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Related Experiment Videos

Sesamoid arthritis mimicking trigger thumb.

Ji Yeong Kim1, Jung Hwan Sung, Jeong Gook Seo

  • 1Department of Orthopedic Surgery, Seoul Paik Hospital, Inje University, Seoul, Korea.

Orthopedics
|March 18, 2011
PubMed
Summary

Undiagnosed sesamoid arthritis coexisting with trigger thumb can cause persistent metacarpophalangeal joint pain. Sesamoidectomy resolved pain after initial trigger thumb surgery failed, highlighting the need for thorough evaluation.

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Area of Science:

  • Orthopedics
  • Hand Surgery
  • Rheumatology

Background:

  • Trigger thumb is a common condition affecting the flexor tendon sheath.
  • Metacarpophalangeal joint pain can have various etiologies, often overlooked.
  • Sesamoid pathologies are infrequently considered in differential diagnoses for thumb pain.

Observation:

  • A 25-year-old woman presented with chronic metacarpophalangeal joint pain and trigger thumb.
  • Initial treatment with medication, steroid injection, and A1 pulley release surgery failed to resolve pain.
  • Physical examination localized persistent pain to the radial sesamoid area.

Findings:

  • Radiographs revealed sesamoid arthritis with joint space narrowing and osteophyte formation.
  • Sesamoidectomy successfully resolved the patient's persistent metacarpophalangeal joint pain.
  • Intraoperative findings during A1 pulley release showed no abnormalities in the flexor sheath or tendon.

Implications:

  • Sesamoid arthritis should be considered in the differential diagnosis for persistent metacarpophalangeal joint pain, especially with coexisting trigger thumb.
  • Thorough clinical examination and appropriate imaging (radiographs, sonography) are crucial for accurate diagnosis.
  • Failure to identify underlying sesamoid pathology can lead to prolonged symptoms and ineffective treatment.

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