT 5/5 5/5 5/5 5/5 5/5 5/5 MMT 5/5 5/5 5/5

    Wrist Flexion Extension Radial deviation Ulnar deviation Fingers Flexion MCP PIP DIP Extension

    ROM F/F (0-800) F/F (0-700) F/F (0-200) F/F (0-300) ROM F/F (0-900) F/F (0-1000) F/F (0-900) F/F (0-450)
    0

    MMT 5/5 5/5 5/5 5/5 MMT 5/5 5/5 5/5 5/5

    Thumb Flexion MCP IP Extension Abduction Adduction Opposition

    ROM F/F (0-500) F/F (0-900) F/F (0-900) F/F (0-500) F/F (500-0)

    MMT 5/5 5/5 5/5 5/5 5/5 5/5

    Hip Flexion Extension Abduction Adduction Ext. Rotation Int. Rotation Knee Flexion Extension

    ROM F/F (0-1250) F/F (0-300) F/F (0-450) F/F (0-200) F/F (0-800) F/F (0-800) ROM F/F (0-1350) F/F (1350-0)

    MMT 5/5 5/5 5/5 5/5 5/5 5/5 MMT 5/5 5/5

    Ankle Plantar Flexion Dorsi Flexion Inversion Eversion Toes Flexion MTP IP Extension

    ROM F/F (0-450) F/F (0-300) F/F (0-350) F/F (0-250) ROM F/F (0-300) F/F (0-500) F/F (0-800)

    MMT 5/5 5/5 5/5 5/5 MMT 5/5 5/5 5/5

    Big Toe Flexion MTP IP Extension

    ROM F/F (0-250) F/F (0-250) F/F (0-800) 5/5

    MMT

    5/5 5/5

    Neurological Examination Cranial nerve I-XII : normal Physiological Reflex: BPR +2/+2 KPR +2/+2 TPR +2/+2 APR +2/+2 Pathological Reflex : Babinski -/- HT -/ Sensory deficit :-

    Localize status : digiti III Manus Sinistra I : swelling -, redness -, deformity A difficulty in extending MCP digiti III manus sinistra P : tender point at MCP digiti III manus sinistra Nodule -, clicking snap + at digiti III manus sinistra, Crepitous -

    Diagnosis

    : Trigger finger digiti III manus sinistra

    Functional diagnosis : Impairment : Trigger finger digiti III manus sinistra Disability : difficult to lift / hold with his left hand Handicapped:-

    Problem List : Surgical : Medical : Trigger finger digiti III manus sinistra Diabetes Mellitus Rehabilitation medicine R1 (Ambulation) : R2 (ADL) : lift / hold objects with left hand R3 (Communication) : R4 (Social) : R5 (Psychological) :-

    R6 (Vocational) R7 (Others)

    :: Trigger finger dig.III manus S Pain (VAS 3)

    Planning : Surgical : Medical : continue the medication from internal department Rehabilitation medicine : PDx : PTx : USD at area of MCP dig.III manus S ; Freq. 3 MHz, mode pulsed, pulse duration 4 ms, intensity 0.75-1 W/cm2 duration of treatment 6 minutes PMx : Patient complain PEX : HE / HEP

    Summary
    Reporting a 56 y.o man patient, was referred from Neurologic oupatient clinic with trigger finger dig. III manus sinistra and diabetes with chief complain his middle finger was difficult to extend after flexing of the finger for 4 months. It was needed a help of the other hand to extend the affected finger and there was a clicking sound if the finger flexed. He also complains of pain of the middle finger especially if it moved but

    there was no numbness, tingling sensation and weakness of her hand. He feels difficult to hold / lift with his left hand, eg : for washing clothes, lifting buckets, etc. Diabetes melitus , was known 2 weeks ago, controlled. GDA=210 .Hyperuricemia (+) From Physical Examination was found a difficulty in extending and clicking snap MCP dig. III manus sinistra.

    Assesment : trigger finger dig. III manus sinistra Planning therapy : USD at area of MCP dig.III manus sinistra, Health Education and Home Exercise Program

    THANK YOU

    You might also like