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Purpose: Trigger finger (TF) is a common hand condition that can be treated with surgery. We conducted a systematic review and meta-analysis to assess whether ultrasound-guided (US-guided) percutaneous surgery is superior to other conventional surgical methods. Methods: We conducted a comprehensive search in Medline, Embase, and the Cochrane Library to identify relevant studies. We included randomized clinical trials (RCTs) and observational studies comparing US-guided TF release with blind percutaneous or open approaches. We combined Risk Ratios (RR) and Mean Differences (MD) with 95% Confidence Intervals (CI) across studies. Data processing and analysis were conducted using R software, version 4.3.1. Results: Our analysis included eight RCTs and two observational studies with 555 patients. US-guided surgery significantly reduced postoperative DASH scores (MD -3.75 points; 95% CI = -7.48, -0.02; p < 0.01), shortened time to resume activities (MD -11.52 days; 95% CI = -16.13, -6.91; p < 0.01), hastened discontinuation of oral analgesics (MD -4.44 days; 95% CI = -8.01, -0.87; p < 0.01), and improved patient satisfaction scores (RR 1.13; 95% CI = 1.04, 1.23; p = 0.75). There were no significant differences in VAS scores, time to movement recovery, or surgical success rate. Conclusion: Ultrasound-guided percutaneous release is a safe, effective, and superior alternative for treating TF compared to other methods, leading to improved DASH scores, quicker recovery, faster cessation of oral analgesics, and enhanced patient satisfaction. [ABSTRACT FROM AUTHOR]

Purpose: We hypothesized that increased friction between the flexor tendon and surrounding structures due to hand arthritis is an important risk factor for trigger finger (TF) after carpal tunnel release (CTR). Therefore, we compared TF development according to the presence or absence of arthritis in carpal tunnel syndrome (CTS) patients treated with CTR. Methods: This retrospective study was based on data collected from the National Health Insurance Service-National Sample Cohort (NHIS-NSC) in the Republic of Korea between January 1, 2002, and December 31, 2015. Patients diagnosed with TF between one month and one year after the CTR date or with a history of surgery were included in the study. During subsequent follow-up, the patients were divided into subgroups of those (1) with TF and (2) without TF. Sex, age, arthritis, and TF-related comorbidities were compared between the subgroups. Results: The subgroup with TF had a higher proportion of women (9.43% vs 90.57%), the highest age range between 50 and 59 years, more cases of arthritis (32.55% vs 16.79%), and a higher proportion of patients with hypothyroidism (10.85% vs 4.60%) than the group without TF. The association between arthritis and TF after CTR was examined using a multivariate logistic regression model, showing arthritis to be a significant risk factor for TF after CTR (odds ratio, 1.35; P = 0.049). Conclusions: We identified arthritis as an important risk factor for the development of TF after CTR. [ABSTRACT FROM AUTHOR]

Background: An inflammatory disorder known as trigger finger (TF) results in pain in the proximal and distal palm and digit, as well as restricted movement and diminished function. Physiotherapists use a specific treatment called dry needling (DN) to reduce musculoskeletal pain and assist patients with mobility restriction. Objectives: This study aimed to examine the effectiveness of DN on quality of life in patients suffering from trigger finger. Methods: Forty patients, ranging in age from 45 to 75, were randomized into one of two groups in this Prospective pre and post-test, single-blind parallel group randomized controlled trial. Twenty patients were assigned to the intervention group, which included traditional physiotherapy splinting and ultrasound (ultrasonic dosage was 3MHz, the intensity of 0.5 W/cm2, and the duty cycle 50%. Duration: 5 minutes) as well as to DN upon a nodule at the proximal end of the 1st annular (A1) pulley as well as the discrepancy that existed between the flexor tendon's diameter along with its sheath at the metacarpal head. Twenty patients were assigned to the control group, which consisted of traditional treatment alone, twice weekly, for a total of ten sessions over five weeks. The trial evaluated the quality of life, severity of pain, and hand grip strength using the World Health Organization Quality-of-Life Scale (WHOQOL-BREF), visual analogue scale, and Camry dynamometer respectively two times, beforetreatment and after 10 treatment sessions. Results: Within-group analysis using MANOVA demonstrated a significant decline in VAS (p = 0.001) and a significant improvement in quality of life (p = 0.001) and hand grip strength (p = 0.001). Regarding between group comparison using MANOVA there was significant improvement in favor of the DN intervention (p = 0.001) for all measured variables. Conclusions: A 5-week dry needling approach with a traditional physiotherapy program was effective in improving in quality of life, pain intensity, and hand grip strength in patients with trigger finger, emphasizing it as the better option. Trial registration: Clinical Trial. Gov, NCT05671523. Registered 14 December 2022. [ABSTRACT FROM AUTHOR]

