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Baek JH, Seo JH, Lee JH. Comparative Study of A1 Pulley Release and Ulnar Superficialis Slip Resection in Trigger Finger With Flexion Contracture of the Proximal Interphalangeal Joint. J Hand Surg Am 2024; 49:58.e1-58.e8. [PMID: 35811217 DOI: 10.1016/j.jhsa.2022.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 02/23/2022] [Accepted: 04/08/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to compare the clinical outcomes of A1 pulley release with ulnar superficialis slip resection (group A) and simple A1 pulley release (group B) in trigger finger with flexion contracture of the proximal interphalangeal (PIP) joint. METHODS From January 2016 to December 2019, the 2 surgical procedures were performed alternately every year for trigger fingers with preoperative PIP joint flexion contractures of ≥10°. Twenty-six fingers in group A and 29 fingers in group B that were followed up for >1 year were reviewed in this retrospective study. The visual analog scale (VAS) score; Disabilities of the Arm, Shoulder, and Hand (DASH) score; degree of PIP joint flexion contracture; grip strength; and pinch strength were measured after surgery and compared. RESULTS The differences in postoperative PIP joint flexion contracture between groups were <4° at 2 and 6 weeks, and there were no clinically relevant differences at 6 weeks and 12 months. At the final follow-up, PIP joint flexion contractures of 5° were observed in 2 fingers in each group. The difference in VAS scores between groups was less than half of a point until 3 months, and there were no clinically relevant differences at 6 weeks and 12 months. The DASH score did not show any difference between groups at the final follow-up. There were clinically relevant differences in the grip and pinch strengths between groups at 6 weeks. However, there were no clinically relevant differences at the final follow-up. CONCLUSIONS Proximal interphalangeal joint flexion contracture measurements and clinical scores did not differ between groups at the final follow-up. Therefore, we recommend use of a simple A1 pulley release, which is simpler than an A1 pulley release with ulnar superficialis slip resection, in cases of trigger finger with PIP joint flexion contracture. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Jong Hun Baek
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, Kyung Hee University, Seoul, Korea
| | - Jeung Hwan Seo
- Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University, Seoul, Korea
| | - Jae Hoon Lee
- Department of Orthopaedic Surgery, Yeson Hospital, Bucheon, Korea.
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Saito T, Nakamichi R, Nakahara R, Nishida K, Ozaki T. The Effectiveness of Rehabilitation after Open Surgical Release for Trigger Finger: A Prospective, Randomized, Controlled Study. J Clin Med 2023; 12:7187. [PMID: 38002801 PMCID: PMC10671987 DOI: 10.3390/jcm12227187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/13/2023] [Accepted: 11/17/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND It is not clear whether rehabilitation after surgery for trigger finger is effective. The aim of this study was to reveal its effectiveness for trigger finger. METHODS This study was a randomized, controlled trial that included patients who underwent operations for trigger fingers. The patients in the rehabilitation group had postoperative occupational therapy (OT) for 3 months, while the patients in the control group were not referred for rehabilitation but received advice for a range of motion exercises. We evaluated the severity of trigger finger, Disability of Arm-Shoulder-Hand (DASH) score, pain-visual analogue scale (VAS), grip strength, whether they gained a full range of motion (ROM), and complications before and after surgery. RESULTS Finally, 29 and 28 patients were included in the control and rehabilitation groups, respectively. At final follow-up, the DASH score, grip strength, and ROM were significantly improved in the rehabilitation group compared to that preoperatively. At final follow-up, pain was significantly improved in both groups from that preoperatively. There were no significant differences in the results, including the DASH score, grip strength, ROM and pain-VAS between the control and rehabilitation groups at the final follow-up. Subgroup analysis showed that there is a significant difference in the DASH score of patients doing housework or light work and those with a duration of symptoms >12 months between the control and rehabilitation groups at the final follow-up.
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Affiliation(s)
- Taichi Saito
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1, Shikata-cho, Kitaku, Okayama 700-8558, Japan
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Atthakomol P, Wangtrakunchai V, Chanthana P, Phinyo P, Manosroi W. Are There Differences in Pain Reduction and Functional Improvement Among Splint Alone, Steroid Alone, and Combination for the Treatment of Adults With Trigger Finger? Clin Orthop Relat Res 2023; 481:2281-2294. [PMID: 37083487 PMCID: PMC10566884 DOI: 10.1097/corr.0000000000002662] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/19/2023] [Accepted: 03/20/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Steroid injection and splinting, which are commonly recommended nonsurgical treatments in adults with trigger finger, have been demonstrated to effectively relieve pain and improve function. However, to our knowledge, there have been no direct comparisons of pain relief and function improvement with splinting alone, steroid injection alone, or a combination of splinting and steroid injection in patients with this diagnosis. QUESTION/PURPOSE Are there differences in pain reduction and functional improvement in adults with trigger finger treated with splinting alone, steroid injection alone, and a combination of splinting and steroid injection at 6, 12, and 52 weeks after the intervention? METHODS Between May 2021 and December 2021, we treated 165 adult patients for trigger finger at an academic university hospital. Based on prespecified criteria, all patients we saw during that period were eligible, but 27% (45 of 165) were excluded because they had received a previous local corticosteroid injection (n = 10) or they had concomitant carpal tunnel syndrome (n = 14), first carpometacarpal joint arthritis (n = 3), osteoarthritis of the hand (n = 6), de Quervain disease (n = 3), multiple-digit trigger finger (n = 6), or pregnancy during the study period (n = 3). After screening, 120 patients were randomized to receive either splinting (n = 43), steroid injection (n = 40), or splinting plus steroid injection (n = 37). Patients were randomly assigned to the different treatments using computer-generated block randomization (block of six). Sequentially numbered, opaque, sealed envelopes were used in the allocation concealment process. Both the allocator and the outcome assessor were blinded. Splinting involved the patient wearing a fixed metacarpophalangeal joint orthosis in the neutral position at least 8 hours per day for 6 consecutive weeks. Steroid injection was performed using 1 mL of 1% lidocaine without epinephrine and 1 mL of triamcinolone acetonide (10 mg/mL) injected directly into the flexor tendon sheath. No patients were lost to follow-up or had treatment failure (that is, the patient had persistent pain or triggering with the trigger finger treatment and requested additional medical management including additional splinting, steroid injection, or surgery) at 6 or 12 weeks after the intervention, and at 52 weeks, there was no difference in loss to follow-up among the treatment groups. An intention-to-treat analysis was performed with all 120 patients, and a per-protocol analysis was conducted with 86 patients after excluding patients who were lost to follow-up or had treatment failure. Primary outcomes evaluated were VAS pain reduction and improvement in Michigan Hand Outcomes Questionnaire (MHQ) scores at 6, 12, and 52 weeks after the intervention. The minimum clinically important difference (MCID) values were 1 and 10.9 for the VAS and MHQ, respectively. RESULTS There were no clinically important differences in VAS pain scores among the three treatment groups at any timepoint, in either the intention-to-treat or the per-protocol analyses. Likewise, there were no clinically important differences in MHQ scores at any timepoint in either the intention-to-treat or the per-protocol analyses. CONCLUSION Splinting alone is recommended as the initial treatment for adults with trigger finger because there were no clinically important differences between splinting alone and steroid injection alone in terms of pain reduction and symptom or functional improvement up to 1 year. The combination of steroid injection and splinting is disadvantageous because the benefits in terms of pain reduction and symptom or functional improvement are not different from those achieved with steroid injection or splinting alone. LEVEL OF EVIDENCE Level I, therapeutic study.
