A Novel Case of Trigger Finger Caused by A1 Pulley Calcification Successfully Treated With Ultrasound-Guided Prolotherapy - A Case Report and Literature Review

Sep 28, 2026

Uploaded by Jasmine

Trigger finger is commonly linked to thickening of the A1 pulley or flexor tendons, yet calcification within the A1 pulley is rarely identified as a direct cause of triggering. A 43-year-old woman presented with painful right little-finger triggering, morning stiffness, snapping, and focal volar MCP tenderness and warmth. Radiographs and high-resolution Doppler ultrasonography showed an A1 superficial-layer calcific deposit with hypervascularity. Three sessions of ultrasound-guided prolotherapy with physiotherapy and night splinting resulted in complete resolution of pain, stiffness, and triggering within four weeks.

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CategoryHealthcare

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Abstract

Introduction

How to cite this article

Received 11/04/2025 Review began 11/10/2025 Review ended 11/16/2025 Published 11/30/2025 © Copyright 2025 Yoon et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.98189 Open Access Case Report Published via The Hong Kong Institute Of Musculoskeletal Medicine A Novel Case of Trigger Finger Caused by A1 Pulley Calcification Successfully Treated With Ultrasound-Guided Prolotherapy: A Case Report and Literature Review Yonghyun Yoon 1, 2, Ji Hyo Hwang 1, Jaehyun Shim 3, Rowook Park 4, Jaeyoung Lee 2, King Hei Stanley Lam 5, 6, 7 1. Orthopedic Surgery, Hallym University Kangnam Sacred Heart Hospital, Seoul, KOR 2. Orthopedics, Incheon Terminal Orthopedic Surgery Clinic, Incheon, KOR 3. Neurosurgery, Chungdammadi Neurosurgery Clinic, Seoul, KOR 4. Rehabilitation Medicine, Sae Yonsei Rehabilitation Clinic, Seoul, KOR 5. Faculty of Medicine, The Chinese University of Hong Kong, New Territories, HKG 6. Faculty of Medicine, The University of Hong Kong, Hong kong, HKG 7. The Board of Clinical Research, The Hong Kong Institute of Musculoskeletal Medicine, Kowloon, HKG Corresponding author: King Hei Stanley Lam, [drlamkh@gmail.com](drlamkh@gmail.com) Abstract Trigger finger is commonly attributed to thickening of the A1 pulley or flexor tendons. Although calcific tendinitis is well recognized in regions such as the shoulder, calcification within the A1 pulley itself is extremely rare and seldom reported as a primary cause of triggering. We describe a 43-year-old woman who presented with painful triggering of the right little finger, accompanied by morning stiffness, snapping, and focal tenderness with warmth over the volar metacarpophalangeal (MCP) joint. Radiographs and highresolution ultrasonography revealed a calcific deposit in the superficial layer of the A1 pulley, with surrounding hypervascularity on Doppler imaging. The patient underwent three sessions of ultrasoundguided prolotherapy in conjunction with physiotherapy and night splinting, which led to complete resolution of pain, stiffness, and triggering. This case identifies A1 pulley calcification as a rare but distinct etiology of trigger finger and highlights the diagnostic utility of ultrasonography in detecting this lesion. Moreover, it demonstrates that ultrasound-guided prolotherapy can provide an effective, minimally invasive alternative to surgical release, particularly when standard conservative management fails. Ultrasoundguided prolotherapy was selected as the primary intervention, instead of corticosteroid injection (CI), given its potential to promote tissue repair and resorption of calcific deposits, which are less effectively addressed by corticosteroids whose effect is primarily anti-inflammatory. Symptom improvement was observed after each biweekly session, with complete resolution achieved four weeks after the initial intervention. In addition to pain reduction documented by the Visual Analog Scale (VAS), the patient experienced the elimination of morning stiffness and snapping and restoration of full finger range of motion (ROM) following the final prolotherapy session. Categories: Integrative/Complementary Medicine, Pain Management, Orthopedics Keywords: a1 pulley, calcific tendinitis, calcific tendinopathy, prolotherapy, stenosing tenosynovitis, trigger finger, ultrasound-guided intervention Introduction Trigger finger, or stenosing tenosynovitis, is a prevalent condition characterized by a painful snapping or locking of a digit during flexion and extension. It most commonly affects women in their 40s and 50s [1], with a predilection for the ring finger and thumb [2] . The pathophysiology typically involves a disproportion between the flexor tendon and its pulley system, primarily due to thickening

FAQs

What rare cause of trigger finger does the case report highlight?

The report describes trigger finger caused by calcification within the A1 pulley, a condition described as extremely rare as a primary triggering mechanism.

How was the calcific lesion diagnosed?

Radiographs and high-resolution ultrasonography with Doppler imaging identified a calcific deposit in the superficial layer of the A1 pulley and showed surrounding hypervascularity.

What treatment was used and what outcome was achieved?

The patient received three ultrasound-guided prolotherapy sessions combined with physiotherapy and night splinting, leading to complete resolution of pain, stiffness, and triggering four weeks after the initial intervention.

Sep 28, 2026

Uploaded by Jasmine