Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 6, 2021; 9(25): 7564-7571
Published online Sep 6, 2021. doi: 10.12998/wjcc.v9.i25.7564
Trigger finger at the wrist caused by an intramuscular lipoma within the carpal tunnel: A case report
Chao Huang, Hong-Juan Jin, De-Biao Song, Zhe Zhu, Heng Tian, Ze-Hui Li, Wen-Rui Qu, Rui Li
Chao Huang, Zhe Zhu, Heng Tian, Ze-Hui Li, Wen-Rui Qu, Rui Li, Department of Hand Surgery, The Second Hospital of Jilin University, Changchun 130041, Jilin Province, China
Chao Huang, Department of Orthopaedics, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
Hong-Juan Jin, Department of Plastic and Reconstructive Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
De-Biao Song, Department of Emergency and Critical Care Medicine, The Second Hospital of Jilin University, Changchun 130012, Jilin Province, China
Author contributions: Huang C wrote the manuscript; Jin HJ revised the manuscript, especially regarding language; Song DB and Zhu Z analyzed and interpreted the patient data; Tian H and Li ZH confirmed the histopathological examination results; Qu WR and Li R reviewed the clinical notes and edited the document; all authors provided intellectual contribution to this manuscript and read and approved the final manuscript.
Informed consent statement: Written informed consent was obtained from the patient for the publication of this case report and any accompanying images. A copy of the patient’s written consent is available for review by the Editor-in-Chief of this journal.
Conflict-of-interest statement: The authors declare that they have no competing interests.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wen-Rui Qu, MD, PhD, Doctor, Postdoc, Surgeon, Teacher, Department of Hand Surgery, The Second Hospital of Jilin University, No. 218 Lane Ziqiang, Nanguan District, Changchun 130041, Jilin Province, China. quwenrui@jlu.edu.cn
Received: March 7, 2021
Peer-review started: March 7, 2021
First decision: May 24, 2021
Revised: May 30, 2021
Accepted: July 19, 2021
Article in press: July 19, 2021
Published online: September 6, 2021
Processing time: 176 Days and 21.7 Hours
Abstract
BACKGROUND

Trigger finger at the wrist, which occurs with finger movement, is an uncommon presentation. Few reports describing cases of trigger finger at the wrist have been published. Thus, we present a case of an intramuscular lipoma arising from an anomalous flexor digitorum muscle belly in a 48-year-old female patient causing painful finger triggering at the wrist and carpal tunnel syndrome (CTS).

CASE SUMMARY

A 48-year-old woman with complaints of a catching sensation during wrist motion and a progressive tingling sensation on the palmar aspect of the right hand for approximately 2 years was referred to our hospital. Triggering of the index to middle finger was evident with a palpable and audible clunk over the carpal tunnel during passive motion. Tinel’s sign was positive over the carpal tunnel of the right wrist with a positive Phalen’s test. Nerve conduction studies of the median nerve demonstrated a right CTS. Ultrasound examination revealed a 2.5 cm × 2.0 cm subcutaneous hyperechoic mass with no obvious blood flow at the wrist of the right arm. Surgical excision of the tumor and muscle mass led to a resolution of the patient’s symptoms, and any triggering or discomfort disappeared. The patient has had no evidence of recurrence at more than 1 year of follow-up.

CONCLUSION

Triggering of the fingers at the wrist is rare. It must be noted that there are many possible causes and types of triggering or clicking around the wrist. Accurate diagnosis is mandatory to avoid inaccurate treatment of patients with trigger wrist. During the diagnosis and treatment of CTS, attention should be paid to the variation of tendon tissue in the carpal tunnel, to avoid only focusing on the release of transverse carpal ligament and ignoring the removal of anomalous muscle belly.

Keywords: Intramuscular lipoma; Trigger finger; Muscle belly; Flexor digitorum superficialis; Treatment; Case report

Core Tip: Our manuscript presents a case of an intramuscular lipoma arising from an anomalous flexor digitorum muscle belly in a 48-year-old female patient causing painful finger triggering at the wrist and carpal tunnel syndrome. Moreover, we reviewed the literature and discuss its etiology. Our findings revealed that there are many possible causes and types of triggering or clicking around the wrist. The accurate examination and proper diagnosis are mandatory to avoided improper and time-wasting treatment for patients with trigger finger at the wrist. During the diagnosis and treatment of carpal tunnel syndrome, attention should be paid to the variation of tendon tissue in the carpal tunnel to avoid focusing only on the release of transverse carpal ligament and ignoring the removal of anomalous muscle belly.