Background: None of the commonly cited risk factors for chronic hand conditions such as trigger finger (TF) delivers a convincing explanation for the striking differences among affected fingers or gender predominance. Hence, we aimed to investigate further possible TF-associated risk factors such as extrinsic mechanical constrictions caused by wedding rings. Methods: A retrospective data analysis was conducted at a single centre. Patients operated on for release of the A1 pulley from 2005 to 2019 were included. Exclusion criteria involved multiple TF and unknown marital statuses. Case attribution of patients was made with surgical A1-pulley release of the ring finger vs. controls (all other affected single fingers) with marital status equal to "married" as a risk factor. Differences in frequencies were tested using Fisher's exact test and risk factors expressed as odds ratios (OR). Models adjusting for age were analysed by logistic regression. Results: In our 188-patient cohort (60 male/128 female), the three most affected (92% of cases) were the thumb (n = 69), ring (n = 52), and middle finger (n = 52). When comparing the affected ring fingers to all other digits collectively, we found a significantly higher number of ring fingers in the married group (OR = 3.0, 95% CI: 1.37–6.7 p = 0.005). Although marital status depended strongly on age, the odds ratio remained almost unchanged after adjusting for age. Conclusions: We conclude that any form of extrinsic mechanical constriction of fingers associated with rings increases the risk for developing one of the most common hand conditions worldwide; this may be relevant for reassessing disease-related risk. Level of evidence: Level IV, risk/prognostic. [ABSTRACT FROM AUTHOR]

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Purpose: We aimed to compare trigger finger (TF) development between patients with carpal tunnel syndrome (CTS) treated with carpal tunnel release (CTR) and those treated conservatively, using the National Health Insurance Services data of Korea. We also aimed to investigate risk factors for post-CTR TF development.Methods: We selected CTS patients with or without CTR (3543 patients in each group) between 2002 and 2015. Sex, age, follow-up duration after CTS diagnosis, and comorbidities associated with TF-development were matched using propensity score. We compared the rates of TF diagnosis and subsequent TF operations between groups. Thereafter, we selected patients with CTS undergoing CTR, for whom minimum follow-up exceeded five years. We compared sex, age, height, weight, and comorbidities associated with TF risk factors between the TF-occurrence and non-TF-occurrence groups.Results: On comparing CTR-treated patients with those treated conservatively for CTS, CTR-treated patients presented with significantly higher rates of TF diagnosis (12.2%) and TF operations (4.7%) than patients without CTR (6.2% and 1.2%, respectively). Among 433 TF-diagnosed patients and 166 TF-operated patients after CTR, most were identified < 5 years after CTR, with 379 diagnosed (87.5%) and 147 operated (88.5%) patients. A total of 240 patients presented with newly developed TF over a five year period. Patients with subsequent TF exhibited a higher female sex rate and shorter height. None of the variables was significant risk factors for TF development in logistic regression analysis.Conclusion: We confirmed high incidences of post-CTR TF diagnosis and operations. TF develops most frequently in the first postoperative year. [ABSTRACT FROM AUTHOR]

