1
|
Houegban ASCR, Barthel L, Giannikas D, Marin-Braun F, Montoya-Faivre D. Treatment of advanced trigger finger by ulnar superficialis slip resection: Long-term outcome and predictive factors for poor prognosis. HAND SURGERY & REHABILITATION 2023; 42:121-126. [PMID: 36716964 DOI: 10.1016/j.hansur.2023.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/15/2023] [Accepted: 01/17/2023] [Indexed: 01/30/2023]
Abstract
The aim of this study was to evaluate the outcome of ulnar superficialis slip resection and to determine predictive factors for poor prognosis in patients with advanced trigger finger. Over a 5-year-period, 55 patients (58 fingers) were included. After surgery, two groups were identified: group 1, with complete extension or <10° extension deficit in the proximal interphalangeal (PIP) joint (n = 27 fingers/27 patients); and group 2, with ≥10° residual PIP extension deficit (n = 31 fingers/28 patients). Factors associated with PIP extension deficit were assessed on logistic regression. There was a median extension gain of 20° (range, 10-30°) after surgery. The difference between pre- and post-operative extension deficits was significant (p < 0.001). There was no significant inter-group difference in DASH score (p > 0.9). Two predictive factors were found: >12 months' preoperative symptom duration (OR = 1.02; p = 0.045), and lack of self-rehabilitation (OR = 20; p < 0.001). Ulnar superficialis slip resection was effective in advanced trigger finger. Hand surgeons should operate early on these patients, and encourage self-rehabilitation. LEVEL OF EVIDENCE: 4.
Collapse
Affiliation(s)
- A S C R Houegban
- From the Centre de la Main, SOS Main Clinique Rhena, 10 rue Francois Epailly, 67000 Strasbourg, France.
| | - L Barthel
- From the Centre de la Main, SOS Main Clinique Rhena, 10 rue Francois Epailly, 67000 Strasbourg, France
| | - D Giannikas
- From the Centre de la Main, SOS Main Clinique Rhena, 10 rue Francois Epailly, 67000 Strasbourg, France
| | - F Marin-Braun
- From the Centre de la Main, SOS Main Clinique Rhena, 10 rue Francois Epailly, 67000 Strasbourg, France
| | - D Montoya-Faivre
- From the Centre de la Main, SOS Main Clinique Rhena, 10 rue Francois Epailly, 67000 Strasbourg, France
| |
Collapse
|
2
|
van den Berg C, van der Zwaard B, Halperin J, van der Heijden B. Factors associated with conversion to surgical release after a steroid injection in patients with a trigger finger. Bone Joint J 2022; 104-B:1142-1147. [PMID: 36177636 DOI: 10.1302/0301-620x.104b10.bjj-2022-0058.r3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this retrospective study was to evaluate the rate of conversion to surgical release after a steroid injection in patients with a trigger finger, and to analyze which patient- and trigger finger-related factors affect the outcome of an injection. METHODS The medical records of 500 patients (754 fingers) treated for one or more trigger fingers with a steroid injection or with surgical release, between 1 January 2016 and 1 April 2020 with a follow-up of 12 months, were analyzed. Conversion to surgical release was recorded as an unsuccessful treatment after an injection. The effect of patient- and trigger finger-related characteristics on the outcome of an injection was assessed using stepwise manual backward multivariate logistic regression analysis. RESULTS Treatment with an injection was unsuccessful in 230 fingers (37.9%). Female sex (odds ratio (OR) 1.87 (95% confidence interval (CI) 1.21 to 2.88)), Quinnell stage IV (OR 16.01 (95% CI 1.66 to 154.0)), heavy physical work (OR 1.60 (95% CI 0.96 to 2.67)), a third steroid injection (OR 2.02 (95% CI 1.06 to 3.88)), and having carpal tunnel syndrome (OR 1.59 (95% CI 0.98 to 2.59)) were associated with a higher risk of conversion to surgical release. In contrast, an older age (OR 0.98 (95% CI 0.96 to 0.99)), smoking (OR 0.39 (95% CI 0.24 to 0.64)), and polypharmacy (OR 0.39, CI 0.12 to 1.12) were associated with a lower risk of conversion. The regression model predicted 15.6% of the variance found for the outcome of the injection treatment (R2 > 0.25). CONCLUSION Factors associated with a worse outcome following a steroid injection were identified and should be considered when choosing the treatment of a trigger finger. In women with a trigger finger, the choice of treatment should take into account whether there are also one or more patient- or trigger-related factors that increase the risk of conversion to surgery.Cite this article: Bone Joint J 2022;104-B(10):1142-1147.
