33yo female presenting for injection of flexor tendon sheath of middle and index finger, suspected stenosing tenosynovitis.
Tenosynovitis of the index and middle finger flexor tendons was noted. Clinically this was a strange presentation as “trigger finger” is more common in 5th and 6th decades so we extended the examination to assess for any signs of systemic arthropathy.
Further assessment noted mild tenosynovitis of the flexor tendon sheaths of ring and little finger, FPL and FCR. On the dorsal aspect of the wrist a grossly thickened synovium was noted around ECU with bony erosions noted at distal ulnar. the other hand was assessed with synovitis and erosion of the 2nd MTP joint. Due to ultrasound findings x-rays were performed.
The patient had recently had an ultrasound of the wrist at another practice which noted the ECU tenosynovitis but failed to extend the exam to look at any more than the dorsal tendons thus giving an incomplete picture of the patients pathology and delaying appropriate treatment.
Always ensure the clinical presentation and patient match the pathology seen. If you have a feeling this is an unusual presentation or the picture doesn’t fit consider extending your examination to gain further information.
ECA tenosynovitis with bony erosions of distal ulnar.
Second MCP jt synovitis and erosions.
X-ray showing erosions at MCP joints.