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Affiliation(s)
- Pichitchai Atthakomol
- Clinical Epidemiology and Clinical Statistic Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Vorathep Wangtrakunchai
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Phongniwath Chanthana
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Phichayut Phinyo
- Clinical Epidemiology and Clinical Statistic Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Worapaka Manosroi
- Clinical Epidemiology and Clinical Statistic Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Nadar MS. Orthosis vs. exercise for the treatment of adult idiopathic trigger fingers: A randomized clinical trial. Prosthet Orthot Int 2023:00006479-990000000-00186. [PMID: 37870373 DOI: 10.1097/pxr.0000000000000294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 07/20/2023] [Indexed: 10/24/2023]
Abstract
OBJECTIVE Trigger finger is a common clinical disorder that often results in pain and functional limitations. This study aimed to determine whether joint-blocking orthosis was effective in treating adult idiopathic trigger fingers. METHODS Fifty-five participants were randomly assigned to either a hand therapy group or an orthosis group that immobilized the proximal interphalangeal joint for 6 weeks. The Green classification of triggering; short-form version of the Disabilities of the Arm, Shoulder, and Hand; and numeric pain rating scale were used to assess participants' data. RESULTS The orthosis was "successful" in completely resolving the symptoms of trigger finger in 53.6% of the participants at 6 weeks postintervention, whereas the hand therapy control group did not result in any "successful" outcomes. The Green classification score for the orthosis group decreased from 2.68 (standard deviation = 0.47) at baseline to 0.93 (standard deviation = 1.12) at 6 weeks. The short-form version of the Disabilities of the Arm, Shoulder, and Hand disability score was significantly reduced after wearing the orthosis, F (2, 52) = 74.16 p < 0.001, and improved from baseline (M = 37.6) to 6 weeks (M = 20.26). The pain intensity score was also significantly decreased after wearing the orthosis, F (2, 52) = 52.17 p < 0.001, partial η2 = 0.67. CONCLUSION Using orthosis to immobilize the proximal interphalangeal joint, day and night, for 6 weeks, is an effective and reasonable option for treating idiopathic trigger fingers with Green grade 2 or 3. Hand therapy without orthosis did not result in significant improvements.
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Affiliation(s)
- Mohammed Sh Nadar
- Occupational Therapy Department, Faculty of Allied Health Sciences, Kuwait University, Jabriah, Kuwait
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Velmurugan BK, Huang CY, Ding DC, Wu KC. An innovation percutaneous needle knife use for trigger finger: A retrospective cohort study. Tzu Chi Med J 2023; 35:242-246. [PMID: 37545799 PMCID: PMC10399844 DOI: 10.4103/tcmj.tcmj_277_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/08/2022] [Accepted: 01/17/2023] [Indexed: 08/08/2023] Open
Abstract
Objectives This study retrospectively evaluated the effectiveness of percutaneous pulley release by our newly designed needle knife in terms of cure, relapse, and complication rates. Materials and Methods Two hundred and fifty-seven patients were allocated into male and female groups between October 2014 and September 2021. We included patients >15 years of age with a trigger finger (TF) (types II-VI). The primary outcome was the absence of a TF and pain-free movement. In contrast, the secondary outcome included second-time surgery and the number of complications such as infection and admission for antibiotics. Results One hundred patients were male, and 157 patients were female. Males and females had mean ages of 62.45 ± 11.76 and 61.50 ± 8.57 years, respectively. The operative time was significantly longer in males than in females (7.88 ± 6.02 vs. 6.52 ± 3.74 min in males and females, respectively, P = 0.027). However, the percentages of diabetes mellitus and gout were the same in both groups. For the percutaneous methods with our needle knife, remission of the trigger was achieved in all cases. In addition, seven patients received revision and three patients with complications. After needle surgery, topical and joint pain scores were improved in both groups (from 5.09 ± 1.31 to 0.80 ± 1.56). Conclusion The percutaneous methods with our needle knife displayed effectiveness. The cure rate was high, and the relapse rate was low. Further large-scale clinical trials comparing percutaneous needle to open surgery for releasing the TF will be needed to confirm our results.
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Affiliation(s)
| | - Chih-Yang Huang
- Department of Medical Laboratory Science and Biotechnology, Asia University, Taichung, Taiwan
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
- Cardiovascular and Mitochondrial Related Disease Research Center, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- Center of General Education, Buddhist Tzu Chi Medical Foundation, Tzu Chi University of Science and Technology, Hualien, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Dah-Ching Ding
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Foundation and Tzu Chi University, Hualien, Taiwan
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
| | - Kun-Chi Wu
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
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De Gasperi D, Guo D, Guo D, Lu Y, Brounts SH. Ex vivo evaluation of a percutaneous thread-transecting technique for desmotomy of normal palmar/plantar annular ligaments in horses. Vet Surg 2023; 52:388-394. [PMID: 36625237 DOI: 10.1111/vsu.13932] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 11/23/2022] [Accepted: 12/20/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To develop and describe a minimally invasive, ultrasound-guided, percutaneous technique for the desmotomy of equine palmar/plantar annular ligaments (PALs) using a transecting thread. STUDY DESIGN Ex vivo study. SAMPLE POPULATION Twenty-one normal equine distal limb specimens. METHODS Under ultrasonographic guidance, a surgical thread was percutaneously placed around the PAL through 2 skin punctures (proximal and distal) using a 18 gauge spinal needle in equine limbs (11 forelimbs, 10 hindlimbs) with normal PALs. The ligament was transected by a back-and-forth motion of the thread until the loop emerged from the proximal skin puncture site. Each specimen was dissected and assessed for completeness of transection and iatrogenic damage under direct visualization. Descriptive statistics were reported. RESULTS The PAL was completely transected in 17/21 limbs. The mean duration of the procedure was 16 minutes. Superficial needle puncture or subtle abrasion of the superficial digital flexor tendon was noticed in 4 limbs. No iatrogenic injury to other intrathecal structures was identified. After PAL division, the needle entry and exit points had a mean diameter of 1.2 and 1 mm, respectively. CONCLUSION Desmotomy of normal PALs in equine limb specimens was performed effectively using the percutaneous thread-transecting technique with minimal iatrogenic damage to adjacent structures. CLINICAL SIGNIFICANCE Information from this study will allow refinement of the technique for use in equine clinical cases either in standing or anesthetized horses.
