Health Awareness blog

     Trigger finger is not uncommon. However, it still can be distressing.

     Trigger finger is also associated with tendon nodules. This condition occurs when there is constriction at the base of the tendon sheath. This will lead to the narrowing of the affected tendon. Local trauma in the narrowed sheath make the fibrous flexor sheath thickens and a nodule develops on it.

     The condition usually occurs at the level of metacarpal head or neck. Ring and middle fingers are most commonly affected. Thumb might be affected but usually occur in children and babies. If there are multiple ‘triggering’ digits, rheumatoid arthritis might be the cause and proper investigation should be done for appropriate management.

Signs & symptoms

• Unable to achieve full extension of affected finger
• If the finger is fully flexed, the patient may have to extend it passively
• If aided by the other hand, ‘click’ or ‘snap’ may be felt by the flexor tendon (this occur as the nodules passes through the area of stenosis)
• As extension occurs, the nodule moves with the flexor tendon, but then becomes jammed on the proximal side of a pulley and has to be flicked straight, so producing triggering of the affected digits or fingers.
• A nodule may be palpable at the site of thickening

Treatment

• Spontaneous resolution may occur, so, in some condition no treatment needed.
• Steroid injection into the region of the nodule may be tried (this is not given to child or patient with renal failure or diabetes mellitus). The injection shouldn’t be done to the tendon itself and should be given under low pressure beside the tendon. (e.g. 1mlof Depomedrone with lidocaine may be tried).
• If this fails, surgical intervention is indicated. In this case, longitudinal division of the constricted section of the flexor sheath will be done by the experienced surgeon.

Reference

1. Oxford handbook of clinical specialties. 5^th edition. 2001.
2. Churchill’s pocketbook of surgery. Andrew T Raftery. 2^nd edition. 2001.

     Scabies is a skin disease that is very common among children but still can be found in adult. Any part of the body may be affected and transmission is by skin to skin contact. Infestation is caused by the mite sarcoptes scabei.

How does it present?

     The mites burrow into the skin and lay eggs. The resulting offspring crawl out onto the skin and makes new burrows. This process will keep going if no treatment taken. The absorption of mite excrement into skin capillaries will generate a hypersensitivity reaction that will cause the most irritating symptom – generalized itch, especially at night. This main symptom might take four to six week to develop.

Interdigital folds, the wrists and elbows, umbilical and feet.

Signs:  

Characteristic silvery lines may be seen in the skin where mites have burrowed.

Management and advice: 

• Detailed explanation should be given to parents regarding the condition, the principal way how it will be spread and the right management and treatment.
• Treat everyone in the household or in close contact at same time
• Change bedding, nightclothes and towels on night of treatment and clean them in a hot water or hot iron.
• Treatment: Benzyl Benzoate lotion (EBB), sulpha with calamine, crotamiton and antihistamine (to relieve itch)

 Mites separated from the human host will die after 72 hours