Trigger wrist caused by a giant cell tumour of tendon sheath

Trigger wrist is a rare condition unlike the trigger finger of the metacarpophalangeal joint. This report describes a case of trigger wrist secondary to a giant cell tumour of the flexor tendon sheath. No previous reports are available in the medical literature.     

"Trigger finger at the wrist" due to anomalous flexor digitorum superficialis muscle belly within the carpal tunnel

"Triggering of the fingers at the wrist" is a relatively unusual condition. It consists in a triggering at the wrist produced by finger motion. Its etiology and presentation may vary. This condition should be clearly differentiated from the other clinical entity called "trigger wrist", occurring on wrist movement. In the present article, we report the case of an anomalous flexor digitorum superficialis muscle belly, arising from the right ring finger at the carpal tunnel, in a 47-year old female patient, causing triggering of the right ring finger at the wrist and a carpal tunnel syndrome. Surgical excision of the muscle mass and carpal tunnel release relieved patient's symptoms and has led to the disappearance of the triggering phenomenon. To date, few cases of trigger finger at the wrist have been reported in the literature. These reported cases were reviewed. The clinical entity of "true trigger wrist" and its etiology are also discussed.     

Trigger wrist caused by a partial laceration of the flexor superficialis tendon of the ring finger

Trigger wrist is a rare condition. This report describes a case with trigger wrist secondary to a partial laceration of the flexor digitorum superficialis tendon of the ring finger. No previous reports are available in the literature.     

Correction to: A Clinical Approach to Diagnosing Trigger Wrist

BackgroundTrigger wrist is a relatively unusual condition, produced by wrist or finger motion. The various causes of trigger wrist can originate from flexor tendon, extensor tendon, bones, or tumour. A proper clinical approach is required to diagnose and manage patients with trigger wrist.MethodsA keyword search was performed across Google Scholar and PubMed. Articles describing trigger wrist conditions were analysed. Based on the information obtain from the articles, the clinical manifestations and approach to diagnosing the cause of trigger wrist is discussed.ResultsA detailed history alone may lead to a reasonably accurate diagnosis. Patients can present with trigger wrist occurring during movement of the fingers or with wrist movements. Presence of tenderness around A1 pulley suggest trigger finger. Absence of tenderness over the A1 pulley may suggest trigger wrist. The wrist should be examined for any swelling or malunion around the wrist joint. Palpate for any bony prominence, clicking, or crepitus with the movement of the wrist. Examination for the presence of carpal tunnel syndrome should be performed. A simple radiograph of the wrist joint is needed to see any possible bony pathology such as malunion, instability or arthritis of the carpal bone. For soft tissue assessment ultrasound would be a good choice and can be done during finger or wrist movement. MRI is useful for further assessment of space occupying lesion within the carpal tunnel and is useful for surgical planning. Nerve conduction study is indicated for patients with median nerve compression symptoms. During the initial stage, the patient should be advised for activity modification to reduce the wrist and finger movements. Surgical treatment will depend on the causative factor. Surgery done under local anaesthesia has the advantage of reconfirming with the patient, resolution of triggering during surgery by asking the patient to actively move the fingers or wrist. ConclusionsTrigger wrist is a relatively rare condition compared with trigger finger, which is the most common disorder of the hand. To avoid inadequate and ineffective treatment of patients with trigger wrist, careful examination and proper diagnosis are vital.     

Acute true trigger wrist following partial extensor carpi radialis brevis tendon rupture

Triggering in association with movements of the wrist or “true trigger wrist” due to the extensor tendon is rare. There are only few case reports in literature, but none were associated with the acute partial tendon rupture. We present a case of true trigger wrist originating from partial rupture of extensor carpi radialis brevis tendon (ECRB). In contrast to the other reports, the interval between an initial injury and development of triggering was short because the partial tendon rupture was bunching and forming a nodule. The triggering was attributed to the snapping of the nodule under the extensor pollicis longus tendon (EPL).     

Trigger Wrist

Trigger wrist is a relatively rare disease compared to trigger finger, which is the most common disorder found in hands. Patients with trigger wrist usually complain about the following symptoms: snapping and clicking or triggering around carpal tunnel with or without mild to moderate median neuropathy. There are a total of five cases of trigger wrist: three cases of anomalous muscle belly of flexor digitorum superficialis and two cases of fibroma around flexor tendon sheath within carpal tunnel. This study reports on two of those cases: one with anomalous muscle and the other with fibroma of flexor tendon sheath. Accurate examination and proper diagnosis are mandatory to obviate improper and time-wasting treatment for patients with trigger wrist.     

