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The flexor tendon pulleys in the fingers of the hand are fibrous structures of variable size, shape, and thickness that cover the synovial sheath of these tendons. Despite their clinical relevance, their arrangement and configuration in each of the triphalangeal fingers have been little studied and with small sample sizes. 192 triphalangeal fingers belonging to 48 fresh body donors' hands were dissected. Multivariate analysis was carried out. Twenty-five cases (52%) were left hands, and 26 of the 48 hands belonged to female donors (54.2%). The results were analyzed by fingers for each of the 5 annular pulleys, the 3 cruciform pulleys and the gaps between them. In addition, the most and least frequent configurations of the pulleys in each of the fingers were studied, observing that the classic pattern with all the pulleys appeared only in 3 fingers (1.56%), while the most frequent pattern was A1-A2-C1-A3-A4, which was seen in 35 fingers (18.22%). CONCLUSIONS: The flexor pulleys in the triphalangeal fingers of the hand have shown enormous variability in arrangement and shape, and also rarely appear all in the same finger. This peculiar anatomical arrangement can help the different professionals who perform their clinical work in this region., Depto. de Anatomía y Embriología, Fac. de Medicina, TRUE, pub

Purpose: To evaluate the safety and effectiveness of percutaneous release procedures under sonography using Sono-Instruments® in the treatment of carpal tunnel syndrome (CTS) and trigger finger (TF). Methods: Prospective study involving 30 patients, divided into two groups (15 CTS, and 15 TF). The primary outcomes were surgical performance-related outcomes (visibility, ease of use, satisfaction, duration) using Sono-Instruments® and patient-related outcomes (pain, activity limitations, time to return to work, functional scores). Secondary outcomes included complications. Patients were followed for two months post-operatively. Results: In the CTS group, the average age of the patients was 58.7 years. The percutaneous release of the transverse carpal ligament was effectively completed in all cases, with excellent device performance and no adverse events. At one week, all patients could wash their hands, 80% could perform activities of daily living, and 80% of those working had returned to their activities. At two months, all patients had resumed all activities. Pillar pain was still present in 53.3%. In the TF group, the patients had an average age of 57.9 years. The percutaneous release of the A1 annular pulley was successful in all cases, with excellent device performance and no adverse events. At one week, all patients could wash their hands, 93.3% could do all activities of daily living, and 75% of those working were back to their professional activities. At two months, all patients were back to all activities of daily living and work. The DASH score was significantly improved at two months, compared to preoperative, for both groups (p < 0.001). Conclusion: Percutaneous sono-guided release using Sono-Instruments® is safe and efficient, and associated with quick functional recovery. Level of evidence: II., SCOPUS: ar.j, info:eu-repo/semantics/published

PurposeThe purpose of this study was to determine whether extremities undergoing carpal tunnel release (CTR) have an increased rate of trigger finger (TF) compared with conservatively managed carpal tunnel syndrome.MethodsData were collected from the Humana Insurance Database, and subjects were chosen on the basis of a history of CTR with propensity matching performed to develop a nonsurgical cohort. Following propensity matching, 16,768 patients were identified and equally split between surgical and nonsurgical treatments. Demographic information and medical comorbidities were recorded. Univariate and multivariate analyses were performed to identify risk factors for the development of TF within 6 months of carpal tunnel syndrome diagnosis.ResultsPatients in the surgical cohort were more likely to develop TF than those in the nonsurgical cohort whether in the ipsilateral or contralateral extremity. Whether managed surgically or nonsurgically, extremities with carpal tunnel syndrome demonstrated an increased prevalence of TF than their contralateral, unaffected extremity.ConclusionsSurgeons should be aware of the association of TF and CTR both during the presurgical and postsurgical evaluations as they might impact patient management. With knowledge of these data, surgeons may be more attuned to detecting an early TF during the postsurgical period and offer more aggressive treatment of TF pathology during CTR.Type of study/level of evidencePrognostic III.

