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Ferrara PE, Codazza S, Maccauro G, Zirio G, Ferriero G, Ronconi G. Physical therapies for the conservative treatment of the trigger finger: a narrative review. Orthop Rev (Pavia) 2020; 12:8680. [PMID: 32913608 PMCID: PMC7459363 DOI: 10.4081/or.2020.8680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 11/23/2022] Open
Abstract
Trigger finger (TF) disorder is a sudden release or locking of a finger during flexion or extension. Treatments for this disease are conservative and surgical, including NSAIDs, hand splints, corticosteroid injections, physical therapies and percutaneous or open surgery. However, the effectiveness about the optimal treatment of TF is still in lack of evidence. The aim of this study is to investigate the effectiveness of physical therapies as conservative treatment for trigger finger. A comprehensive literature search of the MEDLINE (via PubMed), Cochrane Library Databases and PEDro databases has been conducted without limits because few papers were published about this argument. The literature search identified four papers in PubMed. Two types of physical therapies were used in the conservative management of trigger finger: external shock wave therapy (ESWT) in three papers, and ultrasound therapy (UST) in one paper. ESWT is an effective and safe therapy for the conservative management of TF. It seems to reduce pain and trigger severity and to improve functional level and quality of life. UST has proven to be useful to prevent the recurrence of TF symptoms. Even if the results suggest the effectiveness of ESWT and UST for TF, future studies are necessary to understand the characteristics of the optimal treatment protocol for trigger finger.
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Affiliation(s)
| | | | - Giulio Maccauro
- Orthopedic and Traumatology Institute, Catholic University of the Sacred Heart, Rome
| | - Gianfranco Zirio
- Orthopedic and Traumatology Institute, Catholic University of the Sacred Heart, Rome
| | - Giorgio Ferriero
- Istituto Scientifico di Tradate, IRCCS Istituti Clinici Maugeri, Tradate (VA), Italy
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Abstract
The wide awake anesthesia technique is a useful tool in secondary tendon reconstruction. With active participation of the patient, the tendon repair can be adjusted appropriately to prevent repairs that are too tight or too loose. Areas of tendon scarring or triggering can be identified and released. Other advantages of active participation include reduction of gapping, ensuring adequate strength of repair, and avoiding tendon imbalances. Last, it allows intraoperative patient education and may therefore increase patient satisfaction. This article discusses how the technique can be applied to tenolysis, 2-stage tendon reconstruction, and tendon transfer.
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Affiliation(s)
- Lin Lin Gao
- Chase Hand and Upper Limb Center, Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, 770 Welch Road, Suite 400, Palo Alto, CA 94304, USA.
| | - James Chang
- Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, 770 Welch Road, Suite 400, Palo Alto, CA 94304, USA
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Abstract
BACKGROUND Although steroid injection remains a common first-line treatment of trigger finger, clinical experience suggests that not all cases of trigger finger respond the same. The purpose of this study was to use a classification system for trigger finger that is simple and reproducible, and produces clearly definable, clinically relevant cutoff points to determine whether responsiveness to steroid injection correlates to clinical staging. METHODS The authors conducted a prospectively collected longitudinal study of trigger finger patients separated into four stages of severity. Each subject received a single injection of 6 mg of dexamethasone acetate. One-month outcomes were analyzed to evaluate the efficacy of steroid injection. These outcomes were further stratified based on baseline characteristics and stage of triggering. RESULTS A total of 99 digits and 69 subjects were included. Two variables were found to be significant in predicting response to initial injection: (1) multiple affected digits and (2) stage severity. Patients with multiple involved fingers were 5.8 times more likely to have no resolution of symptoms compared with those with a single affected finger. For every level of stage increase, the odds doubled for having no resolution of symptoms. CONCLUSIONS Steroid injection remains a viable first-line option for patients presenting with mild triggering (stage 1 and 2). For more severe triggering (stage 3 and 4) or multiple affected digits, the success of steroid injection is significantly lower at 1 month. For the latter patients, surgery may be a more reasonable initial treatment. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, II.
