Ultrasound
Kyle Malek, MD
PMR Resident | PGY-4
Honor Health
Phoenix, Arizona, United States
Michael Retzer, DO
Physician
Phoenix VA Health Care System
Phoenix, Arizona, United States
Kyle Malek, MD
Honor Health
Phoenix, Arizona, United States
A 43-year-old male veteran and professional plumber with a history of chronic pain and tobacco/alcohol use presented to PM&R clinic with a painful volar nodule at the base of his left fourth finger. The lesion limited grip strength and use of hand tools, impacting his ability to work. He denied triggering, numbness, or weakness. Ultrasound performed at the point of care demonstrated a 0.7 × 0.4 × 0.8 cm hypoechoic, well-circumscribed lesion superficial to the flexor tendons in the region of the A2 pulley, with posterior acoustic enhancement, no vascularity, and no evidence of bowstringing. Findings were consistent with a ganglion cyst. The patient was referred to hand surgery, underwent uncomplicated excision, and pathology confirmed a benign ganglion cyst. He healed without complication and achieved complete symptom resolution with return to full occupational function.
Ganglion cysts of the flexor tendon sheath are common; however, those originating from the A2 pulley are rare and may be difficult to distinguish clinically from trigger finger, pulley rupture, or other nodular lesions. In this case, point-of-care ultrasound enabled rapid, accurate diagnosis and timely referral without additional advanced imaging. The case highlights the broader value of ultrasound in musculoskeletal medicine. While ultrasound training is increasingly incorporated into medical education and is widely used in specialties such as emergency medicine, sports medicine, and rheumatology, PM&R training remains variable across programs despite physiatrists’ frequent evaluation of complex musculoskeletal complaints.
