Aeitiology

1. Caused by fibrosis and thickening of flexor tendson sheath as the tendon enters the digit
2. May be idiopathic
3. May follow trauma
4. Can be congenital and present in children
5. Also associated with rheumatoid arthritis

Approach

• Examine as for hand examination
• Ask patient to place hands palm upwards on a white pillow

1. Look

   

   • Flexion of one or more fingers
   • Most frequently affects middle or ring fingers
2. Feel
   • Ask patient if there is any pain and then palpate carefully over the palm proximal to finger involved
   • May be a small nodule overlying the flexor tendon sheath as it enters the digit
   • Nodule usually approximately at the level of the proximal transverse palmar crease
3. Move
   • Active movement

     FDP: active flexion of DIPJ with PIPJ fixed in full extension
     FDS: active flexion of PIPJ when the examiner fixes the other fingers in full extension

Treatment

1. Steroid injection
2. Tendon release by incision of sheath