Congenital Trigger Finger

A 4-month-old boy, first in birth order, born by spontaneous vaginal birth at full term, was brought with a complaint of flexion deformity of the left ring finger. His mother stated that the deformity had been noticed by the primary care physician during routine neonatal check-up at birth. There was no history of peri-natal trauma, infections, or rheumatologic / metabolic disorders and development milestones had been achieved normally. No prior intervention had been done for the complaint. On physical examination, there was triggering of left ring finger (4th digit) with a snap on flexion to about 60° (Fig 1 A & B). Palpation revealed a non-tender, firm nodule over the palmar side of the metacarpophalangeal joints of the affected finger. There was no other anomaly. Plain radiographs of both hands were normal. Parents were counselled and attached to the services of hand physiotherapy/orthotics division where a nocturnal splint was advised with passive daytime, home exercises of finger flexion/extension. However, due to lack of compliance, no benefit could be appreciated after follow up at 8 weeks of presentation. Hence, after informed consent, surgical release of A-1 pulley was undertaken under general anaesthesia and proximal tourniquet control (Fig. 1C). The deformity was markedly reduced after surgical release (Fig. 1D), but the final outcome could not be ascertained due to loss of patient to follow-up.