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

Abstract

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 lowintensity mass on T1-weighted images (Fig.

Trigger Wrist and Carpal tunnel syndrome caused by a flexor tendon-related ganglion in a teenager: A case report

“…A review of the literature only revealed three cases of trigger wrist in the pediatric age group [1], [3], [4]. All three cases had tumors related to the flexor tendons within the carpal tunnel: a giant cell tumor of tendon sheath [1], a synovial mass [3], and a fibroma of tendon sheath [4].…”

“…All three cases had tumors related to the flexor tendons within the carpal tunnel: a giant cell tumor of tendon sheath [1], a synovial mass [3], and a fibroma of tendon sheath [4]. None of the pediatric cases had concurrent carpal tunnel syndrome, although it has been reported in adults [5], [6].…”

“…History and physical examination should guide the surgeon to the probable etiology. A history of juvenile arthritis is suggestive of the presence of a synovial mass (Type A) [3]. Anomalous muscles (Type B and C) are usually associated with a bulge in the distal forearm which is more apparent on passive hyper-extension of the wrist [2].…”

“…If there was a history of a laceration on the dorsal aspect of the wrist, exploration of the area of laceration and release of the extensor retinaculum should be done [8], [9]. In all other cases, carpal tunnel release is indicated [1], [2], [3], [4], [5], [6], [10], [11]. In neurologically asymptomatic patients, the carpal tunnel release serves to provide access to the pathology within the carpal tunnel rather than to decompress the median nerve.…”

“…During the release of the carpal tunnel, the surgeon should look for the cause of triggering and treat it accordingly. This will include synovectomy, resection of the anomalous muscles, excision of space occupying lesions, and release of tendon adhesions [1], [2], [3], [4], [5], [6], [10], [11]. Triggering related to partial flexor tendon lacerations is usually associated with oblique lacerations and tendon “flap” formation [12].…”