Trigger Finger? Just Shoot!

Triggering, clicking, locking and crepitus of the finger: A comprehensive overview

Triggering, locking, clicking, and crepitus of the fingers are common symptoms patients present with. Even though crepitus and triggering can occur as part of the same underlying diagnosis, it is important to differentiate between them, as they usually indicate different possible diagnoses. The differential diagnoses that should be considered include trigger finger, metacarpophalangeal joint (MCPJ) arthritis, fractures or dislocations, extensor digitorum communis subluxation or dislocation, locked MCPJ, avascular necrosis of the metacarpal head, and Dupuytren's disease. A thorough clinical examination with appropriate special investigations can permit the clinician to make the correct diagnosis. Appropriate management of a confirmed diagnosis is successful in providing symptomatic improvement.

Health-related factors and dysregulation of epigenetic related genes in metabolic syndrome trigger finger patients and smoker trigger finger patients: preliminary analysis of patient-derived sample

PURPOSE

To investigate the health-related factors and analyze the expression of epigenetic related genes and inflammatory genes in metabolic syndrome Trigger Finger (TF) and smoker TF.

METHODS

Samples from patients' fingers with symptomatic TF were collected. There were seven groups: healthy control group, carpal tunnel syndrome (as a control for gene expression analysis), TF, diabetic TF, hypertensive TF, dyslipidemic TF and smoker TF. The expression levels of epigenetic related genes and inflammatory genes in metabolic syndrome TF and smoker TF were evaluated by the reverse transcription-polymerase chain reaction (RT-PCR) technique. The Perceived Stress Scale (PSS), Pittsburgh Sleep Quality Index (PSQI) questionnaires, disability of the arm, shoulder and hand (DASH) and numeric pain rating scale were given to the participants to fill out.

RESULTS

There was a significant increase in hand dysfunction in the metabolic TF groups and smoker group compared to the TF group (p < 0.0001). The stress levels of the smoker TF group and TF with hypertension group were significantly increased compared with those in the TF group (p < 0.03) and (p < 0.021), respectively. On the other hand, there was a significant increase in the COL-I, COL-II and TNF-α gene expression of the metabolic TF groups and smoker group (p < 0.0001).

CONCLUSIONS

Health-related factors in the TF tendons was highly associated with the level of inflammation and genetic alteration in TF metabolic syndromes and smoker TF patients. Therefore, further investigation is required to examine the combination of occupational therapy, gene expression, and health-related factors as a promising method of managing TF.

National Benchmarks for the Efficacy of Trigger Finger and the Risk Factors Associated With Failure

BACKGROUND

The purpose of this study was to compare the efficacy of single and multiple corticosteroid injections used for symptomatic trigger finger. The rates of subsequent injections and the rate of tendon sheath release are reported along with the identification of risk factors correlated with failure of injection.

METHODS

A retrospective review of a national healthcare database was conducted identifying patients with a diagnosis of trigger finger or thumb. Inclusion required a tendon sheath injection on the same day or within six weeks of diagnosis. Patient cohorts were further stratified based on treatment success and those requiring additional injections within 6 months or surgery within 1 year of initial diagnosis.

RESULTS

Thirty-one thousand seven hundred fifty-one patients met inclusion criteria and underwent an initial injection within the study period. The efficacy of initial, second, and third injection was 66.3%, 79.4%, and 79.6%, respectively. Of the patients who failed an injection, 9.4% had tendon sheath release after a primary injection, 23.1% had surgery after a second injection, and 30.4% had surgery after a third injection. Only obesity (OR 1.2; P < 0.0001) and concomitant diagnosis of carpal tunnel syndrome (OR 1.4; P < 0.0001) were found to be significant for injection failure on multivariate logistic regression analysis.

DISCUSSION

Overall corticosteroid injections were effective in greater than 65% of patients. This information may help guide treatment practice because there seems to be continued additional benefit to repeat corticosteroid injections after injection failure.