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Affiliation(s)
- Diego De Gasperi
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | | | - Danzhu Guo
- BayCare Clinic, Green Bay, Wisconsin, USA
| | - Yan Lu
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, Wisconsin, USA
| | - Sabrina H Brounts
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, Wisconsin, USA
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Tajik H, Shirzad N, Rahimibarghani S, Rezapour B, Nejadhosseinian M, Faezi ST, Fateh HR. The effects of adding splint use to corticosteroid injection for the treatment of trigger finger: A randomized controlled trial. Musculoskeletal Care 2022; 20:908-916. [PMID: 35584268 DOI: 10.1002/msc.1647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 05/05/2022] [Accepted: 05/08/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Trigger finger is the most common flexor tendinopathy affecting the general population. We evaluated the effects of adding a static metacarpophalangeal joint splint to corticosteroid injection for the management of trigger finger in the short term. METHODS We carried out a randomized controlled trial with two parallel arms in Department of Physical Medicine and Rehabilitation at a university hospital. We randomly allocated 60 participants (34 women) with trigger fingers other than the thumb to two groups (both n = 30). The mean (SD) age was 41.5 (7.6) years. All participants received a single injection of 40 mg methylprednisolone plus 0.5 ml of lidocaine at the A1 pulley. Patients in the splint group wore a full time static splint for blocking the metacarpophalangeal joint for 3 months. The primary outcome was the Numerical Pain Rating Scale and the secondary outcomes were Boston questionnaire scores for symptom severity and functional status, grip strength, and the stages of stenosing tenosynovitis. We measured the outcomes at baseline, and in 1 and 3 months post-intervention. RESULTS Both interventions were effective; however, the splint group showed more reductions in pain (p = 0.013) and symptom severity (p = 0.047) and a larger decrease in the stages of tenosynovitis (p = 0.004) after 3 months. There was no significant difference in decreasing functional scores between the groups (p = 0.162). The splint group had a better (but not statistically significant) restoring grip strength (p = 0.056). CONCLUSION Wearing of a static metacarpophalangeal joint splint for 3 months following a single injection of corticosteroid increases and stabilises the benefits of the treatment for trigger finger.
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Affiliation(s)
- Hamidreza Tajik
- Department of Prosthetics and Orthotics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Niloofar Shirzad
- Department of Rehabilitation, Shariati Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Sarvenaz Rahimibarghani
- Department of Physical Medicine and Rehabilitation, Shariati Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Bahare Rezapour
- Department of Rehabilitation, Shariati Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | | | - Seyedeh T Faezi
- Rheumatology Research Center, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Hamid R Fateh
- Department of Physical Medicine and Rehabilitation, Shariati Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
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Blough C, Najdawi J, Kuschner S. Patient preference for trigger finger treatment. World J Orthop 2022; 13:1006-1014. [PMID: 36439373 PMCID: PMC9685636 DOI: 10.5312/wjo.v13.i11.1006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/28/2022] [Accepted: 10/28/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Trigger finger is a common disorder of the hand that can cause disabling symptoms. Treatment options range from conservative management with observation and splinting, to surgical release, but there is currently not a consensus on a treatment algorithm.
AIM To determine patient preference for the treatment of trigger finger using an online survey.
METHODS An online crowdsourcing platform, Amazon Mechanical Turk, was used to recruit participants for this study. Participants were led through a scenario in which they were diagnosed with trigger finger. They were then asked to rank their preference of treatment options from the following: Observation, splinting, corticosteroid injection, surgery. The results of the surveys were then analyzed using R software.
RESULTS Of 323 participants completed the survey. 7 participants were excluded because they failed to correctly answer the attention question, leaving 316 participants whose results were included. As a first choice for treatment 117 (37%) of the included participants chose observation, 86 (27%) chose splinting, 61 (19%) chose corticosteroid injection, and 52 (16%) chose surgery. The mean rank for observation was 2.26, for splinting was 2.30, for corticosteroid injection was 2.53, and for surgery was 2.91. The ranking of each treatment option was statistically different (P value < 0.05) from the others except for observation and splinting.
CONCLUSION The practice of shared decision making with patients is imperative to providing the best care possible. The results from this study, especially the preference for less invasive treatment, may help providers better frame discussion around treatment options of trigger fingers. This in turn, may increase patient satisfaction in the treatment of trigger finger.
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Affiliation(s)
- Christian Blough
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States
| | - Jawad Najdawi
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States
| | - Stuart Kuschner
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States
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Guillén Astete CA, Rodriguez López R, García Montes N. Determinants of therapeutic success of corticoids injections in trigger finger syndrome. REUMATOLOGIA CLINICA 2022; 18:518-522. [PMID: 34961691 DOI: 10.1016/j.reumae.2021.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 07/20/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND OBJECTIVE Trigger finger is a frequent complaint in which corticosteroid infiltrations play a relevant therapeutic role in intermediate degrees of severity when conservative treatment has not worked. However, there are no criteria to select which patients will benefit most from this procedure. The present study aimed to identify the factors leading to the therapeutic success of corticosteroid infiltration in these patients. MATERIALS AND METHODS We designed a prospective longitudinal study based on routine clinical practice with adult patients with a clinical diagnosis of trigger finger grade II or III on the Quinnell scale, who underwent an infiltration of 20 mg of triamcinolone acetate. The outcome variables were to achieve a Quinnell grade I or reduce the severity of the symptoms by at least one category two months after the procedure. To identify the determinants of complete or partial therapeutic success, binary logistic regression predictive modelling was performed using those variables that had a satisfactory univariate correlation. RESULTS 74 patients were included over three years, 42 of whom (61.8%) were classified as Quinnell grade III. After infiltration, 22 (32.4%) achieved complete resolution and 50 (73.5%) partial resolution. The variables tendon thickening (HR 10.72; 95%CI 2.88-39.93; P < .001) and progression time (HR 1.23; 95%CI 1.02-1.49; P = .027) proved to be predictors of therapeutic success in complete resolution. For the modelling for partial resolution, the same variables proved to be determining predictors (HR 5.57; 95%CI 1.38-22.41; P = .016 and HR 1.18; 95%CI .99-1.41; P = .051, respectively). Pulley thickening did not demonstrate predictive ability in either model. DISCUSSION AND CONCLUSIONS Our results indicate that the demonstration of finger flexor apparatus thickening is the main determining factor for the success of corticosteroid infiltrations in this pathology. This is in agreement with the histological findings of specimens obtained from both tenosynovial and pulley tissue. In the former, in addition to an infiltrate of inflammatory characteristics, the presence of chondrocytoid cells producing hyaluronic acid is demonstrated. Although the therapeutic success of infiltrations in previous studies reaches 70%, the recurrence rate is similar after 12 months. The selection of patients with tendon thickening ensures therapeutic success in the short term, could reduce recurrence in the long term, and avoid delay in release surgery.