We dissected 192 fingers in 48 fresh cadaveric hands (23 right and 25 left hands from 26 female and 22 male donors) and analysed the incidence, location, length and structure of the five annular and three cruciform pulleys. No statistically significant differences were found between left and right or between male and female hands. The A1, A2 and A4 pulleys were present in all fingers, while the incidence of other pulleys varied. We found 32 different patterns of pulley combinations. The structure of the pulleys also varied. Most important was the variation of A1, which consisted of one to four separate rings. In 18% there was no gap between the A1 and A2 pulleys. A greater understanding of the anatomical variation of the pulley system is beneficial for hand surgeons performing open or percutaneous trigger finger releases and for radiologists examining the area sonographically., Depto. de Anatomía y Embriología, Fac. de Medicina, TRUE, pub

The interventional use of sonography is growing fast, and percutaneous sonographically guided release is more and more used as minimally invasive treatment of carpal tunnel syndrome as well as trigger finger digit. The benefits of these procedures seem promising in clinical studies, but biomechanical studies comparing these procedures with open classical surgery are scarce. Minimally invasive releases of carpal tunnel and trigger finger could limit the phenomenon of tendon bowstringing observed after open surgery. A new model is presented to compare the biomechanical effects of open and sono-guided carpal tunnel and trigger finger releases., SCOPUS: re.j, info:eu-repo/semantics/published

Introduction: Mucopolysaccharidosis is a rare and congenital autosomal recessive lysosomal storage disorder of glycosaminoglycans. An enzyme defect leads to cell, tissue and organ dysfunction. Carpal tunnel syndrome and trigger finger are the results of mucopolysaccharid deposition.Material and methods: We are treating 6 patients with mucopolysaccharide associated trigger fingers in an interdisciplinary setting with the department of pediatric hematology and oncology at Hannover Medical School, where each patient is examined inter alia for symptoms of trigger finger annually.Besides an interview of the parents about abnormalities with regard to hand function, pain and/or neurologic symptoms the children are examined by palpation and by assessment of the active and passive range of finger motion.In the case of finger locking due to an impaired excursion of the flexor tendons in the A2 and A3 pulley region, we performed a trap-door incision technique for A2 pulley widening and a simple release of the A3 pulley.Results: In 6 patients 43 fingers were affected. The average age was 10 years. Pulley thickening was palpated in 19 fingers of to the left hand and 24 fingers of the right hand. In 7 fingers the A1 pulley was affected, in 28 fingers the A2 pulley and in 25 fingers the A3 pulley. The A4 and A5 pulley were not affected in any case. Trigger symptoms were seen in 13 fingers. Five of the 6 children were given an operation indication. In these cases we performed carpal tunnel release, release of Loge de Guyon, and trigger finger release, either in combination or alone. In all cases the procedure led to pain relief and functional improvement.Conclusion: The treatment of trigger fingers in children with mucopolysaccharidosis as a rare disease is challenging with regard to diagnostics and indication.The main treatment goal is pain relief and improvement of hand function., Einleitung: Die Mukopolysaccharidose ist eine seltene und angeborene, autosomal rezessive und lysosomale Speicherkrankheit von Glykosaminoglykanen. Ein Enzymdefekt führt zu Zell-, Gewebe- und Organfunktionsstörungen. Das Karpaltunnelsyndrom und der schnappende Finger sind die Folge der Mukopolysaccharidablagerungen.Material und Methode: Wir behandeln zurzeit 6 Patienten mit Mucopolysaccharid-assoziiertem Schnappfinger in einem interdisziplinären Setting zusammen mit der Abteilung für pädiatrische Hämatologie und Onkologie an der Medizinischen Hochschule Hannover. Jeder Patient wird im Rahmen der jährlichen Kontrolluntersuchungen unter anderem im Hinblick auf die Symptome eines schnappenden Fingers hin untersucht.Neben einer detaillierten Befragung der Eltern zu bestehenden Funktionsstörungen der Hände ihrer Kinder, begleitenden Schmerzen und/ oder neurologischen Symptomen werden die Kinder eingehend klinisch durch Palpation und mit Bestimmung der aktiven und passiven Beweglichkeit der Finger untersucht.In den Fällen mit auslösbarem Schnappphänomen der betroffenen Finger und Blockade auf Höhe der A2- und A3-Ringbänder wurde die Indikation zur A2-Ringbanderweiterungsplastik und A3-Ringbandspaltung gestellt.Ergebnisse: Bei den 6 untersuchten Patienten waren insgesamt 43 Finger betroffen. Das durchschnittliche Alter der Kinder lag bei 10 Jahren. Eine Verdickung der Ringbänder fand sich bei 19 Fingern der linken Hand und bei 24 Fingern der rechten Hand. Bei 7 Fingern war das A1-Ringband betroffen, bei 28 Fingern das A2-Ringband und bei 25 Fingern das A3-Ringband. Das A4- und A5-Ringband war bei keinem der untersuchten Patienten betroffen. Ein Schnappphänomen beobachteten wir bei insgesamt 13 Fingern. Bei 5 der 6 Kinder stellten wir eine Operationsindikation. In diesen Fällen erfolgten, entweder kombiniert oder isoliert, eine Karpaldachspaltung, eine Spaltung der Loge de Guyon und eine A2-Ringbanderweiterungsplastik und A3-Ringbandspaltung. In allen Fällen führte der Eing