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

Background

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

Case

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

Results

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

Conclusions

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

Ultrasound-guided needle release of A1 pulley combined with corticosteroid injection is more effective than ultrasound-guided needle release alone in the treatment of trigger finger

BACKGROUND

The purpose of the present study was to evaluate the clinical effectiveness of ultrasonography-guided needle release of A1 pulley combined with corticosteroid injection by comparing it with ultrasound-guided needle release of the A1 pulley alone.

METHODS

A total of 49 patients (55 fingers, thumb) with trigger fingers were included in this retrospective study. Twenty-seven fingers were treated with ultrasound-guided needle release of the A1 pulley alone (monotherapy group), and 28 fingers were treated with needle release of the A1 pulley combined with corticosteroid injection (combination group). Visual analog scale (VAS), Froimson scale, postoperative recurrence rate, and thickness of A1 pulley at baseline, Week-2, Week-12, and Month-6 were recorded.

RESULTS

Higher clinical cure rates were observed in the combination group at Week-2 after treatment among patients with the Froimson scale Grade III and IV (p < 0.05). Among Froimson scale Grade IV patients, the combination group had a significantly thinner thickness of A1 pulley and better articular pain relief at Week-2 (all p < 0.05). No significant differences were found in the clinical cure rate, the thickness of the A1 pulley, articular pain relief, and recurrence rate between the two groups at Week-12 and Month-6 (all p > 0.05).

CONCLUSIONS

Ultrasonography-guided needle release of A1 pulley plus corticosteroid injection was superior to ultrasonography-guided A1 pulley needle release alone during early-stage treatment of severe patients with trigger fingers. Moreover, ultrasonography-guided A1 pulley needle release combined with corticosteroid injection narrows the thickness of the A1 pulley. It is necessary to carry out preoperative evaluation and individualized treatment for patients of various severities.

The most common disorders of the hand associated with carpal tunnel syndrome in adults

Carpal tunnel syndrome (CTS) is one of the most common peripheral neuropathies caused by chronic compression of the median nerve in the area of the carpal tunnel and its etiology is multifactorial. Trigger fingers and de Quervain’s disease are common disorders of the hand related to CTS in adults.Theaim of this study was to present the most common disorders of the hand such as stenosing tenosynovitis in adults with surgically treated CTS and to evaluate their demographic data.Material and methods: A total of 116 surgically treated patients with established diagnosis of CTS (clinically and by electrophysiological examination) were included in this prospective study, which was conducted at the University Clinic for Orthopedic Diseases in Skopje. Demographic data, findings of history of the disease and clinical examination were recorded and analyzed.Results: Participants with CTS included in the study were with a mean age of 55.41±10.7 years (age range 29-75). 75% of them were female. 63.8% of participants suffered from one or more comorbid chronic diseases. On admission to hospital, disorders such as trigger fingers and de Quervain’s disease were concomitantly diagnosed in 15.51% on ipsilateral hand with CTS. All disorders were surgically treated following open carpal tunnel release, as “one stage procedure”, under local anesthesia.Conclusion: Our findings have determined concomitant existence of CTS and stenosing tenosynovitis (trigger fingers and de Quervain’s disease) on ipsilateral hand, which suggests common etiological factors. Female gender and age range 40-60 years are major common factors related to these three disorders.

Corticosteroid injection treatment for dactylitis in psoriatic arthritis

Dactylitis – a hallmark clinical feature of psoriatic arthritis (PsA) – that occurs in 30–50% of PsA patients, is a marker of disease severity for PsA progression, an independent predictor of cardiovascular morbidity and impairs the motor functions of PsA patients. There is a paucity of evidence for the treatment due to the absence of randomized controlled trials assessing dactylitis as a primary endpoint and current practice arises from the analysis of dactylitis as a secondary outcome. Corticosteroid (CS) injections for dactylitis in PsA patients are a therapeutic treatment option for patients with isolated dactylitis or for patients with flares in tendon sheaths, despite stable and effective systemic treatment. The aim of this narrative review is to briefly illustrate the clinical aspects of dactylitis in PsA, the imaging and clinimetric tools used to diagnose and monitor dactylitis, the current treatment strategies and principally to provide a comprehensive picture of the clinical efficacy and safety with ultrasound-guide and blind techniques of CS injections for dactylitis in PsA patients.