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Affiliation(s)
| | - Rocío Rodriguez López
- Departamento de Cirugía Ortopédica y Traumatología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
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Bryant BSH, Marsh K, Smithson IR, Wigton MD, Luo TD, Chao L, Wiesler E. Patient Risk Factors Associated With Postoperative Complications After Common Hand Procedures. Hand (N Y) 2022; 17:993-998. [PMID: 33467919 PMCID: PMC9465798 DOI: 10.1177/1558944720988102] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Carpal tunnel syndrome (CTS), trigger finger (TF), and De Quervain tenosynovitis (DQ) are 3 common pathologies of the hand often treated with relatively simple surgical procedures. However, outcomes from these procedures can be compromised by postoperative complications. The aim of this study was to evaluate the association between diabetes, tobacco use, and obesity and the incidence of postoperative complications. METHODS We reviewed 597 patients treated surgically for CTS, TF, or DQ from 2010 to 2015. We used bivariate and multivariate analyses to assess independent associations between diabetes, tobacco use, obesity, and surgical complications and compared the incidences with healthier patients without these comorbidities. We also looked at patients with overlapping diagnoses of these comorbidities. RESULTS Bivariate analysis showed that patients with diabetes and smokers were more likely to have a surgical complication. Multivariate analysis showed diabetes and tobacco use as independent predictors of complications. The disease states or combinations placing patients at the highest risk of a postoperative complication were the diabetic-smoker-obese, diabetic-smoker, diabetic-obese, diabetic, and smoker-obese groups. The diabetic-smoker-obese patient population had a 42.02% predicted rate of postoperative complications. CONCLUSIONS Diabetes and tobacco use are independent risk factors for complications after operative treatment of CTS, TF, and DQ. Obesity when coexisting with diabetes mellitus (DM) and/or tobacco use increased the risk of complications. When the 3 patient factors evaluated, DM, obesity, and tobacco use, were present, the rate of complications was 42.02%. Careful assessment and discussion should occur before proceeding with operative treatment for simple hand conditions in patients with the risk factors studied.
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Affiliation(s)
| | - Kathleen Marsh
- Wake Forest Baptist Medical Center,
Winston-Salem, NC, USA
| | | | | | - T. David Luo
- Wake Forest Baptist Medical Center,
Winston-Salem, NC, USA
| | - Linda Chao
- Wake Forest Baptist Medical Center,
Winston-Salem, NC, USA
| | - Ethan Wiesler
- Wake Forest Baptist Medical Center,
Winston-Salem, NC, USA
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Abstract
Importance Carpal tunnel syndrome, trigger finger, de Quervain tenosynovitis, and basilar (carpometacarpal) joint arthritis of the thumb can be associated with significant disability. Observations Carpal tunnel syndrome is characterized by numbness and tingling in the thumb and the index, middle, and radial ring fingers and by weakness of thumb opposition when severe. It is more common in women and people who are obese, have diabetes, and work in occupations involving use of keyboards, computer mouse, heavy machinery, or vibrating manual tools. The Durkan physical examination maneuver, consisting of firm digital pressure across the carpal tunnel to reproduce symptoms, is 64% sensitive and 83% specific for carpal tunnel syndrome. People with suspected proximal compression or other compressive neuropathies should undergo electrodiagnostic testing, which is approximately more than 80% sensitive and 95% specific for carpal tunnel syndrome. Splinting or steroid injection may temporarily relieve symptoms. Patients who do not respond to conservative therapies may undergo open or endoscopic carpal tunnel release for definitive treatment. Trigger finger, which involves abnormal resistance to smooth flexion and extension ("triggering") of the affected finger, affects up to 20% of adults with diabetes and approximately 2% of the general population. Steroid injection is the first-line therapy but is less efficacious in people with insulin-dependent diabetes. People with diabetes and those with recurrent symptoms may benefit from early surgical release. de Quervain tenosynovitis, consisting of swelling of the extensor tendons at the wrist, is more common in women than in men. People with frequent mobile phone use are at increased risk. The median age of onset is 40 to 59 years. Steroid injections relieve symptoms in approximately 72% of patients, particularly when combined with immobilization. People with recurrent symptoms may be considered for surgical release of the first dorsal extensor compartment. Thumb carpometacarpal joint arthritis affects approximately 33% of postmenopausal women, according to radiographic evidence of carpometacarpal arthritis. Approximately 20% of patients require treatment for pain and disability. Nonsurgical interventions (immobilization, steroid injection, and pain medication) relieve pain but do not alter disease progression. Surgery may be appropriate for patients unresponsive to conservative treatments. Conclusions and Relevance Carpal tunnel syndrome, trigger finger, de Quervain tenosynovitis, and thumb carpometacarpal joint arthritis can be associated with significant disability. First-line treatment for each condition consists of steroid injection, immobilization, or both. For patients who do not respond to noninvasive therapy or for progressive disease despite conservative therapy, surgical treatment is safe and effective.
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Affiliation(s)
- Kelly Bettina Currie
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Kashyap Komarraju Tadisina
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Susan E Mackinnon
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University in St Louis School of Medicine, St Louis, Missouri
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Dijksterhuis A, Gardiner M, Pinder R, Debeij J, Rodrigues J, Howes R, Smith K, Jain A, Coert J, van der Heijden E, Anandan SM, Anesti K, Ankarath S, Aranganathan S, Arnaout A, Bainbridge C, Basso O, Bednarz B, Chu H, Dean B, Dekker A, Donnely E, Fleet M, Fowler A, Gallagher M, Heinze Z, Hommes J, Jacob A, Jagodzinsky N, Jones M, Khajuria A, Kilbane L, Kodumuri P, Koziara M, Maahi R, Mather D, Mckenna H, Murphy T, Newton A, Noordzij N, Osei-Kuffour D, Poulter R, Rai J, Reay E, Shanbhag V, Smith G, Smits E, Spaans A, Stevenson S, Storey P, Stuart P, Toh VV, Trickett R, Uhiara O, Velani A, Wensley K, West C, Wickham N. CLINICAL VARIATION IN THE TREATMENT OF TRIGGER FINGER: AN INTERNATIONAL SURVEY OF ORTHOPAEDIC AND PLASTIC SURGEONS. J Plast Reconstr Aesthet Surg 2022; 75:3628-3651. [DOI: 10.1016/j.bjps.2022.06.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 06/15/2022] [Accepted: 06/21/2022] [Indexed: 10/17/2022]
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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.