Subcutaneous granuloma annulare (SGA) is a rare variant of granuloma annulare most commonly affecting children. We report a 33-year-old female with a 2-year history of multiple plaques and subcutaneous nodules affecting her hands, elbow, ear and feet. Some lesions resembled rheumatoid nodules; the lesion on her left hand caused a trigger finger; and the nodule of the foot mimicked a Morton's neuroma. Laboratory investigations were unremarkable for rheumatoid arthritis. Histological findings showed dermal necrobiosis with palisades of histiocytes and lymphocytic inflammation. Assessment with ultrasound of the foot nodule supported a diagnosis of subcutaneous SGA, with a non-compressible lesion located between the nerves rather than arising from the nerve. The patient was initially treated with hydroxychloroquine, low-dose methotrexate and a short course of prednisolone. She was unable to tolerate methotrexate and had an inadequate response to hydroxychloroquine. Some nodules responded to intralesional triamcinolone injections while others spontaneously resolved. SGA can mimic a rheumatoid nodule and Morton's neuroma and be the cause of a trigger finger.

Un patient qui consulte pour des doigts qui se rétractent est une situation relativement fréquente en chirurgie de la main. L’anamnèse différenciera le caractère aigu du caractère chronique. En cas de pathologies aigues, un traumatisme est souvent évoqué par le patient. Le diagnostic différentiel comprend une lésion tendineuse ou une atteinte ostéo-articulaire. Elles ne seront pas abordées ici. Le tableau chronique comprend essentiellement deux entités pathologiques à savoir la maladie de Dupuytren et le doigt à ressaut. Le diagnostic, surtout clinique, peut être aidé par l’échographie si nécessaire. Pour la maladie de Dupuytren, le traitement est habituellement conservateur tant que la paume de la main peut être globalement appliquée sur une surface plane. Une fois que c’est n’est plus possible, un traitement du symptôme, à savoir la rétraction, peut être envisagé. Le traitement actuellement privilégié est celui à base d’injection de collagénase (Xiapex®). Il est important de signaler qu’à l’heure actuelle, il n’est toujours pas possible de soigner la maladie en elle-même. Concernant le doigt à ressaut, le traitement à promouvoir en première intention est l’infiltration. Le recours à la solution chirurgicale d’emblée n’est envisagé que chez des patients présentant un doigt à ressaut secondaire où des études montrent une tendance à la récidive en cas d’infiltrations., [Doctor, my fingers are curling] A patient who consults for curling fingers is a common situation in hand surgery. Based on history taking, it is possible to distinguish between an acute and chronic condition. In acute cases, patients often report a trauma. The differential diagnosis includes tendon injury or osteoarticular involvement, which are not discussed here. In case of chronic symptoms, two pathological conditions must be considered, namely Dupuytren's disease and trigger finger. The diagnosis is mainly clinical, but can be assisted by ultrasound if necessary. For Dupuytren's disease, the treatment is usually conservative as long as the palm of the hand can be completely laid down on a flat surface. When this is no longer possible, treatment of the symptom, i.e. contracture, may be considered. Collagenase (Xiapex®) injections are the currently preferred treatment option. To date, there is no cure for this disease. Regarding trigger finger, corticosteroid infiltrations are the first-line treatment to be privileged. First-line surgery should only be considered in case of secondary trigger finger, where studies have shown a trend towards recurrence following infiltrations

