Patient Information:
Name: John Smith
Age: 45
Gender: Male
Occupation: Mechanic
Socioeconomic Status: Middle-class
Chief Complaint: Pain and catching sensation in the right index finger when flexing or extending, worsens during gripping activities.
Presenting Complaints:
Mr. Smith presented with pain and a catching sensation in his right index finger, localized to the palm area, especially when attempting to flex or extend the finger. He reported that the symptoms had been progressively worsening over the last six months. He described difficulty in performing his job as a mechanic, particularly when gripping tools.
History of Presenting Complaints:
The patient’s symptoms started as occasional discomfort while performing gripping tasks at work. Over time, the pain became more frequent, and he noticed a “popping” sensation in his finger when he attempted to straighten or bend it. He tried over-the-counter pain medications and rest, but the symptoms did not improve.
Past Medical and Surgical History:
No significant past medical history.
No history of previous hand or finger injuries.
No history of chronic illnesses.
Family History:
No significant family history of hand-related issues or trigger finger.
Socioeconomic Status:
Mr. Smith is a middle-class individual with stable employment as a mechanic.
Present and Pre-Morbid Functional Status:
Prior to the onset of symptoms, Mr. Smith had full functional use of his right hand and was able to perform his job without any limitations.
General Health Status:
Overall, Mr. Smith’s general health status is good. He has no major health concerns apart from the trigger finger symptoms.
Vitals:
Blood Pressure: 130/80 mmHg
Heart Rate: 75 bpm
Respiratory Rate: 16 breaths per minute
Temperature: 98.6°F (37°C)
Aggravating Factors:
Gripping tools or objects.
Repetitive finger movements.
Prolonged periods of hand use.
Easing Factors:
Resting the hand.
Keeping the finger straight.
Examination:
Palpation of the affected finger’s palmar surface revealed a palpable nodule at the base of the finger.
Restricted finger flexion and extension, with a catching sensation during movement.
No signs of redness, warmth, or swelling.
Sleep and 24-Hour Pattern:
Mr. Smith reported disrupted sleep due to pain and discomfort, especially when he unintentionally flexed his finger while sleeping.
Duration of Current Symptoms:
Approximately six months.
Mechanism of Injury/Current Symptoms:
The trigger finger symptoms likely resulted from repeated microtrauma to the flexor tendon, leading to inflammation and the development of a nodule in the tendon sheath. This nodule catches on the pulley system during finger movement, causing pain and a “triggering” sensation.
Progression Since the Current Episode:
Symptoms have gradually worsened, starting with occasional discomfort and progressing to constant pain and catching during finger movement.
Significant Prior History:
No significant prior history of hand injuries or similar symptoms.
Previous Treatment:
Mr. Smith attempted over-the-counter pain medications and rest, which provided temporary relief but did not address the underlying issue.
Diagnostic Test/Imaging:
Clinical diagnosis was made based on history and physical examination. No imaging studies were conducted.
Differential Diagnosis:
De Quervain’s Tenosynovitis
Carpal Tunnel Syndrome
Rheumatoid Arthritis
Osteoarthritis
Postural Observation:
No significant postural abnormalities noted.
Precautions and Contraindications:
Avoid excessive gripping or repetitive finger movements.
Be cautious when using hand tools.
Functional Movement Analysis (Sign):
Catching and pain during finger flexion and extension, especially when gripping objects.
Quick Screening Tests/Clearing of Additional Joint Structures:
No joint structures were implicated based on clinical examination.
Range of Motion (ROM):
Limited finger flexion and extension due to pain and catching.
Special Tests:
No special tests were conducted in this case.
Assessment:
Mr. Smith presents with trigger finger, likely caused by inflammation and a nodule in the flexor tendon’s sheath at the base of the right index finger.
Problem List/Complaints:
Trigger finger in the right index finger.
Pain and catching sensation during finger movement.
Disrupted sleep due to finger discomfort.
Treatment:
Conservative Management:
Activity modification: Advise Mr. Smith to avoid excessive gripping and repetitive finger movements.
Hand therapy: Refer to a hand therapist for exercises to improve finger mobility and reduce inflammation.
Corticosteroid Injection:
Consider a corticosteroid injection into the tendon sheath to reduce inflammation and alleviate symptoms.
Prognosis:
With appropriate treatment and activity modification, Mr. Smith’s trigger finger symptoms are likely to improve, allowing him to regain functional use of his hand.
Goals:
Alleviate pain and catching sensation.
Improve finger flexibility and range of motion.
Enable Mr. Smith to resume his normal job activities without limitations.
Interventions:
Education on activity modification and precautions.
Referral to a hand therapist for exercises.
Consider corticosteroid injection for symptom relief.
Patient Education:
Explanation of trigger finger, its causes, and the treatment options available.
Demonstration of finger exercises to improve flexibility and reduce inflammation.
Emphasis on the importance of activity modification and adherence to precautions.
Patient/Family Education:
Mr. Smith’s family should be aware of his condition, treatment plan, and the importance of supporting his activity modifications.
Encourage open communication regarding progress and any concerns.
Discharge Plan:
Follow-up appointment in two weeks to assess response to treatment.
If symptoms persist, consider further corticosteroid injections or surgical consultation.
Continued hand therapy and exercises as prescribed.
This case study illustrates the presentation, assessment, and management of trigger finger in a middle-aged mechanic. It underscores the importance of patient education, conservative management, and a multidisciplinary approach to achieve optimal outcomes.