J Korean Soc Surg Hand.  2013 Jun;18(2):71-75. 10.12790/jkssh.2013.18.2.71.

Trigger Wrist

• Lee JH
• Chung DW
• Han CS
• Rhyu KH
• Lim SJ

• KMID: 2194160
• DOI: http://doi.org/10.12790/jkssh.2013.18.2.71

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.

Keyword

Trigger wrist; Synovial hypertrophy; Fibroma

MeSH Terms

Fibroma
Fingers
Hypertrophy
Inflammation
Muscles
Tendons
Wrist

Figure

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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).

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  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.

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  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.

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  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-

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  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.

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  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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