Subcutaneous granuloma annulare (SGA) is a rare variant of granuloma annulare most commonly affecting children. We report a 33-year-old female with a 2-year history of multiple plaques and subcutaneous nodules affecting her hands, elbow, ear and feet. Some lesions resembled rheumatoid nodules; the lesion on her left hand caused a trigger finger; and the nodule of the foot mimicked a Morton's neuroma. Laboratory investigations were unremarkable for rheumatoid arthritis. Histological findings showed dermal necrobiosis with palisades of histiocytes and lymphocytic inflammation. Assessment with ultrasound of the foot nodule supported a diagnosis of subcutaneous SGA, with a non-compressible lesion located between the nerves rather than arising from the nerve. The patient was initially treated with hydroxychloroquine, low-dose methotrexate and a short course of prednisolone. She was unable to tolerate methotrexate and had an inadequate response to hydroxychloroquine. Some nodules responded to intralesional triamcinolone injections while others spontaneously resolved. SGA can mimic a rheumatoid nodule and Morton's neuroma and be the cause of a trigger finger.

Introduction The hand and wrist have multiple functions that are extremely important for daily life Deviation from normal function can lead to disability Important to recognize various traumatic and non traumatic disorders that can lead to hand and wrist pain and dysfunction Acute, subacute, and chronic conditions

目的采用高頻超聲評價在針刀治療扳機指中超聲引導的價值。方法使用便攜式超聲診斷儀M9CV,將8例診斷為A1滑車環狀增厚的扳機指或扳機拇患者隨機分為兩組:非超聲引導治療組(NUGR)和超聲引導下治療組(UGR)。比較兩組實際進針點與標記進針點的距離、操作時間,以及有無并發癥等。對兩組治療前、治療后即刻和治療后一周手指屈伸狀況進行臨床分級評估。結果 UGR組操作時間為(16.75±1.71)min,NUGR組操作時間為(5.5±0.58)min,UGR組操作時間明顯長于NUGR組(P<0.01)。治療后即刻和治療后一周UGR組一次性治療成功率明顯高于NUGR組(P<0.05)。結論在超聲引導下進行針刀治療,能全程顯示整個操作過程,不依賴于操作者的經驗和感覺,可最大程度一次性切割徹底,還能避免傳統治療因切割不夠或切割過度導致的復診率增高或周圍組織損傷。 Objective This study was performed to evaluate the values of ultrasound-guided A1 pulley release in the treatment of trigger finger/thumb(TF/TT)using needle-knife.Methods The ultrasonography was performed with a portable ultrasound(Linear Array L12~4 S,Frequency of 3-13 MHz,M9 CV,MINDRAY Company).A total of 8 patients were clinically and ultrasonographically diagnosed with A1 pulley thickness as TF or TT.Then they were randomly divided into two groups:non ultrasound-guided release(NUGR)and ultrasound-guided release(UGR).The distances between the marked with the real entry point,the operating time,and complication as needle-knife releasing in two groups were compared.All patients were grading evaluated clinically with the completion of flexion and extension of the TF or TT before and after the operation(Day 0 and 7).Results The operating time were(16.75±1.71)min and(5.5±0.58)min respectively in UGR and NUGR groups(P0.01).The operating time in UGR was longer extremely than in NUGR.The clinical grading evaluation was better in UGR than in NUGR after treatment(Day 0 and 7)(P0.05).Conclusions It is very easy to display the whole operating process using ultrasound-guided release,and also independent from the personal experience and feelings of operator.As a result,it is not only able to release the thickness place of A1 pulley completely at the first time,but avoidable from the frequent visits or the surrounding tissue injury occurred due to the superficial or deep release in the traditional blind operation.