Collapse
Affiliation(s)
- Catherine van den Berg
- Department of Plastic and Reconstructive Surgery and Hand Surgery, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, the Netherlands
| | - Babette van der Zwaard
- Department of Orthopedic Surgery, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, the Netherlands
| | - Joni Halperin
- Department of Plastic and Reconstructive Surgery and Hand Surgery, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, the Netherlands.,Department of Plastic and Reconstructive Surgery and Hand Surgery, UMC Utrecht, GA Utrecht, the Netherlands
| | - Brigitte van der Heijden
- Department of Plastic and Reconstructive Surgery and Hand Surgery, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, the Netherlands.,Department of Plastic and Reconstructive Surgery and Hand Surgery, Radboudumc, Nijmegen, the Netherlands
| |
Collapse
|
3
|
Pompeu Y, Aristega Almeida B, Kunze K, Altman E, Fufa DT. Current Concepts in the Management of Advanced Trigger Finger: A Critical Analysis Review. JBJS Rev 2021; 9:01874474-202109000-00002. [PMID: 35417430 DOI: 10.2106/jbjs.rvw.21.00006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» While the majority of patients with trigger finger obtain excellent outcomes from nonoperative treatment or release of the A1 pulley, a subset of patients with advanced trigger finger, defined as trigger finger with loss of active or passive range of motion, may have incomplete symptom relief and warrant specific attention. » Advanced trigger finger is more refractory to complete symptom resolution from corticosteroid injection, and particular attention should be paid to incomplete improvement of flexion contractures. » Unlike simple trigger finger, the pathology in advanced trigger finger involves not only the A1 pulley but also the flexor tendon, including thickening and degeneration. » Progression toward surgical intervention should not be delayed when nonoperative measures fail, and specific attention should be paid to persistent inability to achieve full extension following A1 pulley release. » Facing substantial residual flexion contracture, reduction flexor tenoplasty and partial or complete resection of the superficialis tendon followed by hand therapy and splinting may be needed to allow patients to regain reliable full range of motion.
Collapse
Affiliation(s)
- Yuri Pompeu
- Department of Hand Surgery, Hospital for Special Surgery, New York, NY
| | - Bryan Aristega Almeida
- Department of Hand Surgery, Hospital for Special Surgery, New York, NY
- Cornell University Weill Cornell Medical College, New York, NY
| | - Kyle Kunze
- Department of Hand Surgery, Hospital for Special Surgery, New York, NY
| | - Emily Altman
- Department of Hand Surgery, Hospital for Special Surgery, New York, NY
| | - Duretti T Fufa
- Department of Hand Surgery, Hospital for Special Surgery, New York, NY
- Cornell University Weill Cornell Medical College, New York, NY
| |
Collapse
|
4
|
Bianchi S, Gitto S, Draghi F. Ultrasound Features of Trigger Finger: Review of the Literature. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:3141-3154. [PMID: 31106876 DOI: 10.1002/jum.15025] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/25/2019] [Accepted: 04/19/2019] [Indexed: 06/09/2023]
Abstract
Trigger finger is a common pathologic condition of the digital pulleys and flexor tendons in the hand. The key clinical finding is a transient blockage of the digit when it is flexed with subsequent painful snapping when it is extended. Imaging is a helpful guide for establishing the severity of the disease, identifying the underlying cause, and deciding the appropriate management. This narrative review aims to recall the anatomic and pathologic bases and describe the ultrasound features of trigger finger, also including common ultrasound findings and complications after therapy. Ultrasound enables an accurate static and dynamic evaluation of trigger finger as well as a comparison with the adjacent normal digits and thus should be considered the radiologic modality of first choice for its diagnosis.
