Disclosures: Matthew R. Kelly, MD: No financial relationships or conflicts of interest

Case Description: The patient presented with intermittent tenderness over the volar second metacarpophalangeal joint of his dominant hand. He reported pain only while gripping a steering wheel and holding a hockey stick or golf club. He denied weakness or sensory changes and had remained asymptomatic outside of these activities with no mechanical symptoms or finger catching. He denied prior hand injury or surgical interventions. Of note, the patient reported more than 20 years of hockey, golf and baseball participation.

Setting: Outpatient sports medicine clinic.

Patient: 30-year-old male athlete with intermittent volar hand pain. Assessment/

Results: Examination was unremarkable except for discomfort to palpation over the volar second metacarpophalangeal joint of the dominant hand. An ultrasound examination was performed and demonstrated no significant effusion at the MCP joint. The flexor digitorum superficialis and profundus tendons were identified in long- and short-axis and slid smoothly beneath the A1-pulley without catching or subluxation on dynamic exam. During sono-palpation, the patient reported discomfort and was noted to have a hyper-echoic area of calcification within the A1-pulley. Due to the infrequency of symptoms, no immediate interventions were performed, however if symptoms worsen, an injection or A1-pulley release/resection may be indicated.

Discussion: Stenosing tenosynovitis (trigger finger) commonly results from repetitive microtrauma resulting in a thickened and disorganized tendon or pulley. These same forces can also lead to calcification of the tendon-pulley complex. Clinically, patients often present with difficult finger extension and painful snapping, however this case demonstrates that, even without mechanical symptoms, calcifications may develop that are painful and can hinder performance. The repetitive stress to the volar hand, inherent in stick and racket-sports, may predispose athletes to these injuries.

Conclusion: Musculoskeletal ultrasound is an important tool allowing for direct visualization of the A1-pulley-flexor tendon complex and can help identify pathology even in the absence of mechanical symptoms.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/hand-pain-in-an-athlete-with-a-calcific-a1-pulley-a-case-report/