Background: Stenosing tenosynovitis of fingers is one of the common tendinopathy attended in orthopaedic practice. A number of methods have been described for the treatment of this problem. Treatment ranges from conservative management to surgical procedures. Stenosing tenosynovit is also known as Trigger finger. Material & Methods: in this Prospective study all patients presented with trigger finger Grade 2 and 3 were randomly allocated into 2 groups. One group received local corticosteroid injection and in the other group, percutaneous release of pulley was performed as treatment option. These patients were then followed and assessed weekly over a period of two month and their progress noted. Results: We studied a total of 42 patients. Majority (71.4%) were females. The commonest age group is 40-50 years olds (56.6%).The most common presenting symptom was pain with triggering (52.3%). There was significant improvement in pain in the first two weeks in both groups but there was better improvement of pain in the corticosteroid group initially especially after first week. As for the triggering, there was significant improvement noted in first week in corticosteroid group but there was no difference in degree of improvement between both the groups after four week. The corticosteroid group had a complication rate of 10% whereas the percutaneous release group complication rate was 18.1%%. The recurrence rate was comparable in both the groups. Conclusion: Trigger finger is a common condition in orthopaedic practice. The commonly affected fingers are the centrally located on the palm. Local infiltration corticosteroid percutaneous release of pulley gives comparable results in long follow-up however corticosteroid injection gives better result initially with less complication.

Background: Stenosing tenosynovitis of fingers is one of the common tendinopathy attended in orthopaedic practice. A number of methods have been described for the treatment of this problem. Treatment ranges from conservative management to surgical procedures. Stenosing tenosynovit is also known as Trigger finger. Material & Methods: in this Prospective study all patients presented with trigger finger Grade 2 and 3 were randomly allocated into 2 groups. One group received local corticosteroid injection and in the other group, percutaneous release of pulley was performed as treatment option. These patients were then followed and assessed weekly over a period of two month and their progress noted. Results: We studied a total of 42 patients. Majority (71.4%) were females. The commonest age group is 40-50 years olds (56.6%).The most common presenting symptom was pain with triggering (52.3%). There was significant improvement in pain in the first two weeks in both groups but there was better improvement of pain in the corticosteroid group initially especially after first week. As for the triggering, there was significant improvement noted in first week in corticosteroid group but there was no difference in degree of improvement between both the groups after four week. The corticosteroid group had a complication rate of 10% whereas the percutaneous release group complication rate was 18.1%%. The recurrence rate was comparable in both the groups. Conclusion: Trigger finger is a common condition in orthopaedic practice. The commonly affected fingers are the centrally located on the palm. Local infiltration corticosteroid percutaneous release of pulley gives comparable results in long follow-up however corticosteroid injection gives better result initially with less complication.

The article presents the results of the analysis of electroneuromyography carried out in 56 patients with trigger finger, who were treated at the department of hand microsurgery at Regional clinical trauma hospital of Donetsk in 2008–2012. The objective of the study was to investigate the options of electroneuromyography for the diagnosis, staging and/or confirmation of trigger finger, evaluation of treatment outcomes. The results were compared by Student’s t-test and Mann — Whitney — Wilcoxon test. As a result of this work we have concluded that patients with the second stage of trigger finger are characterized by decrease in the amplitude motor unit potentials (MUP) to the level of 700–800 mV, and duration — up to 7.5–8.0 ms, patients with the third stage — 500–600 mV and 5.5–7.4 ms, respectively. Thus, patients with second and third stages of trigger finger have significant differences in the basic neurometric indicators: the duration and amplitude of MUP. Electroneuromyography is objective and reliable method for diagnosing the stage of trigger finger., В статье изложены результаты анализа электронейромиографического обследования 56 пациентов со стенозирующими лигаментитами пальцев кисти, которые находились на лечении в отделении микрохирургии кисти ОКТБ г. Донецка в период 2008–2012 гг. Целью исследования стало изучение возможностей электронейромиографии для диагностики, определения и/или подтверждения стадии процесса стенозирующих лигаментитов пальцев кисти, оценки результатов лечения. Полученные результаты сравнивались по критерию Стьюдента и Манна — Уитни — Уилкоксона. В результате проведенной работы сделаны выводы, что для пациентов со второй стадией стенозирующего лигаментита характерно снижение амплитуды потенциалов двигательных единиц (ПДЕ) до уровня 700–800 мV, а длительности — до 7,5–8,0 мс, для пациентов с третьей стадией — 500–600 мV и 5,5–7,4 мс соответственно. Таким образом, у пациентов со второй и третьей стадиями стенозирующего лигаментита имеются достоверные отличия в основных нейрометрических показателях: длительности и амплитуде ПДЕ. Электронейромиография является объективным и достоверным методом диагностики стадии стенозирующего лигаментита., У статті викладено результати аналізу електронейроміографічного обстеження 56 пацієнтів зі стенозуючими лігаментитами пальців кисті, які знаходилися на лікуванні у відділенні мікрохірургії кисті ОКТЛ м. Донецька в період 2008–2012 рр. Метою дослідження стало вивчення можливостей електронейроміографії для діагностики, установлення та/або підтвердження стадії процесу захворювання, оцінки результатів лікування. Отримані дані порівнювалися за допомогою критеріїв Стьюдента та Манна — Уітні — Уілкоксона. У результаті роботи зроблено висновки, що для пацієнтів із другою стадією стенозуючого лігаментиту характерне зниження амплітуди потенціалу рухової одиниці (ПРО) до рівня 700–800 мV, а тривалості — до 7,5–8,0 мс, для пацієнтів із третьою стадією — 500–600 мV і 5,5–7,4 мс відповідно. Таким чином, у пацієнтів із другою та третьою стадіями захворювання є вірогідні відмінності в основних показниках — амплітуді та тривалості ПРО. Електронейроміографія є об’єктивним і вірогідним методом діагностики стадії стенозуючого лігаментиту.

