PREFERRED PRACTICE PATTERN3
4D: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Connective Tissue Dysfunction
A 45-year-old female receptionist presents with pain over the volar aspect of her second metacarpophalangeal (MCP) joint that has been present for the past 5 months. She reports the pain is worsening and now noting “catching” or feeling that her finger “gets stuck” when bending and straightening. The patient has a palpable nodule over the volar aspect of the first MCP, which is painful to palpation and has crepitus during finger flexion. She notes that she is having difficulty grasping dishes or utensils when eating or cooking due to pain and weakness. She has also recently been in consultation with a rheumatologist for other medical concerns unrelated to this specified hand pain.
(A) Extensor expansion. (B) Movements of the lumbrical and interossei muscles. (C) Ligaments and joints of the hand. (From Morton DA, Foreman KB, Albertine KH. The Big Picture: Gross Anatomy. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)
(A) Trigger finger occurs when a fibrous thickening of the tendon does not allow it to slide through the pulley. (B) Clinical photo of a finger locked in place due to trigger finger. (From Simon RR, Sherman SC. Emergency Orthopedics. 6th ed. www.accessemergencymedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)
Painful snapping or catching/locking of finger or thumb
Inflammation of the fluid-filled sheath (tenosynovitis) surrounding the flexor tendons of the phalanges
Painful nodule at the distal flexion crease
Inflammation causes interference with gliding of tendon at the location of the A1 pulleys
Thickening of sheath or tendon leads to constriction of the sliding tendon, and nodules can develop
Crepitus and nodules may be palpable at location of A1 pulley
Cause is typically nonspecific overuse
Pain with digit motion precedes triggering or locking sensations
Pain may precede symptoms of triggering.
Mechanical symptoms exacerbate condition, leading to increased pain and decreased motion of the digit.
Can be managed surgically or nonsurgically depending upon signs and symptom severity, response to conservative treatment, and orthopedic physician recommendations.
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