Trigger wrist: a case report

Previously published reports on trigger wrist have described triggering of the fingers at the wrist. We observed a case of true triggering of the wrist that was due to a nodule in the extensor carpi radialis longus tendon as it entered the second dorsal compartment. Reduction tenoplasty of the traumatic nodule and release of the second dorsal compartment relieved all symptoms. This is the first reported case that is accurately identified as trigger wrist.     

Trigger wrist due to idiopathic synovial hypertrophy

The phenomenon of "trigger wrist" has been reported several times since 1961, when it was first described (Eifel, 1961). Most of these cases related to patients suffering from "triggering" at the wrist associated with carpal tunnel compression. Below is a hitherto undescribed case of trigger wrist occurring in a fit girl, without carpal tunnel syndrome, due to idiopathic synovial hypertrophy.     

Syndrome du canal carpien et poignet à ressaut révélant un fibrome de la gaine des fléchisseurs

The tendinous sheath fibroma (TSF) is a rare benign tumor, exceptionally responsible for carpal tunnel syndrome and “trigger” wrist: we found this association less than ten times in the English and French literature. We report the case of a 63-year-old right-handed carpenter who featured a triggering phenomenon of the right wrist during the flexion-extension movements and compression of the median nerve at the carpal tunnel, secondary to a TSF of the flexor digitorum superficialis. The diagnosis was suspected at the sonography and MRI, the tumor was excised and proven histologically to be a TSF. One year later, the patient remained free of symptoms.     

Trigger wrist phenomenon in rheumatoid arthritis

Flexor tendon synovitis in patients with rheumatoid arthritis commonly presents with a carpal tunnel syndrome and a concomitant trigger finger. Triggering at the wrist joint is in this disease an uncommon additional feature. In the two cases reported, histological examination of the tissue has indicated that, as well as chronic synovitis, there was a true rheumatoid nodule present at the wrist joint, either pedunculated or fusiform. The passage of the nodule, with a 'Click' from the proximal side of the transverse carpal ligament to the distal aspect, when the fingers are flexed, creates the sensation, signs and symptoms of a trigger wrist.     

Intrasynovial lipoma causing trigger wrist and carpal tunnel syndrome

Triggering of the flexor tendon at the wrist is rare. We report a case of intrasynovial lipoma that caused a trigger wrist. As far as we know it is unique in that the intrasynovial lipoma simultaneously caused carpal tunnel syndrome. The massive tenosynovitis and adhesion of flexors tendons after the locking of the intrasynovial lipoma may have resulted from inflammation caused by attrition within the carpal tunnel.     

Snowboard wrist guards--use, efficacy, and design. A systematic review

The popularity of snowboarding has brought awareness to injuries sustained during the sport. Wrist injuries are among the most common injuries, and there is an interest in using protective equipment to prevent these injuries. The purpose of this study was to review the literature on wrist guard use, injury prevention, the biomechanical effects of wrist guards, and the various types of wrist guards commercially available for consumers. A literature search was done using MEDLINE? Ovid (1950 to January 2009), MEDLINE? PubMed? (1966 to January 2009), and EMBASE? (1980 to January 2009) for studies on snowboard injuries and wrist guards. References from the studies found were also reviewed. Two randomized controlled studies (Level I), one meta-analysis (Level II), eight prospective case control studies (Level II), one cross-sectional study, and four biomechanical-cadaveric studies were found from the literature search. Based on the review of this literature, wrist injuries are among the most common injury type, and wrist guard use may provide a protective effect in preventing them. There is no consensus as to what type or design of wrist guard is the most effective and which wrist guards are available for use by the consumer.     

The role of VFG in wrist arthrodesis: Long term results in a series of 11 patients and literature review

BackgroundTotal wrist fusion (TWF) is indicated for longstanding degenerative, posttraumatic and/or post-oncological conditions to provide pain relief and wrist stability at partial expense of wrist motion.Patients and MethodsA total of 11 consecutive patients who had completed TWF with Vascularized Fibula Graft (VFG) for massive distal radius defects were identified retrospectively from our center using inpatient records. We evaluated bone fusion times and long term functional outcomes following the procedure. Post-operative grip strength (GS) and prono-supination were objectively measured. The new Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire was used to rate disability and symptoms; pre- and post- operative pain with the Visual Analog Scale (VAS) was assessed. A literature review of the present studies about TWF with VFG was performed, with the aim of comparing long-term functional results of the surgical techniques so far reported in the English literature.ResultsOur experience with TWF using VFG appeared slightly better than that found in the literature. The procedure was successful in all the cases, achieving bone union in 4,8 months on average. Complication rate was 27,2%, no flap loss was recorded. There were no wrist instability, deformation or dislocation; mean pronation/supination (P/S) was 57,5°/61,2° Average grip strength resulted 59% of the contralateral side. Mean recorded levels of visual analog scale (VAS) for pain postoperatively were 2,32 ± 0,792, which improved significantly from the pre-operatively value of 7,90 ± 0,79. Mean overall satisfaction was good and all the patients comfortably returned to normal activities.ConclusionsWrist arthrodesis by means of VFG resulted to be an effective and reliable option in dealing with massive defects of distal radius with involvement of radio-carpal joint. Although the cohort analyzed is relatively small and definitive conclusions cannot be drawn, the long term radiographs and the overall functional outcomes encourage to use the described surgical option over other techniques, such as prosthetic replacement and non-vascularized bone grafts.     

