Carpal tunnel release can be a risk factor for trigger finger: National Health Insurance data analysis

Identifying non-genetic factors associated with trigger finger

BACKGROUND

The non-genetic factors predisposing to trigger finger (TF) have mostly been characterised in small studies from individual institutions. Here, we aimed to provide a more complete picture of TF and its associations.

METHODOLOGY

This case-control study used cross-sectional data from the UK Biobank population-based cohort to identify and determine the strength of associations of phenotypic variables with TF. We performed multivariable logistic regression of a multitude of phenotypic factors associated with TF.

RESULTS

We identified 2250 individuals with medical and surgical diagnostic codes for TF, and 398,495 controls. TF was found to be significantly associated with age (OR 1.04, 95% CI 1.03-1.04, P < 2.23×10-308), female sex (OR 1.22, 95% CI 1.08-1.39, P = 2.35×10-3), body mass index (OR 1.10, 95% CI 1.04-1.16, P = 5.52×10-4), carpal tunnel syndrome (OR 9.59, 95% CI 8.68-10.59, P < 2.23×10-308), Dupuytren's disease (OR 4.89, 95% CI 4.06-5.89, P < 2.23×10-308), diabetes mellitus without complications (OR 1.35, 95% CI 1.15-1.58, P = 2.03×10-4) and with complications (OR 2.46, 95% CI 1.90-3.17, P = 4.98×10-12), HbA1c (OR 1.01, 95% CI 1.01-1.02, P = 8.99×10-9), hypothyroidism (OR 1.24, 95% CI 1.07-1.43, P = 4.75×10-3) and rheumatoid arthritis (OR 1.33, 95% CI 1.06-1.68, P = 0.014).

CONCLUSION

Our results provide evidence supporting the well-known risk factors such as diabetes mellitus, carpal tunnel syndrome, age and female sex. Furthermore, we can confirm putative associations such as hypothyroidism, obesity and rheumatoid arthritis, while providing evidence against others such as hypertension and hyperlipidaemia. A novel finding arising from this study is the strong association with Dupuytren's disease. Our study design allowed us to identify these associations as being independent from carpal tunnel syndrome, thereby indicating a shared pathophysiology between this disease and TF.

Is arthritis an associated risk factor for trigger finger occurrence after carpal tunnel release? A nationwide, population-based study in Korea

PURPOSE

We hypothesized that increased friction between the flexor tendon and surrounding structures due to hand arthritis is an important risk factor for trigger finger (TF) after carpal tunnel release (CTR). Therefore, we compared TF development according to the presence or absence of arthritis in carpal tunnel syndrome (CTS) patients treated with CTR.

METHODS

This retrospective study was based on data collected from the National Health Insurance Service-National Sample Cohort (NHIS-NSC) in the Republic of Korea between January 1, 2002, and December 31, 2015. Patients diagnosed with TF between one month and one year after the CTR date or with a history of surgery were included in the study. During subsequent follow-up, the patients were divided into subgroups of those (1) with TF and (2) without TF. Sex, age, arthritis, and TF-related comorbidities were compared between the subgroups.

RESULTS

The subgroup with TF had a higher proportion of women (9.43% vs 90.57%), the highest age range between 50 and 59 years, more cases of arthritis (32.55% vs 16.79%), and a higher proportion of patients with hypothyroidism (10.85% vs 4.60%) than the group without TF. The association between arthritis and TF after CTR was examined using a multivariate logistic regression model, showing arthritis to be a significant risk factor for TF after CTR (odds ratio, 1.35; P = 0.049).

CONCLUSIONS

We identified arthritis as an important risk factor for the development of TF after CTR.

Effects of socioeconomic status on patient-reported outcome after surgically treated trigger finger: a retrospective national registry-based study

OBJECTIVES

To investigate if socioeconomic status impacts patient-reported outcomes after a surgically treated trigger finger (TF).

DESIGN AND SETTING

Data on patients with TF treated with surgery were collected from the Swedish National Quality Registry of Hand Surgery (HAKIR) 2010-2019 with an evaluation of symptoms and disability before surgery and at 3 and 12 months after surgery, using the short version of the Disabilities of Arm, Shoulder and Hand (QuickDASH) questionnaire.Data from HAKIR and the Swedish National Diabetes Registry (ndr.nu) were combined with socioeconomic data from Statistics Sweden (scb.sc), analysing the impact of marital status, education level, income, occupation, sickness benefits, days of unemployment, social assistance and migrant status on the outcome by a linear regression model.

PARTICIPANTS

In total, 5477 patients were operated on for primary TF during the study period, of whom 21% had diabetes, with a response rate of 35% preoperatively, 26% at 3 months and 25% at 12 months.

RESULTS

At all time points, being born in Sweden (preoperatively B-coefficient: -9.74 (95% CI -13.38 to -6.11), 3 months postoperatively -9.80 (95% CI -13.82 to -5.78) and 12 months postoperatively -8.28 (95% CI -12.51 to -4.05); all p<0.001) and high earnings (preoperatively -7.81 (95% CI -11.50 to -4.12), 3 months postoperatively -9.35 (95% CI -13.30 to -5.40) and 12 months postoperatively -10.25 (95% CI -14.37 to -6.13); all p<0.0001) predicted lower QuickDASH scores (ie, fewer symptoms and disability) in the linear regression models. More sick leave during the surgery year predicted higher QuickDASH scores (preoperatively 5.77 (95% CI 3.28 to 8.25; p<0.001), 3 months postoperatively 4.40 (95% CI 1.59 to 7.22; p<0.001) and 12 months postoperatively 4.38 (95% CI 1.35 to 7.40; p=0.005)). No socioeconomic factors impacted the change in QuickDASH score from preoperative to 12 months postoperatively in the fully adjusted model.

CONCLUSION

Individuals with low earnings, high sick leave the same year as the surgery and those born outside of Sweden reported more symptoms both before and after surgery, but the relative improvement was not affected by socioeconomic factors.

High incidence of trigger finger after carpal tunnel release: a systematic review and meta-analysis

INTRODUCTION

Trigger finger (TF) often occurs after carpal tunnel release (CTR), but the mechanism and outcomes remain inconsistent. This study evaluated the incidence of TF after CTR and its related risk factors.

MATERIALS AND METHODS

​PubMed, Embase, and Scopus databases were searched up to 27 August 2022, with the following keywords: "carpal tunnel release" and "trigger finger". Studies with complete data on the incidence of TF after CTR and published full text. The primary outcome was the association between CTR and the subsequent occurrence of the TF and to calculate the pooled incidence of post-CTR TF. The secondary outcomes included the potential risk factors among patients with and without post-CTR TF as well as the prevalence of the post-CTR TF on the affected digits.

RESULTS

Ten studies with total 10,399 participants in 9 studies and 875 operated hands in one article were included for meta-analysis. CTR significantly increases the risk of following TF occurrence (odds ratio=2.67; 95% CI 2.344-3.043; P <0.001). The pooled incidence of TF development after CTR was 7.7%. Women were more likely to develop a TF after CTR surgery (odds ratio=2.02; 95% CI 1.054-3.873; P =0.034). Finally, the thumb was the most susceptible fingers, followed by middle and ring fingers.

CONCLUSIONS

High incidence of TF comes after CTR, and women were more susceptible than man. Clinicians were suggested to notice the potential risk of TF after CTR in clinical practice.

LEVEL OF EVIDENCE

Level III, meta-analysis.