The human finger contains tendon/ligament mechanisms essential for proper control. One mechanism couples the movements of the interphalangeal joints when the (unloaded) finger is flexed with active deep flexor. This study's aim was to accurately determine in a large finger sample the kinematics and variability of the coupled interphalangeal joint motions, for potential clinical and finger model validation applications. The data could also be applied to humanoid robotic hands. Sixty-eight fingers were measured in seventeen hands in nine subjects. Fingers exhibited great joint mobility variability, with passive proximal interphalangeal hyperextension ranging from zero to almost fifty degrees. Increased measurement accuracy was obtained by using marker frames to amplify finger segment motions. Gravitational forces on the marker frames were not found to invalidate measurements. The recorded interphalangeal joint trajectories were highly consistent, demonstrating the underlying coupling mechanism. The increased accuracy and large sample size allowed for evaluation of detailed trajectory variability, systematic differences between flexion and extension trajectories, and three trigger types, distinct from flexor tendon triggers, involving initial flexion deficits in either proximal or distal interphalangeal joint. The experimental methods, data and analysis should advance insight into normal and pathological finger biomechanics (e.g. swanneck deformities), and could help improve clinical differential diagnostics of trigger finger causes. The marker frame measuring method may be useful to quantify interphalangeal joints trajectories in surgical/rehabilitative outcome studies. The data as a whole provide the most comprehensive collection of interphalangeal joint trajectories for clinical reference and model validation known to us to date., Evaluation Studies, Journal Article, Validation Studies, SCOPUS: ar.j, info:eu-repo/semantics/published

The human finger contains tendon/ligament mechanisms essential for proper control. One mechanism couples the movements of the interphalangeal joints when the (unloaded) finger is flexed with active deep flexor. This study's aim was to accurately determine in a large finger sample the kinematics and variability of the coupled interphalangeal joint motions, for potential clinical and finger model validation applications. The data could also be applied to humanoid robotic hands. Sixty-eight fingers were measured in seventeen hands in nine subjects. Fingers exhibited great joint mobility variability, with passive proximal interphalangeal hyperextension ranging from zero to almost fifty degrees. Increased measurement accuracy was obtained by using marker frames to amplify finger segment motions. Gravitational forces on the marker frames were not found to invalidate measurements. The recorded interphalangeal joint trajectories were highly consistent, demonstrating the underlying coupling mechanism. The increased accuracy and large sample size allowed for evaluation of detailed trajectory variability, systematic differences between flexion and extension trajectories, and three trigger types, distinct from flexor tendon triggers, involving initial flexion deficits in either proximal or distal interphalangeal joint. The experimental methods, data and analysis should advance insight into normal and pathological finger biomechanics (e.g. swanneck deformities), and could help improve clinical differential diagnostics of trigger finger causes. The marker frame measuring method may be useful to quantify interphalangeal joints trajectories in surgical/rehabilitative outcome studies. The data as a whole provide the most comprehensive collection of interphalangeal joint trajectories for clinical reference and model validation known to us to date., Evaluation Studies, Journal Article, Validation Studies, SCOPUS: ar.j, info:eu-repo/semantics/published