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  • Definitions: inhibition of smooth tendon gliding due to mechanical impingement

  • Caused by stenosing tenosynovitis at the A1 pulley

  • Symptoms are usually progressive and include pain, clicking, catching, and locking of the digit in flexion

  • More common in diabetics and in females (>50yo)

  • Associated conditions: carpal tunnel syndrome, hypothyroidism, gout, diabetes….

  • Imaging are not required for Diagnosis

  • Treatment :

    • Night splinting, activity modification, NSAIDS : first line

    • Corticosteroids injection: 1 to 3 injections in or just superficial to flexor tendon sheath

      • Limited results if diabetes and if thumb

    • Surgical : debridement and release of the A-1 pulley