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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
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Abdoli A, Asadian M, Banadaky SHS, Sarram R. A cadaveric assessment of percutaneous trigger finger release with 15° stab knife: its effectiveness and complications. J Orthop Surg Res 2021; 16:426. [PMID: 34217345 PMCID: PMC8254281 DOI: 10.1186/s13018-021-02566-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 06/17/2021] [Indexed: 12/20/2022] Open
Abstract
Percutaneous release of the A1 pulley has been introduced as a therapeutic approach for trigger fingers and is suggested as an effective and safe alternative, where conservative treatments fail. The aim of the current study was to determine if percutaneous release with a 15° stab knife can effectively result in acceptable efficacy and lower complication rate. METHODS In the present study, the percutaneous release of the A1 pulley was evaluated by percutaneous release using a 15° stab knife in 20 fresh-frozen cadaver hands (10 cadavers). One hundred fingers were finally included in the present study. The success rate of A1 pulley release as well as the complications of this method including digital vascular injury, A2 pulley injury, and superficial flexor tendon injury was evaluated, and finally, the data were analyzed by the SPSS software. RESULTS The results showed a success rate of 75% for A1 pulley release in four fingers, followed by eleven fingers (90%) and eighty-five fingers (100%). Therefore, the A1 pulley was found to be completely released in eighty-five fingers (100%). Overall, the mean of A1 pulley release for these fingers was determined as 97.9%, indicating that percutaneous trigger finger release can be an effective technique using a 15° stab knife. Furthermore, our findings revealed no significant difference in the amount of A1 pulley release in each of the fingers in the right and left hands. Additionally, 17 fingers developed superficial scrape in flexor tendons, while 83 fingers showed no flexor tendons injuries and no other injuries (i.e., vascular, digital nerve, and A2 pulley injuries). CONCLUSIONS Percutaneous release of the A1 pulley using a 15° stab knife was contributed to acceptable efficacy and a relatively good safety in the cadaveric model.
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Affiliation(s)
- Abbas Abdoli
- Department of Orthopedics, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Majid Asadian
- Department of Orthopedics, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
| | | | - Rabeah Sarram
- Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Colberg RE, Jurado Vélez JA, Garrett WH, Hart K, Fleisig GS. Ultrasound-guided microinvasive trigger finger release technique using an 18-gauge needle with a blade at the tip: A prospective study. PM R 2021; 14:963-970. [PMID: 34213082 DOI: 10.1002/pmrj.12665] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 05/26/2021] [Accepted: 05/29/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Open surgical trigger finger release has limited success and the risk of complications; however, percutaneous techniques offer a successful alternative. There is limited understanding of the success of percutaneous trigger finger release. OBJECTIVE To prospectively evaluate the functional outcomes of patients with Green classification Grade 2 to 4 trigger finger treated with an ultrasound-guided microinvasive trigger finger release using a special 18-gauge needle with a blade at the tip. DESIGN Prospective, case-series study. SETTING This study took place at an academic institution by one sports medicine physician (R.E.C.) with subspecialty training and certification in musculoskeletal ultrasound. PATIENTS Sixty patients (79 cases) met criteria and agreed to participate in this study; 19 patients had multiple fingers treated. Average patient age was 62.8 years (SD 10.2). Average trigger finger severity diagnosis was Grade 3. INTERVENTIONS Patients were treated with an ultrasound-guided microinvasive trigger finger release using a special 18-gauge needle with a blade at the tip. MAIN OUTCOME MEASUREMENTS Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), numerical rating scale (NRS), and Nirschl scores were captured preprocedure, at various time points, and at final follow-up. Changes between preprocedure and final follow-up were analyzed by paired t test (p < .05). Differences were also analyzed between finger, grade level, and gender by repeated measures analyses of variance (p < .05). RESULTS No adverse events were documented perioperatively or postoperatively. Average follow-up time was 18.4 months (SD 4.6). At final follow-up, 100% of patients reported no recurrence of catching/locking, 97% had complete resolution of symptoms and significant improvement in QuickDASH scores, and 99% required no further treatment. All measurements showed a decrease in pain and symptoms over time. The improvements in QuickDASH score, NRS, and Nirschl scale and the resolution of mechanical symptoms were all statistically significant. CONCLUSIONS Ultrasound-guided release using the 18-gauge needle with a blade provides significant functional improvement and full resolution of mechanical symptoms with minimal adverse events.
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Affiliation(s)
- Ricardo E Colberg
- Andrew's Sports Medicine and Orthopedic Center, Pelham, Alabama, USA
- American Sports Medicine Institute, Birmingham, Alabama, USA
| | | | - William Hunter Garrett
- Andrew's Sports Medicine and Orthopedic Center, Pelham, Alabama, USA
- American Sports Medicine Institute, Birmingham, Alabama, USA
| | - Karen Hart
- American Sports Medicine Institute, Birmingham, Alabama, USA
| | - Glenn S Fleisig
- American Sports Medicine Institute, Birmingham, Alabama, USA
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Chen YP, Lin CY, Kuo YJ, Lee OKS. Extracorporeal Shockwave Therapy in the Treatment of Trigger Finger: A Randomized Controlled Study. Arch Phys Med Rehabil 2021; 102:2083-2090.e1. [PMID: 34029555 DOI: 10.1016/j.apmr.2021.04.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 04/19/2021] [Accepted: 04/28/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To determine the efficacy of extracorporeal shockwave therapy (ESWT) and to determine the ideal energy flux density of wide-focused ESWT in the treatment of trigger finger (TF). DESIGN Double-blind randomized controlled trial. SETTING A university hospital. PARTICIPANTS A total of 60 patients (N=60) with grade II TF according to the Quinnell classification were randomly and evenly allocated to 3 treatment groups. INTERVENTIONS Three treatment groups included a high-energy ESWT (HS) group (energy flux density of 0.01 mJ/mm2, 5.8 bar, 1500 impulses, once per week for 4wk), a low-energy ESWT (LS) group (energy flux density of 0.006 mJ/mm2, 3 bar, 1500 impulses, once per week for 4wk), and a sham intervention group (sham group). All participants received 6 months of follow-up after intervention when only painkillers were allowed as concomitant treatment. MAIN OUTCOME MEASURES Clinical outcomes were followed at baseline and 1, 3, and 6 months after intervention, including pain score, frequency of triggering, severity of triggering, functional impact of triggering, and quick Disabilities of the Arm, Shoulder, and Hand questionnaire (qDASH). RESULTS All groups showed significant improvements from baseline in all clinical parameters, except for functional impact of triggering, 6 months after the interventions. However, the HS group demonstrated a higher magnitude of improvement than the LS and sham groups. In addition, the HS group reported significantly lower pain (P=.01) and lower qDASH (P=.008) than the sham group 6 months after the interventions. No adverse effects were reported in the HS and LS groups within 6 months of follow-up. CONCLUSIONS Wide-focused ESWT is a safe and effective but dose-dependent alternative facilitating pain relief and functional improvement in the treatment of grade II TF according to the Quinnell classification.