Collapse
Affiliation(s)
| | - Salvatore Gitto
- Postgraduate School in Radiodiagnostics, Università Degli Studi di Milano, Milan, Italy
| | - Ferdinando Draghi
- Radiology Institute, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Università Degli Studi di Pavia, Pavia, Italy
| |
Collapse
|
5
|
Baek JH, Chung DW, Lee JH. Factors Causing Prolonged Postoperative Symptoms Despite Absence of Complications After A1 Pulley Release for Trigger Finger. J Hand Surg Am 2019; 44:338.e1-338.e6. [PMID: 30054030 DOI: 10.1016/j.jhsa.2018.06.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 05/18/2018] [Accepted: 06/22/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE This study aimed to investigate the incidence and prognostic factors for prolonged postoperative symptoms after open A1 pulley release in patients with trigger finger, despite absence of any complications. METHODS We reviewed 109 patients (78 single-finger involvement, 31 multiple-finger involvement) who underwent open A1 pulley release for trigger finger from 2010 to 2016, with 8 weeks or longer postsurgical follow-up and without postoperative complications. The group had 16 men and 93 women, with mean age of 56 years (range, 21-81 years), and average follow-up period of 24.8 weeks (range, 8.0-127.4 weeks). Prolonged postoperative symptoms were defined as symptoms persisting for longer than 8 weeks after surgery. Factors analyzed for delay in recovery included duration of preoperative symptoms; number of preoperative local corticosteroid injections; preoperative flexion contracture of proximal interphalangeal (PIP) joint; multiplicity of trigger finger lesions; occupation; presence of type 2 diabetes mellitus, other hand disorders like carpal tunnel syndrome, de Quervain disease, or Dupuytren contracture; and fraying or partial tear of the flexor tendon. RESULTS Twenty-six fingers (19.3%) showed prolonged postoperative symptoms, with mean time until complete relief being 14.0 ± 6.4 weeks (range, 9-34 weeks). Risk factors associated with prolonged postoperative symptoms included duration of preoperative symptoms, preoperative flexion contracture of the PIP joint, and fraying or partial tear of the flexor tendon. CONCLUSIONS Physicians should consider the duration of preoperative symptoms and preoperative flexion contracture of the PIP joint when deciding timing of surgery for trigger finger patients. In addition, they should explain to patients with a positive history of these factors and in whom flexor tendon injury is found during surgery about the possibility of prolonged postoperative symptoms. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.
Collapse
Affiliation(s)
- Jong Hun Baek
- Department of Orthopedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Duke Whan Chung
- Department of Orthopedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Jae Hoon Lee
- Department of Orthopedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea.
| |
Collapse
|
6
|
Werner BC, Boatright JD, Chhabra AB, Dacus AR. Trigger digit release: rates of surgery and complications as indicated by a United States Medicare database. J Hand Surg Eur Vol 2016; 41:970-976. [PMID: 27313182 DOI: 10.1177/1753193416653707] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED A United States insurance database was examined for trigger digit release using International Classification of Diseases, 9th Revision diagnoses and procedures or Current Procedural Terminology codes. Complications after trigger digit release, including stiffness, infection and revision surgery, were assessed. A total of 209,634 patients who underwent trigger digit release were included. The rate of trigger digit release increased significantly from 2005 to 2012, with the middle finger the most frequently released. The rate of postoperative stiffness was low, ranging from 0.8% to 1.6% depending on the operated digit. The rate of postoperative infection was lower, ranging from 0.5% to 0.6%. The need for revision within 3 years of initial trigger digit release was also low, ranging from 0.3% to 0.8%. Complications, including infection, stiffness and revision surgery, occur infrequently, but certain factors, including diabetes, Dupuytren's disease, smoking, rheumatoid arthritis, obesity and age, increase risk. LEVEL OF EVIDENCE Therapeutic Level III, Retrospective comparative study.
