Acupuncture for the treatment of trigger finger in adults: a prospective case series

Resolution of Trigger Finger with Electroacupuncture

Background

Trigger finger (TF; a type of stenosing tenosynovitis) is common, affecting the flexor tendons of the hand, often causing significant pain and functional impairment. Treatment can include splinting, corticosteroid injection, or surgical release. There is little published research on the role of electroacupuncture (EA) for treating TF.

Case

After more than 1 year of pain and triggering, a 58 year-old male had locking of his left, fourth ring finger requiring painful manual reduction. EA was performed with 4-6 needles in a rectangular pattern along the radial and ulnar aspects of the A1 pulley of the fourth digit, with 10 Hz delivered in a daisy-chain formation for 45 minutes. Nodule size, frequency of triggering and locking, and severity of pain were assessed before and after 4 treatments over ∼1.5 months.

Results

This patient's frequency of locking and severity of pain decreased significantly by 50% after his first treatment. Additional clinically significant reductions of locking, pain, and nodule-size were evident after each treatment along with substantial functional gains between visits. After his fourth treatment, he reported 100% resolution of his symptoms with no further pain or triggering. Throughout this time, he continued his usual activities.

Conclusions

EA alone directed at the A1 pulley may be an effective treatment modality for patients with TF. The authors hypothesize that EA may reduce pain enabling a return to normal function and compression of the nodule, thus eliminating triggering. Further research evaluating the efficacy of EA for TF may help substantiate these results.

Reduced Pain and Improved Quality of Life After Laser Acupuncture Therapy for Trigger Finger

Background

Trigger fingers is a condition that causes locking/stiffness due to inflammation and hypertrophy of the tendon sheaths. This inflammatory process occurs due to degenerative conditions, such as aging, chronic daily overuse, and other factors such as metabolic disorders.

Case

A 51-year-old woman had grade IIIb trigger finger on her right hand for ∼2 months before going to an outpatient clinic. She also had stiffness and swelling for a longer time but it felt more severe by the time she presented at the clinic, thus, interfering with her work and quality of life (QoL). She was given acupuncture with low-level-laser therapy, using a low-energy laser, 3 times per week, on her right hand. The unilateral points used were LU-10 Yuji, LI-4 Hegu, PC-6 Neiguan, LI-11 Quchi, GB-21 Jianjing, and an Ashi point on the first finger of the metacarpophalangeal [MCP-I] joint). The bilateral body points used were ST 36 Zusanli and LR-3 Taichong.

Results

After 12 sessions of therapy, there was a decrease her numerical rating scale (NRS) score of 6/10 to an NRS score of 0/10. She also had an improvement in her QoL, as measured by the Short Form-36 and Quick-Disabilities of the Arm, Shoulder and Hand instruments.

Conclusions

Laser acupuncture may be considered for treating pain and improving QoL of patients with trigger finger. In addition, laser acupuncture causes minimal side-effects, compared with other medical treatments.

Different acupotomy for stenosing tenosynovitis: A protocol for systematic review and network meta-analysis

BACKGROUND

Stenosing tenosynovitis (STS) is a chronic aseptic inflammation caused by mechanical friction. The main clinical manifestations are local pain and limited activity of the affected parts, which reduce people's quality of life. The clinical effect of acupotomy in the treatment of STS is significant, and the operation is simple and the side effect is small. But there are many kinds of acupotomology, and there is a lack of comparative study between different Acupotomology. In this study, the effectiveness of 4 commonly used needle knife therapies (v-knife, oblique knife, crochet knife, flat knife) was ranked by the method of network meta.

METHODS

CNKI, Wanfang, VIP, Sinomed, PubMed, and Cochrane Library were searched to collect randomized controlled trials of v-knife, oblique knife, crochet knife, and flat knife in the treatment of STS. The search time limit is from the date of establishment to October 15, 2021. Revman5.3, gemtc 0.14.3, and stata14.2 were used for data analysis, and Cochrane bias risk assessment tool was used to screen and evaluate the quality of included literatures.

CONCLUSION

Objective to provide evidence-based medicine evidence for clinical selection of the best needle knife treatment scheme for STS.

A Critical Appraisal of Adult Trigger Finger: Pathophysiology, Treatment, and Future Outlook

Trigger finger (TF) is a common referral to a hand surgeon, with people with diabetess being the most at-risk population. Abnormal thickening, scarring, and inflammation occur at the A1 pulley and flexor tendon, and histological changes correlate well with the clinical severity of TF. Corticosteroid injections decrease the thickness of the A1 pulley and are considered a first-line treatment. However, corticosteroids are only moderately effective, especially for people with diabetes. Patients may elect for surgery if nonoperative treatments prove ineffective; some may choose immediate surgical release instead. To release the A1 pulley, patients have the option of an open or percutaneous approach. The open approach has a greater risk of infection and scar tissue formation in the short run but an overall superior long-term outcome compared with the percutaneous approach.

METHODS

We critically reviewed the efficacy and cost-effectiveness of the treatment methods for TF through a comprehensive search of the PubMed Database from 2003 to 2019.

RESULTS

To reduce costs, while still delivering the best possible care, it is critical to consider the likelihood of success for each treatment method in each subpopulation. Furthermore, some patients may need to return to work promptly, which ultimately may influence their desired treatment method.

CONCLUSIONS

Currently, there is no universal treatment algorithm for TF. From a purely financial standpoint, women without diabetes presenting with a single triggering thumb should attempt 2 corticosteroid trials before percutaneous release. It is the most cost-effective for all other subpopulations to elect for immediate percutaneous release.