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Capon A, Watson A, England H. Therapeutic management of closed central slip injuries: Outcome of a service evaluation. HAND THERAPY 2019. [DOI: 10.1177/1758998318822663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Closed central slip injuries can be difficult to manage and there is a lack of published research to support evidence-based clinical decision making in practice. This article presents the results of a service review in a busy trauma hospital hand therapy department. Method Following a literature review and retrospective review of outcomes, new clinical guidelines for central slip injuries were developed. These were implemented with 22 patients referred to hand therapy for conservative management of closed central slip injuries during a one-year period. Results The majority of patients (72%) had either an excellent or good outcome using the Strickland-Glogovac outcome measure and an average total active motion of 90% compared to their unaffected hand. Conclusions The outcomes following implementation of new treatment guidelines following the service review are in line with the small amount of published data currently available. They provide detailed guidelines for the conservative management of closed central slip injuries in a busy out-patient setting.
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Affiliation(s)
- Annie Capon
- Hand Therapy Department, St George’s Hospital, London, UK
| | | | - Holly England
- Hand Therapy Department, St George’s Hospital, London, UK
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Malliaropoulos N, Jury R, Pyne D, Padhiar N, Turner J, Korakakis V, Meke M, Lohrer H. Radial extracorporeal shockwave therapy for the treatment of finger tenosynovitis (trigger digit). Open Access J Sports Med 2016; 7:143-151. [PMID: 27843364 PMCID: PMC5098764 DOI: 10.2147/oajsm.s108126] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Introduction Stenosing tenosynovitis that is characterized by the inability to flex the digit smoothly, usually leads to prolonged rehabilitation or surgery. Study design This case series is a retrospective cohort study. Purpose The aim of this case series was to evaluate the effectiveness of radial extracorporeal shockwave therapy (rESWT) for the treatment of stenosing tenosynovitis of the digital flexor tendon (trigger digit). Methods A retrospective analysis of 44 patients (49 fingers) treated with an individually adapted rESWT protocol was conducted. Trigger digit pain and function were evaluated at baseline and 1-, 3-, and 12-months posttreatment. Recurrence and pretreatment symptom duration were analyzed. Results Significant reductions in pain scores and functional improvement were found between baseline and all follow-up assessments (P<0.001). Pretreatment symptom duration was significantly correlated with the number of rESWT sessions required (r=0.776, P<0.001) and 1-year posttreatment pain score (r=0.335, P=0.019). Conclusion This study provides initial evidence that rESWT is an effective treatment for trigger digit, but randomised controlled trials are required to provide further evidence of this effect.
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Affiliation(s)
- Nikos Malliaropoulos
- Sports and Exercise Medicine, Thessaloniki Musculoskeletal Clinic; Thessaloniki National Track and Field Centre, Sports Medicine Clinic of S.E.G.A.S., Thessaloniki, Greece; European Sports Care; Department of Rheumatology, Sports Clinic, Barts Health NHS Trust; Centre for Sports & Exercise Medicine, Queen Mary University of London, London, UK
| | - Rosanna Jury
- Sports and Exercise Medicine, Thessaloniki Musculoskeletal Clinic; Thessaloniki National Track and Field Centre, Sports Medicine Clinic of S.E.G.A.S., Thessaloniki, Greece; Centre for Sports & Exercise Medicine, Queen Mary University of London, London, UK
| | - Debasish Pyne
- European Sports Care; Department of Rheumatology, Sports Clinic, Barts Health NHS Trust; Centre for Sports & Exercise Medicine, Queen Mary University of London, London, UK
| | - Nat Padhiar
- European Sports Care; Centre for Sports & Exercise Medicine, Queen Mary University of London, London, UK
| | | | - Vasileios Korakakis
- European Sports Care; Aspetar, Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Maria Meke