Collapse
Affiliation(s)
- B C Werner
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - J D Boatright
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - A B Chhabra
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - A R Dacus
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA, USA
| |
Collapse
|
7
|
Yildirim P, Gultekin A, Yildirim A, Karahan AY, Tok F. Extracorporeal shock wave therapy versus corticosteroid injection in the treatment of trigger finger: a randomized controlled study. J Hand Surg Eur Vol 2016; 41:977-983. [PMID: 26763271 DOI: 10.1177/1753193415622733] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED The purpose of this study was to compare the efficacies of extracorporeal shock wave therapy and corticosteroid injection for the management of trigger finger. In this prospective randomized clinical trial, 40 patients with actively correctable trigger fingers were randomly assigned to extracorporeal shock wave therapy (1000 impulses and 2.1 bar) or injection groups. The effectiveness of the treatment was assessed using cure rates, a visual analogue scale, the frequency of triggering, the severity of triggering, the functional impact of triggering, and the Quick-Disabilities of the Arm, Shoulder, and Hand questionnaire at 1, 3, and 6 months after treatment. An intention-to- treat analysis was used in this study. Both groups demonstrated statistically significant improvements in all outcome measures after treatment. The intention-to-treat analyses showed no between-group differences for cure rates, pain, and functional status at follow-up. We conclude that extracorporeal shock wave therapy could be a non-invasive option for treating trigger finger, especially for those patients who wish to avoid steroid injections. LEVEL OF EVIDENCE Level II.
Collapse
Affiliation(s)
- P Yildirim
- 1 Department of Physical Medicine and Rehabilitation, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - A Gultekin
- 2 Department of Orthopedics and Traumatology, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - A Yildirim
- 3 Department of Plastic Reconstructive and Aesthetic Surgery, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - A Y Karahan
- 4 Department of Physical Medicine and Rehabilitation, Konya Beyhekim State Hospital, Kocaeli, Turkey
| | - F Tok
- 5 Department of Physical Medicine and Rehabilitation, Gulhane Military Medical Academy, Kocaeli, Turkey
| |
Collapse
|
8
|
Shinomiya R, Sunagawa T, Nakashima Y, Yoshizuka M, Adachi N. Impact of Corticosteroid Injection Site on the Treatment Success Rate of Trigger Finger: A Prospective Study Comparing Ultrasound-Guided True Intra-Sheath and True Extra-Sheath Injections. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:2203-2208. [PMID: 27365258 DOI: 10.1016/j.ultrasmedbio.2016.05.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 04/15/2016] [Accepted: 05/16/2016] [Indexed: 06/06/2023]
Abstract
The aim of this study was to investigate whether differences in corticosteroid injection site influence the therapeutic effect on trigger finger and thickness of local structures such as the A1 pulley and flexor tendons. Previously untreated trigger fingers were randomly assigned to receive either a true intra-sheath (group I) or an extra-sheath (group E) injection under ultrasonographic guidance. Symptom remission and recurrence rates and recurrence timing did not significantly differ between the groups. Ultrasonography revealed mean (standard deviation) pre-injection A1 pulley thicknesses of 1.1 (0.3) and 1.1 (0.2) mm in groups I and E, respectively. One month after injection, these decreased to 0.7 (0.2) and 0.8 (0.2) mm, respectively (p < 0.05). Furthermore, mean (standard) pre-injection flexor digitorum tendon thickness was 4.1 (0.4) and 4.0 (0.5) mm in groups I and E, respectively, and, 1 mo after injection, decreased to 3.9 (0.3) and 3.8 (0.5) mm, respectively (p < 0.05). However, the difference at each time point between the two groups was not statistically significant. True intra-sheath injection offers no apparent advantage over extra-sheath injection for treating trigger fingers because both have the same effect on local structures.
Collapse
Affiliation(s)
- Rikuo Shinomiya
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
| | - Toru Sunagawa
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yuko Nakashima
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Masaaki Yoshizuka
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| |
Collapse
|