A 50-year-old diabetic presents with acute flexion of the ring finger DIP and PIP joints with inability to extend, plus a palpable tender nodule at the base of the finger and triggering on movement. The most appropriate first-line treatment is:

• A Surgical A1 pulley release (open or percutaneous)
• B Intralesional collagenase injection
• C MRI of the hand to exclude flexor tendon tear
• D Corticosteroid injection into the flexor tendon sheath at the A1 pulley ✓

Explanation

Trigger finger (stenosing tenosynovitis) due to A1 pulley constriction causing snapping/locking of the digit is first treated with corticosteroid injection into or around the flexor tendon sheath, which resolves symptoms in 50-90% of cases. Surgical A1 pulley release (open or percutaneous) is reserved for failed conservative treatment (2 injections) or a locked trigger finger. Collagenase injection is for Dupuytren's contracture. In diabetics, trigger finger is more likely to fail corticosteroid injection and may require earlier surgery.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.