- Sports and Exercise Medicine, Thessaloniki Musculoskeletal Clinic
| | - Heinz Lohrer
- European Sports Care; European SportsCare Network (ESN), Zentrum für Sportorthopädie, Wiesbaden-Nordenstadt, Germany
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Zhao JG, Kan SL, Zhao L, Wang ZL, Long L, Wang J, Liang CC. Percutaneous first annular pulley release for trigger digits: a systematic review and meta-analysis of current evidence. J Hand Surg Am 2014; 39:2192-202. [PMID: 25227600 DOI: 10.1016/j.jhsa.2014.07.044] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 07/22/2014] [Accepted: 07/23/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the overall success rate and potential influencing factors within the current evidence for percutaneous first annular pulley release. METHODS We searched PubMed, EMBASE, and the Cochrane Library for all clinical studies of percutaneous release. The rates of successful procedure and complication were extracted and analyzed. We charted the overall success rate on a forest plot with 95% confidence intervals. Data of success rates were analyzed in 5- and 10-year intervals to determine whether the rate of success had increased chronologically. We then performed 3 subgroup analyses according to instrument type (needles vs knife blades), cortisone use (cortisone vs noncortisone), and sonography guidance (sonography vs non-sonography guidance). Pooled success rates were calculated in the subgroups and compared using chi-square test. RESULTS A total of 34 studies involving 2,114 percutaneous procedures were included in this systematic review and meta-analysis. The total success rate was 94%. There was a trend toward increasing number of publications in the past 20 years. We found a statistically significant trend showing that overall success rates had increased over time. Chi-square test revealed that percutaneous release with sonography guidance had a significantly higher success rate than non-sonography guidance. There were no significant differences in other subgroup analyses including instrument type and cortisone use. CONCLUSIONS Percutaneous release is an effective and safe procedure for the treatment of trigger digit. It has become progressively popular in recent years, with a trend toward increased overall success. Sonography might be a helpful tool for maximizing success. The success rates were not affected by instruments and cortisone use. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Jia-Guo Zhao
- Departments of Orthopaedic Surgery, Hand Surgery, Sports Medicine and Arthroscopic Surgery, Orthopaedic Radiology, and Orthopaedic Traumatology, Tianjin Hospital, Clinical College of Orthopaedic Surgery, Tianjin Medical University, Tianjin, China.
| | - Shi-Lian Kan
- Departments of Orthopaedic Surgery, Hand Surgery, Sports Medicine and Arthroscopic Surgery, Orthopaedic Radiology, and Orthopaedic Traumatology, Tianjin Hospital, Clinical College of Orthopaedic Surgery, Tianjin Medical University, Tianjin, China
| | - Li Zhao
- Departments of Orthopaedic Surgery, Hand Surgery, Sports Medicine and Arthroscopic Surgery, Orthopaedic Radiology, and Orthopaedic Traumatology, Tianjin Hospital, Clinical College of Orthopaedic Surgery, Tianjin Medical University, Tianjin, China
| | - Zeng-Liang Wang
- Departments of Orthopaedic Surgery, Hand Surgery, Sports Medicine and Arthroscopic Surgery, Orthopaedic Radiology, and Orthopaedic Traumatology, Tianjin Hospital, Clinical College of Orthopaedic Surgery, Tianjin Medical University, Tianjin, China
| | - Lei Long
- Departments of Orthopaedic Surgery, Hand Surgery, Sports Medicine and Arthroscopic Surgery, Orthopaedic Radiology, and Orthopaedic Traumatology, Tianjin Hospital, Clinical College of Orthopaedic Surgery, Tianjin Medical University, Tianjin, China
| | - Jia Wang
- Departments of Orthopaedic Surgery, Hand Surgery, Sports Medicine and Arthroscopic Surgery, Orthopaedic Radiology, and Orthopaedic Traumatology, Tianjin Hospital, Clinical College of Orthopaedic Surgery, Tianjin Medical University, Tianjin, China
| | - Cong-Cong Liang
- Departments of Orthopaedic Surgery, Hand Surgery, Sports Medicine and Arthroscopic Surgery, Orthopaedic Radiology, and Orthopaedic Traumatology, Tianjin Hospital, Clinical College of Orthopaedic Surgery, Tianjin Medical University, Tianjin, China
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