Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with a history of left thumb locking, catching, and pain at the level of the A1 pulley. Symptoms are exacerbated by repetitive gripping and are most pronounced upon morning awakening. Patient denies recent trauma, numbness, or paresthesia in the thumb distribution.
Clinical Examination Findings
Examination of the left hand reveals localized tenderness over the palmar aspect of the thumb metacarpophalangeal (MCP) joint. Palpable nodule noted at the A1 pulley site. Active flexion/extension demonstrates a reproducible triggering phenomenon with an audible/palpable click. No signs of infection, erythema, or significant joint instability. Distal neurovascular status is intact.
Treatment Protocol
Plan: 1. Conservative management initiated with activity modification and splinting of the left thumb MCP joint in extension. 2. Non-steroidal anti-inflammatory drugs (NSAIDs) as needed. 3. Discussed corticosteroid injection at the A1 pulley site for symptom resolution. 4. Surgical release (A1 pulley release) discussed as a definitive option if conservative measures fail.