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Affiliation(s)
- Yu-Pin Chen
- Institute of Clinical Medicine, National Yang-Ming University, Taipei; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei; Department of Orthopedic Surgery, Wan Fang Hospital, Taipei Medical University, Taipei; Department of Orthopedic Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei
| | - Chung-Ying Lin
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan
| | - Yi-Jie Kuo
- Department of Orthopedic Surgery, Wan Fang Hospital, Taipei Medical University, Taipei; Department of Orthopedic Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei
| | - Oscar Kuang-Sheng Lee
- Institute of Clinical Medicine, National Yang-Ming University, Taipei; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei; Department of Medical Research, Taipei Veterans General Hospital, Taipei; Department of Orthopedics, China Medical University Hospital, Taichung, Taiwan.
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Colberg RE, Pantuosco J, Fleisig G, Drogosz M. Ultrasound-Guided Microinvasive Trigger Finger Release Technique Combined With Three Tests to Confirm a Complete Release. Am J Phys Med Rehabil 2020; 99:1150-1156. [PMID: 33214498 DOI: 10.1097/phm.0000000000001510] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Trigger finger at the A1 pulley is a common cause of hand pain leading to functional limitations. This study evaluated the outcomes of patients treated with a microinvasive ultrasound-guided trigger finger release technique using an 18 blade and described three tests that confirm a complete release. DESIGN A retrospective chart review and cross-sectional study of 46 cases of A1 pulley trigger finger releases in 28 patients performed at a private, sports medicine clinic using this technique were completed, meeting power criteria. The primary outcome measure was the resolution of mechanical catching/locking; secondary outcome measures were reduction in visual analog scale for pain and improvement of function in the modified Nirschl scale. RESULTS Complete release was achieved in all patients, with no recurrence of catching/locking during the first year (P < 0.0001). Ninety-eight percent of patients had significant pain and functional improvement (P < 0.0001). There were no complications perioperatively and postoperatively. The three confirmatory tests ensured that all cases obtained a successful outcome. CONCLUSION This technique combined with confirmatory tests resulted in full resolution of the locking for all patients and statistically significant reduction in pain and improvement in function.
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Affiliation(s)
- Ricardo E Colberg
- From the Andrews Sports Medicine and Orthopedic Center, Birmingham, Alabama (REC); Department of Physical Medicine and Rehabilitation, University of Alabama School of Medicine, Birmingham, Alabama (JP); and American Sports Medicine Institute, Birmingham, Alabama (GF, MD)
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Aspinen S, Nordback PH, Anttila T, Stjernberg-Salmela S, Ryhänen J, Kosola J. Platelet-rich plasma versus corticosteroid injection for treatment of trigger finger: study protocol for a prospective randomized triple-blind placebo-controlled trial. Trials 2020; 21:984. [PMID: 33246497 PMCID: PMC7694424 DOI: 10.1186/s13063-020-04907-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 11/16/2020] [Indexed: 11/22/2022] Open
Abstract
Background Trigger finger is a common hand disorder that limits finger range of motion and causes pain and snapping of the affected finger. Trigger finger is caused by an imbalance of the tendon sheath and the flexor tendon. The initial treatment is generally a local corticosteroid injection around the first annular (A1) pulley. However, it is not unusual that surgical release of the A1 pulley is required. Moreover, adverse events after local corticosteroid injection or operative treatment may occur. Platelet-rich plasma (PRP) has been shown to be safe and to reduce symptoms in different tendon pathologies, such as DeQuervain’s disease. However, the effects of PRP on trigger finger have not been studied. The aim of this single-center triple-blind randomized controlled trial is to study whether PRP is non-inferior to corticosteroid injection in treating trigger finger. The secondary outcome is to assess the safety and efficacy of PRP in comparison to placebo. Methods The trial is designed as a randomized, controlled, patient-, investigator-, and outcome assessor-blinded, single-center, three-armed 1:1:1 non-inferiority trial. The patients with clinical symptoms of trigger finger will be randomly assigned to treatment with PRP, corticosteroid, or normal saline injection. The primary outcome is Patient-Rated Wrist Evaluation and symptom resolution. Secondary outcomes include Quick-Disabilities of the Arm, Shoulder and Hand; pain; grip strength; finger active range of motion; and complications. Appropriate statistical methods will be applied. Discussion We present a novel RCT study design on the use of PRP for the treatment of trigger finger compared to corticosteroid and normal saline injection. The results of the trial will indicate if PRP is appropriate for the treatment of trigger finger. Trial registration ClinicalTrials.gov NCT04167098. Registered on November 18, 2019.
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Affiliation(s)
- Samuli Aspinen
- Department of Hand Surgery, Helsinki University Hospital, Topeliuksenkatu 5, 00260, Helsinki, Finland.
| | - Panu H Nordback
- Department of Hand Surgery, Helsinki University Hospital, Topeliuksenkatu 5, 00260, Helsinki, Finland
| | - Turkka Anttila
- Department of Hand Surgery, Helsinki University Hospital, Topeliuksenkatu 5, 00260, Helsinki, Finland
| | | | - Jorma Ryhänen
- Department of Hand Surgery, Helsinki University Hospital, Topeliuksenkatu 5, 00260, Helsinki, Finland
| | - Jussi Kosola
- Department of Orthopaedics and Traumatology, Kanta-Häme Central Hospital, Ahvenistontie 20, 13530, Hämeenlinna, Finland
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Belloti JC, Sato ES, Faloppa F. Trigger Finger Treatment. Rev Bras Ortop 2020; 57:911-916. [PMID: 36540752 PMCID: PMC9757962 DOI: 10.1055/s-0040-1713765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 04/15/2020] [Indexed: 10/23/2022] Open
Abstract
Trigger finger is a frequent condition. Although tenosynovitis and the alteration of pulley A1 are identified as triggering factors, there is no consensus on the true cause in the literature, and its true etiology remains unknown. The diagnosis is purely clinical most of the time. It depends solely on the existence of finger locking during active bending movement. Trigger finger treatment usually begins with nonsurgical interventions that are instituted for at least 3 months. In patients with initial presentation with flexion deformity or inability to flex the finger, there may be earlier indication of surgical treatment due to pain intensity and functional disability. In the present review article, we will present the modalities and our algorithm for the treatment of trigger finger.
