A Child with Trigger Wrist Caused by Finger Flexion and Extension: A Case Report

Excerpt

A 9 year-old boy presented with a mass in the left wrist and motion-induced discomfort. The patient had a trigger phenomenon on the palmar side of his wrist caused by extension and flexion of the middle finger. The patient had no significant medical history. A 5-cm mass was visualized extending from the palm over the wrist. The patient did not have finger numbness, motor impairment, thenar muscle atrophy, or a Tinel-like sign of the wrist. X-ray imaging showed no abnormalities. A magnetic resonance image (MRI) showed a mass around a single flexor tendon, a low-intensity mass on T1-weighted images (Fig. 1), and a high-intensity mass on T2-weighted images (Fig. 2). Accordingly, the mass was expected to be a ganglion or cyst. On sagittal images, the mass surrounded the flexor tendon. Because the symptoms did not improve, the patient underwent surgery 2 months after he noticed the mass. The mass was excised by opening the carpal tunnel. The flexor digitorum superficialis (FDS) of the middle finger adhering to the mass was enlarged (Fig. 3). Histological analysis showed cystic synovial tissue accompanied by thickened wall, papillary proliferation towards the lumen, fibrin deposition, and lymphocyte infiltration. (Fig. 4). Based on the above findings, the patient was diagnosed with a ganglion adhering to the FDS. One year after surgery, the patient had no discomfort, recurrence, or disturbance in daily living.

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