Trigger Wrist

Jae-Hoon Lee; Duke-Whan Chung; Chung-Soo Han; Kee-Hyung Rhyu; Sung-Jig Lim

doi:10.12790/jkssh.2013.18.2.71

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Lee, Chung, Han, Rhyu, and Lim: Trigger Wrist

Case Report

J Korean Soc Surg Hand 2013;18(2):71-75.

Published online: 12 June 2013

DOI: https://doi.org/10.12790/jkssh.2013.18.2.71

Trigger Wrist

Jae-Hoon Lee¹, Duke-Whan Chung², Chung-Soo Han², Kee-Hyung Rhyu¹, Sung-Jig Lim³

¹Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Korea

²Department of Orthopaedic Surgery, Kyung Hee University Hospital, Seoul, Korea

³Department of Pathology, Kyung Hee University Hospital at Gangdong, Seoul, Korea

Correspondence to: Jae-Hoon Lee Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, 892 Dongnam-ro, Gangdong-gu, Seoul 134-727, Korea TEL: +82-2-440-6153 FAX: +82-2-440-7498 E-mail: ljhos69@naver.com

Received 27 December 20125 May 2013 Accepted 8 May 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Triggering at the wrist during active flexion and extension of the fingers or wrists is very rare. It is caused by tumors, inflammation, and anomalous muscle belly. We report two cases of trigger wrist caused by synovial hypertrophy and fibroma of flexor tendon.

Keywords: Trigger wrist, Synovial hypertrophy, Fibroma

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Fig. 1.

(A) Sagittal T2 magnetic resonance images shows nodular mass (arrows) surrounded by the flexor tendons at the just distal level to the transverse carpal ligament. The mass shows heterogeneously increased signal intensity on T2-weighted image. (B) On the contrast enhanced axial image, the lesion shows eccentric nodular and peripheral enhancement within the mass (arrows). Flattening and weak enhancement of the median nerve suggest entrapment neuropathy (arrowhead).

Fig. 2.

(A) Irregularly shaped nodular and streaky portion of the mass was freely separated from the tendon. However the proximal end of the mass was fixed to the tendon at the level of proximal entry of carpal tunnel. (B) A photograph taken just after the mass removal. There was no noticeable abnormality of tendon or tendon sheath. Note the separate sheath that encapsulated the mass. (C) A photograph of the mass.

Fig. 3.

A picture of low power microscopic examination (×100) with H&E staining shows portions of muscle bellies (arrows) and surrounding synovial, capillary and fibrous overgrowth. There is no inflammatory cell infiltration except scanty macrophages.

Fig. 4.

(A) T2-weighted magnetic resonance images show well-defined oval mass (arrows) with low heteogenous signal intensity between flexor tendon underneath transverse carpal ligament. (B) Enhanced images show heterogenous enhance-

Fig. 5.

(A) Round gray mass was identified underneath transverse carpal ligament, which was originated from flexor digitorum profundus and connected lumbrical muscle. (B) Excised mass, measuring 2×2×1 cm.

Fig. 6.

Microscopic examination (×200) with H&E staining shows mainly spindle-shaped cell intermixed with collagen fibers and there are no multinucleated giant cells, xanthoma cells, or hemosiderin deposits observed.

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