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Affiliation(s)
- João Carlos Belloti
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Edson Sasahara Sato
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil,Endereço para correspondência Edson Sasahara Sato, PhD Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo, Escola Paulista de MedicinaRua Borges Lagoa, 786, São Paulo, SP, 04038-001Brasil
| | - Flavio Faloppa
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
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Roh YH, Kim S, Gong HS, Baek GH. RETRACTED: A randomized comparison of ultrasound-guided versus landmark-based corticosteroid injection for trigger finger. J Hand Surg Eur Vol 2020; 45:NP1-NP6. [PMID: 30947606 DOI: 10.1177/1753193419839892] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Young Hak Roh
- Department of Orthopaedic Surgery, Ewha Womans University Medical Center, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Sangwoo Kim
- Department of Orthopaedic Surgery, Ewha Womans University Medical Center, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Hyun Sik Gong
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Sungnam, South Korea
| | - Goo Hyun Baek
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
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Parker AM, Greyson M, Iorio ML. Outcomes and indications for early hand therapy after multiple concomitant elective hand procedures. J Hand Ther 2020; 32:457-462. [PMID: 30017409 DOI: 10.1016/j.jht.2018.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 04/04/2018] [Accepted: 04/05/2018] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Retrospective comparative study. INTRODUCTION Trigger finger and carpal tunnel surgery are common, but not without complications including pain and edema, which are treated with hand therapy (HT). There are limited data for the outcomes of multiple trigger finger releases (MTFRs) or combined trigger finger and carpal tunnel surgery and the subsequent need for HT. PURPOSE OF THE STUDY Based on our hypothesis that patients with more than 1 procedure may benefit from an early HT visit, we performed this study to compare the frequency of HT orders after single trigger finger releases (STFRs) and MTFRs and determine the reasoning for variation in the rate of HT orders after releases. METHODS Subjects receiving either an STFR or an MTFR were identified. Patient-reported outcomes were recorded preoperatively and 2 weeks postoperatively. RESULTS One hundred fifty-nine eligible subjects were identified; 33 MTFRs and 126 STFRs. MTFR subjects were prescribed postoperation HT at a higher rate compared with STFR subjects (66.7% vs 34.1%; P < .001). Of the HT subjects, MTFR subjects received prescriptions for edema management at a significantly higher rate compared with STFR subjects (P = .02). DISCUSSION Patients with soft tissue dissection, edema, and stiffness would most likely benefit from HT services. It is important to identify these at-risk subpopulations to potentially alter their postoperative trajectories and improve outcomes. CONCLUSIONS Higher rates of referral to HT occur when there are multiple concomitant hand procedures. This suggests surgeons triage HT services based on need. Policies that disallow postoperative therapy will have a greater impact on patients with these indications.
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Affiliation(s)
- Amber M Parker
- Department of Orthopaedics, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Mark Greyson
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Matthew L Iorio
- Department of Orthopaedics, Beth Israel Deaconess Medical Center, Boston, MA, USA; Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA; Division of Plastic and Reconstructive Surgery, University of Colorado Medical Center, Aurora, CO, USA.
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Lunsford D, Valdes K, Hengy S. Conservative management of trigger finger: A systematic review. J Hand Ther 2020; 32:212-221. [PMID: 29290504 DOI: 10.1016/j.jht.2017.10.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 10/16/2017] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Systematic review INTRODUCTION: Trigger finger (TF) is a common condition in the hand. The primary purpose of this systematic review was to evaluate the current evidence to determine the efficacy of orthotic management of TF. A secondary purpose was to identify the characteristics of the orthotic management. The tertiary purpose of this study was to ascertain if the studies used a patient-reported outcome to assess gains from the patient's perspective. METHODS All studies including randomized controlled trials, prospective, and retrospective cohort studies were included in this review due to limited high-level evidence. RESULTS Four authors demonstrated moderate to large effect sizes ranging from 0.49 to 1.99 for pain reduction after wearing an orthotic device. Two authors demonstrated a change in the stages of stenosing tenosynovitis scale scores showing a clinically important change with a large effect size ranging from 0.97 to 1.63. Seven authors immobilized a single joint of the affected digit using a variety of orthoses. CONCLUSION All authors reported similar results regardless of the joint immobilized; therefore for orthotic management of the TF, we recommend a sole joint be immobilized for 6-10 weeks. In assessing TF, most authors focused on body structures and functions including pain and triggering symptoms, 2 authors used a validated functional outcome measure. In the future therapists should use a validated patient report outcome to assess patient function that is sensitive to change in patients with TF. Furthermore, more randomized controlled trials are needed.
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Open Surgery for Trigger Finger Required Combined a1-a2 Pulley Release. A Retrospective Study on 1305 Case. Tech Hand Up Extrem Surg 2019; 23:115-121. [PMID: 30640812 DOI: 10.1097/bth.0000000000000231] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We retrospectively reviewed 1305 open-surgery for idiopathic trigger finger performed by 4 senior hand surgeons between 2014 and 2016. MATERIAL AND METHODS Medical records and a telephone interview made with a minimum follow-up of 1 year were used to identify the recurrent rate of triggering and other complications. RESULTS This retrospective study let us note that 169 fingers (13%) required simultaneous release of the A1-A2 pulleys because the sectioning of the A1 pulley alone did not lead to complete free sliding of the tendons. We did not record any bowstring complication and we ascribe this to both surgery and bandaging technique. Overall rate of complication was 11.8% and relapse triggering or permanent proximal interphalangeal joint flexion (PPIJF) were among them; notably, however, they occurred only in patients where the A2 pulley was not sectioned. CONCLUSIONS Is possible to reduce the percentage of relapse triggering or PPIJF after trigger finger surgery, by performing that combined A1-A2 pulley release. LEVEL OF EVIDENCE Level III.
