Trigger Finger Consult Letter

Identifying Information:
Thank you for your referral of Julia Carter for Plastic Surgery Consultation. She was examined on January-13-2026.

Clinical History:
Julia Carter presents with a history of progressive triggering affecting multiple fingers of the right hand. The initial episode occurred approximately five years ago and resolved spontaneously. Over the past year, she experienced a recurrence with severe locking, including one episode where unlocking the affected finger independently was nearly impossible. During the summer, she noted triggering in additional digits, specifically the middle and ring fingers bilaterally, with a predominance on the right hand. Activities requiring forceful grip, such as using pruning shears, tightening ropes, or knitting, precipitate the locking phenomenon. She uses a finger splint prophylactically during activities such as chopping or slicing. She denies any prior interventions for the triggering, including corticosteroid injections or other treatments. She reports significant functional impairment during periods of increased manual activity, such as gardening or food preparation, which exacerbates the locking episodes. She anticipates increased symptoms with the resumption of gardening activities in February. She is currently less active due to recent knee replacement surgery. She is left-handed and reports significant functional challenges during manual activities. There is a family history of digital contractures affecting the hands in her father and brother.

Past Medical History:
- Depression (treated with SSRI in December 2022, later discontinued)
- Cervical spondylolysis with severe bilateral spinal stenosis at C5/C6
- Carpal tunnel syndrome (left carpal tunnel release in 2013)
- Cholelithiasis (2021)
- Non-ischemic cardiomyopathy (MRI August 2021: no evidence of sarcoid)
- Colon polyps (colonoscopy November 2023: internal hemorrhoid, nonspecific patchy erythema of cecal pole, colon polyp removed)
- Degenerative disc disease at L5/S1 with left-sided discopathy
- Coronary artery disease (70% stenosis in the second diagonal branch and non-dominant left circumflex coronary artery, potential obstructive lesion in mid LAD on coronary CTA March 2022)
- Paroxysmal atrial flutter (diagnosed March 2021, CHADS score 2)
- Papillary thyroid cancer (total thyroidectomy July 2021)
- Hypertension

Social History:
Currently not active due to recent knee replacement surgery.

Past Surgical History:
- Varicose vein surgery (2011)
- Left carpal tunnel release (2013)
- Hysterectomy (age 42)
- Bladder sling placement
- Total thyroidectomy (July 2021)

Allergies:
Cloxacillin, Macrobid, Polysporin, adhesive tapes, ACE inhibitors, Metoprolol, Amlodipine

Medications:
- Compression stockings 20-30 mmHg
- Rivaroxaban 20 mg daily
- Hydrochlorothiazide 25 mg daily
- Diltiazem CD 240 mg daily
- Pantoprazole 40 mg as needed
- Synthroid 188 mcg daily
- Rosuvastatin 10 mg daily
- Levothyroxine sodium 225 mcg daily

Physical Examination:
Examination of the right hand revealed nodules palpable in the affected fingers with triggering observed during fist-making and opening movements. No current locking of the finger during the consultation.

Investigations:
- MRI (August 2021): No evidence of sarcoid in the context of non-ischemic cardiomyopathy
- Coronary CTA (March 2022): No ischemic findings

Plan:
1. Provided Coban tape to wrap the affected fingers to prevent locking while maintaining functionality.
2. Advised to monitor symptoms during increased manual activity in February pruning season.
3. If symptoms worsen or persist, a corticosteroid injection will be considered.
4. No immediate need for steroid injection or surgery.