Trigger Thumb

Short Case
Wahyu Sita Wardani

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 Patient Identity
Name Mrs J

Age 59 years old

Sex Female

Address Cipta Menanggal I/16 Surabaya

Religion Christian

Occupation Housewife

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 History Taking
Referred from Neurologic Department
Outpatient Clinic with Trigger Finger Dextra.
Mohon Tatalaksana di bidang TS.

Chief Complaint: Jempol kanan sulit diluruskan

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 History of Present Illness

- She felt difficulty to straighten her thumb after she

bend it since 2 month ago. And started to felt pain
since 2 weeks ago (VAS = 6). Sometimes she need
another hand help to straight and bend the thumb.
- she also felt pain and stiff on her right palm ,
especially after she do daily activities such as
cooking, cleaning, washing clothes and dishes,
ironing, writing, and other daily task
- pain was a dull pain, did not radiated, no numbness,
and no tingling sensation.
- Pain increases when she moves her thumb
repeatedly
- There is click sound and snapping sensation when
she move her right thumb.
 History of Past Illness
History of DM (-)
History of HT (-)
Theres no history of previous trauma
 Physical Examination
General State
Consciousness: CM Ambulation: Independent Gait: Normal

Right Handed W: 70 kg H: 149 cm BMI: 31,5

Vital Signs: BP: 120/80 mmHg RR: 20x/min
HR: 85 x/min
Head and Neck Anemic/Jaundice/Cyanosis/ -
Dyspneu
Thorax Heart/Lung N
Abdomen N
Extremities Warm at all extremities
Barthel Index 100 6
 Neurological State

Cranial Nerves I-XII N

Muscle Tone N
Deep Tendon BPR +2 | +2 KPR +2 | +2
Reflexes
TPR +2 | +2 APR +2 | +2
Pathological Hofmann - | - Babinski - | -
Reflexes
Tromner - | -
Sensory Deficits No sensory deficits

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 Musculoskeletal State
Region Movement ROM MMT
Neck Flex. Full (0-45) 5
Ext. Full (0-45) 5
Lat. Flex. Full (0-45)/Full (0-45) 5/5
Rot. Full (0-60)/Full (0-60) 5/5
Trunk Flex. Full 5
Ext. Full (0-30) 5
Lat. Flex. Full (0-35)/Full (0-35) 5/5
Rot. Full (0-45)/Full (0-45) 5/5 8
Region Movement ROM MMT
Shoulder Flex. Full (0-180) Full (0-180) 5 5
Ext. Full (0-80) Full (0-80) 5 5
Abd. Full (0-180) Full (0-180) 5 5
Add. Full (0-45) Full (0-45) 5 5
Int. Rot. Full (0-55) Full (0-55) 5 5
Ext. Rot Full (0-45) Full (0-45) 5 5
Elbow Flex. Full (0-150) Full (0-150) 5 5
Ext. Full (150-0) Full (150-0) 5 5
Pro. Full (0-80) Full (0-80) 5 5
Sup. Full (0-80) Full (0-80) 5 5
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Region Movement ROM MMT
Wrist Flex. Full (0-80) Full (0-80) 5 5
Ext. Full (0-70) Full (0-70) 5 5
Rad. Dev. Full (0-20) Full (0-20) 5 5
Ulnar Dev. Full (0-30) Full (0-30) 5 5
Finger Flex. Full (0-90) Full (0-90) 5 5
MCP Ext. Full (0-15) Full (0-15) 5 5
Abd. Full (0-20) Full (0-20) 5 5
Add. Full (20-0) Full (20-0) 5 5
PIP Flex. Full (0-100) Full (0-100) 5 5
Ext. Full (100-0) Full (100-0) 5 5
DIP Flex. Full (0-90) Full (0-90) 5 5
Ext. Full (90-0) Full (0-180) 5 5 10
Region Movement ROM MMT
Thumb Flex/Ext Full (0-50) Full (0-50) 5 5
MCP Abd/Add Full (0-50) Full (0-50) 5 5
Opposition 5 5
IP Flex/Ext Full (0-90) Full (0-90) 5 5
Hip Flex. Full (0-125) Full (0-125) 5 5
Ext. Full (0-30) Full (0-30) 5 5
Abd. Full (0-45) Full (0-45) 5 5
Add. Full (0-20) Full (0-20) 5 5
Int. Rot Full (0-80) Full (0-80) 5 5
Ext. Rot Full (0-80) Full (0-80) 5 5
Knee Flex. Full (0-135) Full (0-90) 5 5
Ext. Full (135-0) Full (135-0) 5 5 11
Region Movement ROM MMT
Ankle Inver. Full (0-35) Full (0-35) 5 5
Ever. Full (0-25) Full (0-25) 5 5
Dorsal Flex. Full (0-30) Full (0-30) 5 5
Plantar Flex. Full (0-45) Full (0-45) 5 5
Toes Flex. Full (0-30) Full (0-30) 5 5
MTP Ext. Full (0-80) Full (0-80) 5 5
IP Flex. Full (0-50) Full (0-50) 5 5
Ext. Full (0-80) Full (0-80) 5 5
Big Toe Flex. Full (0-25) Full (0-25) 5 5
MTP Ext. Full (0-80) Full (0-80) 5 5
IP Flex Full (0-25) Full (0-25) 5 512
 Local Status : Thumb Area, Manus Dextra
Inspection Deformities N/N

