Reverse Trigger Finger: Does it exist? A Case Report

Trigger finger is a common condition, occurs primarily at the A1 pulley and tenosynovitis is the usual cause. However, although rare, triggering of the flexor tendon can occur in other areas. We present previously unreported condition in adult: triggering at the distal end of A2 pulley, which was caused by nodular thickening of the flexor digitorium profondus tendon with degeneration. A 79-year-old lady presented with atypical presentation of trigger finger at the distal end of A2 pulley. Intra-operatively a nodular thickening of the flexor digitorium profondus tendon with degeneration was found, which was similar to a notta nodule. A sample of the tendon was sent for histology, which showed a degenerative cystic structure. The A2 pulley was therefore fully released and reduction tenoplasty was performed distal to A2 pulley. We hope that by presenting this case we will increase awareness of such presentation of trigger finger leading to improved diagnosis and treatment of the process.