Purpose: The pain from corticosteroid injections is not an insignificant issue for patients with trigger finger. The aim of this study was to evaluate the efficacy of subcutaneous single-injection digital block (SSIDB) for pain reduction during trigger finger corticosteroid injection. Methods: Ninety patients requiring corticosteroid injections for trigger finger were randomized to three groups: SSIDB with 2 ml of 1% lidocaine, SSIDB with 1 ml of 1% lidocaine and no digital block (control group). In SSIDB groups, the intrasynovial corticosteroid injections were performed after digital nerve block. In control group, ethyl chloride spray was applied prior to intrasynovial injection of the corticosteroid and 1% lidocaine mixture. The pain during lidocaine needle insertion, lidocaine infiltration, corticosteroid needle insertion and corticosteroid infiltration were determined with a visual analog scale (VAS). Results: The VAS pain scores for corticosteroid needle insertion in both SSIDB groups were significantly lower than the VAS pain scores in control group (p < 0.001). The VAS pain score during corticosteroid infiltration in 2 ml of 1% lidocaine group was significantly lower than 1 ml of 1% lidocaine group (p = 0.008), and in control group (p < 0.001). Pain during nerve block procedure in both SSIDB groups was significantly lower than the pain from corticosteroid injection in the control group (p < 0.05 and p < 0.05). Conclusions: Subcutaneous single-injection digital block with 2 ml of 1% lidocaine was highly effective in reducing pain associated with injection of corticosteroid for trigger finger. [ABSTRACT FROM AUTHOR]

Trigger finger is one of the most common upper extremity problems seen by hand surgeons. Lesions occupying space in the tendon bed can prevent tendon gliding. We describe a unique case of trigger finger in a patient known for a hereditary multiple exostoses disease where an exostosis in the tendon bed constricted the tendon sheath, leading to triggering and locking. Open surgical treatment was performed by removing of the exostosis which relieved the problem. Level of Evidence: Level V, therapeutic study. [ABSTRACT FROM AUTHOR]

Objective: No studies have reported the use of ultrasound for the evaluation of trigger finger after steroid injection. We evaluated the clinical features and ultrasound appearance of trigger finger before and after steroid injection under ultrasound guidance.Materials and Methods: Thirty-eight digits with triggering were included. A single steroid injection into the tendon sheath was administered. Ultrasound findings and clinical symptoms, including pain, triggering, and the Quinnell score, were analyzed before injection and at 1 and 3 weeks after injection.Results: Ultrasound indicated that the thickness of the flexor tendons and the thickness of A1 pulleys were significantly greater in the trigger fingers than in controls before steroid injection. Three weeks after injection, these two parameters decreased, and there was no significant difference in the two parameters between the trigger finger and the controls. The visual analogue scales at 1 and 3 weeks after the injection were significantly lower than those before the injection. The Quinnell grading system scores significantly improved at 1 and 3 weeks after injection compared with the scores before injection. Moreover, a tendency was seen for the more clinically severe cases to show more swelling of the tendon and pulley.Conclusion: In conclusion, ultrasound assessments could reveal that the thickened A1 pulley and flexor tendon significantly improved after steroid injection, which enables us to confirm the therapeutic effects of the steroid injection. Therefore, ultrasound assessments can be a useful adjunct to understand the response to treatment with the steroid injection. [ABSTRACT FROM AUTHOR]

Introduction: The optimal surgical approach for trigger finger release remains controversial in hindsight of postoperative rehabilitation as well as scar tissue formation. In this study, we comparatively evaluated the outcome of three different types of skin incision by employing the "Disability of the Arm Shoulder and Hand Score" (DASH) and by quantitative ultrasound measurements of scar tissue volume.Materials and Methods: Thirty patients (32 triggerfingers) were enrolled in this study and randomly assigned to one of three groups: incision placed (1) transversal in distal palmar crease, (2) transversal and 2 mm distal from distal palmar crease, (3) longitudinally over MCP joint without crossing the distal palmar crease. Patients characteristics were noted and DASH scores were retrieved at four time points, (1) preoperatively (baseline), (2) 1 month, (3) 3 months, (4) 12 months postoperatively. Scar volume formation was assessed by ultrasound at 3 months postoperatively in 28 patients.Results: All groups showed a significant reduction in DASH values at 3 and 12 months postoperatively when compared to their own baseline levels. Group 3 showed the fastest and most pronounced reduction in DASH values at 1 month. Scar tissue formation was almost 57 % increased in group 1 vs group 2 and 3, however, not significant.Conclusion: There is no clear benefit of one incision technique over another. However, based on scar volume parameters, the significant faster recovery in the first month and the surgical ease of exposure and wound closure inclines us to favor the longitudinal incision (group 3) in future patients. [ABSTRACT FROM AUTHOR]