Inflammation Signs -/-

Redness, Rash -/-

Difficulty to extend thumb +/-

Palpation Tenderness +/-

Crepitus -/-

Warmth -/-

Nodule +/-

Clicking and snapping Sensation +/-

 Special Tests

Right Left
Prayer Test - -
Phalen Test - -
Tinnel Test - -
Finkelstein Test - -

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 Hand Function
Right Left
Cylindrical Normal Normal
Spherical Normal Normal
Hook Normal Normal
Pinch Normal Normal
Tip Normal Normal
Grip Normal Normal
Opposition Normal Normal
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 Assessment
Clinical Diagnosis -Trigger Thumb of The Right Hand
-Obesity

Functional Impairment -thickening of flexor tendon at the

Diagnosis right thumb
- nodul in MCP of the right thumb
- obesity

Disability Difficulty in cleaning, cooking, washing

clothes and dishes, ironing
Handicap

Problem List
Surgical: -
Medical: - Trigger Thumb of the Right Hand
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- Obesity
 Rehabilitation
R1 (Mobilization) No problem
R2 (ADL) Difficulty in cleaning, cooking, washing clothes
and dishes, ironing
R3 (Communication) No problem
R4 (Psychology) No problem

R5 (Social Economy) No problem

R6 (Vocational) No problem
R7 (Other) -Trigger thumb on the right hand
-Pain when straighten the right thumb (VAS =
6)
-Clicking and snapping sensation when
straighten and bending the right thumb
-Nodule at the base of the right thumb
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 PLANNING
Diagnostic Consult to Nutrition Department

Therapeutic Modality: Orthesa:

-USD 0,5 W/cm2 frek 3 -Resting thumb splint for manus D
MHz duration 6-10
mnt at the thumb
area of the right hand,
2X/week, under
water, continue with
gentle stretch of
flexor tendon

Monitoring Clinical, VAS, Nodule

Education -Health Education/Home Exercise Programs

-Explain about patient condition
- Avoid repetitive movement
-Stretching and friction massage in warm water
-Body weight control

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Summary
Reported Female Patient, 59 years old, referred from
Neurologic Outpatient Clinic with Trigger Finger Dextra

- Her Chief complaint : Jempol kanan sulit diluruskan. She

felt difficulty to straighten her thumb after she bend it
since 2 month ago. And started to felt pain since 2
weeks ago (VAS = 6). Pain increases when she moves
her thumb repeatedly. There is sound click and
snapping sensation when she move her right thumb.
She had difficulty in doing her job as a housewife.
From Physical examination, there was tenderness at the right
thumb, nodule at the MCP right thumb, and clicking and snapping
sensation.

Planning therapy are USD underwater at the right thumb area

continue with gentle stretching of flexor tendon .

Planning monitoring are Clinical and VAS

Planning education are avoid repetitive movement, stretching and

friction massage in warm water, body weight control
Thank You

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