Endocrine Abstracts

Introduction: Trigger finger is a stenosing tenosynovitis in which constriction of the tendon sheath is associated with the presence of a nodule on the flexor tendon of the finger. This is an often unrecognised complication in the diabetic patient. We report the case of a diabetic patient with a complication of trigger finger.

Observation: A 55 year old female patient, known to be diabetic for 10 years and treated with a basal-bolus insulin therapy regimen. Her evolutionary profile is marked by several episodes of ketoacidosis decompensation. Her diabetes is complicated by chronic renal disease at the stage of proteinuria, and proliferating diabetic retinopathy. The clinical examination found limited mobility in flexion and extension of the fourth finger of the right hand, with a palpable nodule on the flexor tendon of the finger. Biological findings: HbA1c: 9%, renal function and lipid profile were correct. The patient had unbalanced diabetes complicated by microangiopathy and a trigger finger. The therapeutic management is based first on glycemic control and therapeutic education then we proposed corticosteroid injections, with a good evolution.

Discussion: Trigger finger is an often unrecognised tenosynovitis in the diabetic patient. It can occur during flexion or extension. The nodule is palpable on the flexor tendon of the affected finger. In diabetes, trigger finger occur in 4-10% of cases, and their occurrence is correlated with the length of time the patient has had diabetes, but not with its control. In a study of young insulin-dependent diabetic patients, this symptom was noted in 5% of patients and no controls.Treatment is based on corticosteroid injections in the first instance. If this fails, percutaneous needle lung resection may be performed. A recent meta-analysis has shown that patients treated with percutaneous methods have fewer failures and are more satisfied than those treated with corticosteroid injections.Finally, surgical treatment should only be proposed in case of failure of medical treatment and in case of significant impact but with 45% of side effect.

Conclusion: Our clinical case illustrates one of the osteoarticular complications linked to diabetes, which is frequent but often unrecognized; it is the ‘trigger finger’ it is however at the origin of an important functional handicap. A multidisciplinary management should be proposed to these patients while remembering that the first treatment of these manifestations is generally a better glycemic balance.