Trigger finger (or trigger thumb), also known as sclerosing tenosynovitis, is a common clinical diagnosis that rarely presents for imaging. Because of this selection bias, many radiologists may not be familiar with the process. Furthermore, patients who do present for imaging frequently have misleading examination indications. To our knowledge, magnetic resonance (MR) imaging findings of trigger thumb have not been previously reported in the literature. In this article, we review the entity of trigger thumb, the anatomy involved, and associated imaging findings, which include flexor pollicis longus tendinosis with a distinct nodule, A1 pulley thickening, and tenosynovitis. In addition, in some cases, an abnormal Av pulley is apparent. In the rare cases of trigger finger that present for MR imaging, accurate diagnosis by the radiologist can allow initiation of treatment and avoid further unnecessary workup. [ABSTRACT FROM AUTHOR]

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Introduction: Trigger digit is one of the most common causes of pain and disability in the hand. The mainstay of conservative treatment of this disease has been local steroid injection into the tendon sheath. The aim of this study was to investigate the clinical benefit of an ultrasound-guided corticosteroid injection compared to a blinded application. Materials and methods: 74 patients, who suffered from persistent or increasing symptoms of a single trigger digit, were enroled in this prospective, randomised case-control study. All patients were treated with an injection of 40 mg/1 ml methylprednisolone acetate into the flexor tendon sheath at the level of the A1 pulley. Half of the patients had their injections under ultrasound control (USG) and half without (blinded injection group, BIG). Associated metabolic diseases were recorded. At the 6-week and 6-month follow-up examinations, the complication rate and the need for a second injection were assessed. The outcome was rated using the Quinnell grading. The pain level was assessed using the visual analogue scale. Results: Four patients were excluded due to lack of follow-up. Both study groups were comparable in respect of age, hand dominance and associated diseases. There were significantly more female patients in the USG group (32 versus 23 %). After the corticosteroid injections, all patients improved significantly in terms of pain level and the Quinnell grading at 6 weeks and 6 months after the intervention in comparison to the pre-injection status. There were no significant differences between the groups. 9 patients (13 %) needed a second injection (6 of BIG, 3 of USG), all of whom had diabetes mellitus. No local complications were seen after the injections. Conclusion: The use of ultrasound-guided injection of corticosteroid may be associated with extra time and effort, with no superior clinical benefits compared to the blinded technique. Level of evidence: Level 1(prospective randomised study). [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this retrospective study was to identify the postoperative complications and disorders associated with open trigger finger release. Factors that were investigated by this study included demographic details, the number of digits affected, BMI, level of manual strain, trauma, received systemic medication, hand dominance, pre-treatment with steroid injection, and concomitant diseases. Methods: One hundred and three patients, who underwent open release surgery for 117 trigger fingers and thumbs, were followed up until complete resolution of all complaints. Patients' age, BMI, hand dominance, occupational manual strain, and previous medical history regarding trigger finger or thumb were obtained. Associated conditions and medical treatment, trauma, and previous hand surgical interventions were included as well. Details regarding duration of complaints, ROM, visual analogue pain scale, swelling, recurrence of the disease following previous surgical release, and persistence of complaints following corticosteroid injection were examined. Results: The dominant hand was not significantly more frequently affected than the non-dominant hand. Occupation also did not influence the incidence of trigger digit. Patients with systemic steroid therapy had a significantly shorter duration of postoperative symptoms with a mean duration of 29.3 days (range, 28-31 days ± 1.3). Significantly less postoperative swelling was noticed in patients with a pre-surgical steroid injection. The mean duration of symptoms before and after surgery was significantly shorter for a trigger thumb than for trigger finger. Discussion: Open trigger digit release constitutes an adequate low-risk surgical procedure for treatment of trigger digit. In this study, we could show that the incidence of this disease is not significantly correlated with the manual strain, trauma, BMI, hand dominance or concomitant diseases like diabetes mellitus, rheumatoid arthritis, renal insufficiency, and hypothyroidism. Additionally, this study illustrates the importance of a careful postoperative follow-up treatment to avoid potential persistent functional limitations. [ABSTRACT FROM AUTHOR]