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Brozovich N, Agrawal D, Reddy G. A Critical Appraisal of Adult Trigger Finger: Pathophysiology, Treatment, and Future Outlook. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2360. [PMID: 31592381 PMCID: PMC6756654 DOI: 10.1097/gox.0000000000002360] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 06/03/2019] [Indexed: 12/20/2022]
Abstract
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.
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Berlanga-de-Mingo D, Lobo-Escolar L, López-Moreno I, Bosch-Aguilá M. Association between multiple trigger fingers, systemic diseases and carpal tunnel syndrome: A multivariate analysis. Rev Esp Cir Ortop Traumatol (Engl Ed) 2019. [DOI: 10.1016/j.recote.2018.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Shapiro LM, Eppler SL, Kamal RN. The Feasibility and Usability of a Ranking Tool to Elicit Patient Preferences for the Treatment of Trigger Finger. J Hand Surg Am 2019; 44:480-486.e1. [PMID: 30797655 PMCID: PMC6551231 DOI: 10.1016/j.jhsa.2019.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 10/25/2018] [Accepted: 01/02/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE Shared decision making is an approach where physicians and patients collaborate to make decisions based on patient values. This requires eliciting patients' preferences for each treatment attribute before making decisions; a structured process for preference elicitation does not exist in hand surgery. We tested the feasibility and usability of a ranking tool to elicit patient preferences for the treatment of trigger finger. We hypothesized that the tool would be usable and feasible at the point of care. METHODS Thirty patients with a trigger finger without prior treatment were recruited from a hand surgery clinic. A preference elicitation tool was created that presented 3 treatment options (surgical release, injection, and therapy and orthosis) and described attributes of each treatment extracted from literature review (eg, success rate, complications). We presented these attributes to patients using the tool and patients ranked the relative importance (preference) of these attributes to aid in their decision making. The System Usability Scale and tool completion time were used to evaluate usability and feasibility, respectively. RESULTS The tool demonstrated excellent usability (System Usability Scale: 88.7). The mean completion time was 3.05 minutes. Five (16.7%) patients chose surgery, 20 (66.7%) chose an injection, and 5 (16.7%) chose therapy and orthosis. Patients ranked treatment success and cost as the most and least important attributes, respectively. Twenty-nine (96.7%) patients were very to extremely satisfied with the tool. CONCLUSIONS A preference elicitation tool for patients to rank treatment attributes by relative importance is feasible and usable at the point of care. A structured process for preference elicitation ensures that patients understand the trade-offs between choices and can assist physicians in aligning treatment decisions with patient preferences. CLINICAL RELEVANCE A ranking tool is a simple, structured process physicians can use to elicit preferences during shared decision making and highlight trade-offs between treatment options to inform treatment choices.
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Affiliation(s)
- Lauren M. Shapiro
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
| | - Sara L. Eppler
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
| | - Robin N. Kamal
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
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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.
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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.
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Berlanga-de-Mingo D, Lobo-Escolar L, López-Moreno I, Bosch-Aguilá M. Association between multiple trigger fingers, systemic diseases and carpal tunnel syndrome: A multivariate analysis. Rev Esp Cir Ortop Traumatol (Engl Ed) 2019; 63:307-312. [PMID: 30795997 DOI: 10.1016/j.recot.2018.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 12/04/2018] [Accepted: 12/16/2018] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Trigger finger (TF) is a frequent pathology depending on several factors. The objective of this study was to assess the relationship between multiple TF and systemic or musculoskeletal disorders in a sample of young patients. MATERIAL AND METHOD A retrospective study was performed of all patients with TF operated in our hospital between 2011 and 2015. Multiple or single TF diagnosis and pathologies such as diabetes mellitus (DM), thyroid dysfunction, carpal tunnel syndrome (CTS), epicondylalgia or DeQuervain's disease were collected. Statistical results included a bivariate analysis and a multiple logistic regression. RESULTS Two hundred and seventy-nine patients with a mean age of 48.45years were included. The dominant hand was affected in 217 cases. There were 59 patients with multiple TF, 21 DM, 55 STC, 16 epicondylalgia and 14 DeQuervains. Prevalence of CTS was 19.7%, significantly higher than the general population (2%-4%). No statistical differences were found in age, sex, hypothyroidism, epicondylalgia or DeQuervain in the multiple TF group. Bivariate analysis detected that DM and CTS patients in the multiple TF group was significantly higher than in the single TF group (P=.007, P<.01). Multiple TF was also more frequent on the dominant side (P<.01). Multivariate logistic regression confirmed these findings, showing a statistically significant association between the multiple TF group and DM (OR: 4.98, P<.01), STC (OR: 2.09, P=.037) and dominant side (OR: 3.76, P=.016). CONCLUSIONS Diabetes, CTS and dominant side are independently associated with multiple TF in young patients.
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Affiliation(s)
- D Berlanga-de-Mingo
- MIR, Hospital Asepeyo de Sant Cugat, Sant Cugat del Vallès, Barcelona, España.
| | - L Lobo-Escolar
- MIR, Hospital Asepeyo de Sant Cugat, Sant Cugat del Vallès, Barcelona, España
| | - I López-Moreno
- Unidad de Mano, Hospital Asepeyo de Sant Cugat, Sant Cugat del Vallès, Barcelona, España
| | - M Bosch-Aguilá
- Unidad de Mano, Hospital Asepeyo de Sant Cugat, Sant Cugat del Vallès, Barcelona, España
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Guo D, McCool L, Senk A, Tonkin B, Guo J, Lytie RM, Guo D. Minimally invasive thread trigger digit release: a preliminary report on 34 digits of the adult hands. J Hand Surg Eur Vol 2018; 43:942-947. [PMID: 29764283 DOI: 10.1177/1753193418774497] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The trigger finger release was performed in 34 digits (11 thumbs and 23 fingers) of 24 patients through the thread transecting technique with the tip-to-tip approach, in which a 22-gauge needle inserts into a 18-gauge needle when both needles are inside the hand, guiding the 22-gauge needle to exit the hand at the same access point of 18-gauge needle. We prospectively evaluated the effectiveness and functional recovery of these patients. In all 34 digits, triggering and locking were resolved, and complete extension and flexion occurred immediately following the release. There were no complications, such as incomplete release, neurovascular or flexor tendon or A2 pulley injury, infection, or tendon bow-stringing. Patients did not require prescription pain medications. Most patients used their hands to meet their basic living needs the same day of the procedure. The hand function evaluated with the Quick Disabilities of the Arm, Shoulder and Hand questionnaire, and scored 4 within 3 months. Level of evidence: II.
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Affiliation(s)
| | | | | | | | - Joseph Guo
- 3 Ridge & Crest Company, Monterey Park, CA, USA
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