Description
A 53-year-old, right-handed man was referred to orthopaedic clinic with a 1-year history of progressive 'trigger-like' symptoms and eventual locking of the right ring and middle fingers. There was no history of trauma or joint problems. Medical history included stable chronic kidney disease and well-controlled hypertension. On examination of the right hand, there was limited passive mobility with complete flexion of the ring and middle fingers by 100° at the proximal interphalangeal joint, and additionally the ring finger by 45° at the distal interphalangeal joint. The left hand was unaffected. Furthermore, in the context of a raised serum uric acid concentration of 767 μmol/L 3 years previously, two palpable, non-tender nodules were found on the left olecranon.
Surgical exploration of the right ring finger found multiple small, white speckled deposits infiltrating the flexor tendon from the first annular pulley (A1) to just beyond the A3 pulley (
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