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

IntroductionTrigger wrist is a rare entity and is usually seen in adults. Trigger wrist in children and teenagers is extremely rare.Presentation of caseA case of Trigger wrist and carpal tunnel syndrome in a 16-year-old male is reported. Surgical exploration revealed a ganglion related to the flexor superficialis tendon. After surgical excision, there was complete resolution of symptoms.DiscussionThis is a very rare case and there are no similar cases in the literature. The literature is reviewed and a classification of the causes of triggering at the wrist level is offered. The management approach and outcome are also discussed.ConclusionTrigger wrist with concurrent carpal tunnel syndrome is a rare entity. It is usually caused by space occupying lesions. Excision is usually curative.     

Partial arthrodesis for the rheumatoid wrist

The correct treatment of wrist deformation in the patient who has rheumatoid arthritis has a major impact on the preservation of function of the hand. Surgical decisions should be individualized, based on the patient's needs and the future development of deformation. Partial wrist arthrodesis in rheumatoid wrists is an excellent tool to preserve stability and functional mobility in the long term. In cases of severe destruction complete wrist fusion should be considered alternatively.     

Recurrent synovial chondromatosis of the wrist: case report and literature review

Synovial chondromatosis of the wrist is rare. We report the case of a 35-year-old man with synovial chondromatosis of the left wrist with an 8-year follow-up. Frequent recurrences finally resulted in total wrist arthrodesis. A review of the literature produced 24 case reports of synovial chondromatosis of the wrist with only three cases showing recurrence.     

Non-traumatic osteoarthritis of the wrist: chondrocalcinosis

Post-traumatic arthritis of the wrist is a common disorder, mostly after scapho lunate or scaphoid injury. Some patients in our experience and in literature have no known trauma, are bilateral and have a mean age much higher than usual post-traumatic cases. Radiological (during an often-extensive medical history) and biological studies of these patients led us to think there is a form of chondrocalcinosis of the wrist, with a four stages evolution, similar to SLAC and SNAC wrist but with often no scapho lunate gap, vertical embedding of the scaphoid in the radius and chalky incrustation of the joint. We called that form of dislocation of the carpus: scaphoid chondrocalcinosis advanced collapse or SCAC wrist. Surgical treatment of advanced cases is described. Scaphoidectomy and resection of triquetrum are performed, associated with hamato-luno-capitate fusion. Other rare forms are described and literature (mostly radiological and rheumatological because these patients are often been mistaken as SLAC wrist) is studied.     

La luxation bipolaire de l’avant-bras ou avant-bras flottant (à propos d’un cas)

Bipolar dislocation of the forearm or floating forearm is a rare injury. It combines concomitant elbow and wrist dislocation. Only six cases have been reported in the literature. The diagnosis of wrist dislocation may initially be missed and therefore the prognosis will be worse. The authors report a case of a bipolar dislocation with a posterior dislocation of the elbow and a perilunate dislocation of the wrist.     

Management of the failed biaxial wrist replacement

Nine cases of failed biaxial wrist replacement underwent revision surgery and subsequent clinical and radiographic assessment at a mean follow-up of 28 months. Clinical assessment included the hospital for special surgery (HSS) and activities of daily living scoring systems. Five patients had a revision biaxial wrist replacement, three had wrist fusions and two underwent an excision arthroplasty. The mean HSS score was 73 for the revision biaxial replacements, 63 for the wrist fusions and 92 for the excision arthroplasties. The mean activities for daily living score was 16 for the revision biaxial replacements, 14 for the wrist fusion and 20 for the excision arthroplasties. Despite the experience of implant failure, six patients would still choose a primary wrist replacement again. All patients in this small series appear to have had good clinical outcomes. Revision to another wrist replacement appears no worse than a wrist fusion in the short term and patients value the preservation of movement that an implant offers.     

Midcarpal arthroscopy: anatomy and technique.

Wrist arthroscopy has had a dramatic impact in both evaluation and treatment of a variety of wrist problems. Wrist arthroscopy has typically meant arthroscopy of the proximal wrist joint; however, midcarpal joint arthroscopy is becoming a routine part of a complete arthroscopic examination of the wrist. Specific indications, pertinent anatomy, and a clear technique for performing a midcarpal arthroscopy is not well documented in the literature. This article attempts to offer some insight on these issues.