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This study examines flexor digitorum tendons and A1 pulley in patients presenting trigger fingers using high-resolution ultrasonography (US), determines the accurate causes of trigger fingers, and analyzes the relationship between clinical data and US findings. As much as 50 trigger fingers of 41 patients were examined by high-resolution US, and the US findings were analyzed as tendon thickness, fibrillar echotexture, tendon margin, fluid collection, A1 pulley thickening, tendon sheath cyst, and metacarpophalageal (MCP) joint abnormalities. The affected fingers were compared with the asymptomatic opposite sides. Right thumb and ring finger were the most common fingers involved. Mean thickness of flexor digitorum tendons of the affected fingers was increased significantly, compared with that of the opposite fingers. There were various US findings in flexor digitorum tendons as follows; loss of normal fibrillar echogenic pattern (14%), irregularity or blurring of the tendon margin (62%), and fluid collection in the tendon sheath (16%). Thickening of A1 pulley was noted in 44% of fingers, and mean thickness of A1 pulley was 0.7 mm. As much as 6% of fingers had the sheath cysts and 4% of fingers had abnormalities of MCP joints. The patients with extension difficulty of the fingers had thicker flexor digitorum tendon than those without. The patients with locking fingers had more blurred margin of the tendon than those without. US can detect various lesions in clinical trigger fingers, and some US findings correlated with clinical findings. [ABSTRACT FROM AUTHOR]

Trigger finger is a common finger aliment, thought to be caused by inflammation and subsequent narrowing of the A1 pulley, which causes pain, clicking, catching, and loss of motion of the affected finger. Although it can occur in anyone, it is seen more frequently in the diabetic population and in women, typically in the fifth to sixth decade of life. The diagnosis is usually fairly straightforward, as most patients complain of clicking or locking of the finger, but other pathological processes such as fracture, tumor, or other traumatic soft tissue injuries must be excluded. Treatment modalities, including splinting, corticosteroid injection, or surgical release, are very effective and are tailored to the severity and duration of symptoms. [ABSTRACT FROM AUTHOR]

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Trigger finger and thumb are amongst the most common hand disabilities seen by orthopaedic surgeons. Surgical release of the first annular pulley (A1) is generally indicated when non-operative treatment fails. We present the long-term results of open operative treatment of trigger finger or trigger thumb in adults performed by a single surgeon. From July 1988 to 1998, 305 trigger fingers or thumbs in 276 consecutive patients were treated operatively, including 179 women and 97 men. The average age at operation time was 46.2 years. Two hundred and ten (76%) of the operations were performed for a single trigger digit release, 76 (24%) for multiple trigger digits in individual patients. All operations were done under tourniquet control with local infiltration anaesthesia under outpatient conditions using a transverse incision just distal to the distal palmar crease or on the flexor crease of the thumb at the metacarpophalangeal joint. At latest follow-up after an average of 14.3 years (min: 10, max: 20) 234 patients could be evaluated and were out of complaints, there were no serious complications such as nerve transection or bowstringing or recurrencies. We recommend open surgery of trigger finger and trigger thumb. [ABSTRACT FROM AUTHOR]

Trigger finger is a common condition, and the usual cause is stenosing tenosynovitis. Trigger finger caused by trauma is extremely rare. We examined a patient in whom an apparently trivial laceration caused partial laceration of the flexor tendon, leading to trigger finger. In this case, ultrasonography was useful in establishing the presurgical diagnosis. Removal of the impinging tag cured the trigger finger. We also review nine previously reported cases. When triggering occurs after an injury near the base of a finger, partial laceration of the flexor tendon should be kept in mind as the cause. Ultrasonography may be valuable for the diagnosis. [ABSTRACT FROM AUTHOR]

Copyright of Der Nervenarzt is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)