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Background Traditional dogma regarding management of rheumatoid arthritis (RA) patients with trigger digit symptoms holds that A1 pulley release should be avoided. Surgical release was thought to further destabilize the metacarpophalangeal joint. Biologic disease modifying anti-rheumatic drugs (DMARDs) have limited the development of hand deformities. Despite advances in RA treatment, many textbooks continue to discourage release of the A1 pulley in RA patients. The aim of this study was to determine if this belief is consistent with current trends in surgical management of trigger digits in patients with RA. Methods Active Members of the American Society for Surgery of the Hand (ASSH) were surveyed on their training and current practices as related to RA patients with trigger digits. Results Five hundred three surveys were completed (16% response rate). During training, 55% of ASSH Members were taught to avoid releasing the A1 pulley in RA patients. Seventy-one percent of respondents currently release the A1 pulley in RA patients with no preexisting deformities, no tenosynovial thickening, or if tenosynovectomy and flexor digitorum superficialis slip excision fail to relieve triggering. Forty percent reported that their practice has evolved toward more frequent release of the A1 pulley in RA patients. Conclusion The majority of ASSH Active Members were taught during training to avoid surgical release of the A1 pulley in RA patients to prevent acceleration of finger deformities. Indications and contraindications for A1 pulley release are evolving along with the improved natural history of RA associated with the use of biologic DMARDs.

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.

Resumen Antecedentes y objetivo Las infiltraciones de corticoides son efectivas en el tratamiento de los dedos en gatillo pero el dolor percibido por el paciente durante la inyeccion es un efecto acompanante siempre presente. El objetivo de este estudio fue evaluar la efectividad y el dolor percibido durante una infiltracion corticoidea depositada fuera de la vaina tendinosa utilizando la tecnica comisural dorsal. Material y metodo Se incluyeron 126 pacientes consecutivos. Se realizo una infiltracion esteroidea subcutanea (fuera de la vaina) a traves de la comisura dorsal. En los casos en que los signos o sintomas persistieron, se ofrecio una segunda infiltracion. Se registro el dolor percibido durante la infiltracion mediante la escala visual analogica, el cuestionario DASH antes del tratamiento y al final de seguimiento, la tasa de exito y las complicaciones. Resultados Fueron 86 mujeres y 40 hombres con una edad media de 61 anos. La puntuacion media del dolor durante la infiltracion fue de 3,8. Doce pacientes se perdieron durante el seguimiento. El exito global fue del 68% y el exito tras una unica inyeccion fue del 54%. El mejor resultado se obtuvo en el dedo anular. Los pacientes que no habian sido operados previamente del sindrome del tunel carpiano respondieron mejor. No se objetivaron complicaciones. Conclusiones La infiltracion esteroidea fuera de la vaina tendinosa y utilizando la tecnica comisural dorsal es efectiva y segura en el tratamiento de los dedos en resorte. Parece ser menos dolorosa que los resultados publicados para la tecnica palmar sobre la linea media, aunque esto debe evaluarse en un estudio disenado para ello.

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.

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.

Introduction: Trigger finger or stenosing tenosynovitis is a common cause of painful fingers and thumb that result in painful triggering, snapping or locking of fingers on flexion and extension of involved digit. Available treatment options for this condition are NSAID, splints, intralesional steroid injection, percutaneous release and open release of tendon sheath. Objectives: To study the clinical and functional outcomes and complications of corticosteroid injection and percutaneous release in management of trigger finger. Methodology: In this prospective study, sixty patients who presented with Grade 2 to Grade 3 trigger finger were placed into two groups. Group A(30 patients) were treated with intralesional steroid (40 mg of methylprednisolone) injection. Group B (30 patients) underwent percutaneous surgical release of affected tendon sheath. Both group of patients were treated in outpatient department. Patients of both groups were then asked to follow on scheduled time interval of two-week, six-week, three-months and six-months of period and their progress were recorded. Results: The baseline VAS score before intervention in group A (5.82) and group B (6.12) was statistically significant. In group B there was significant improvement of VAS score till 6 months of follow up. However, in group A there was significant improvement of VAS score by 3 months of follow-up, but by end of 6 months it again raised to 2.14. Yet it was far better than baseline VAS score. Conclusion: In our study both corticosteroid injection and percutaneous trigger finger release were found to be much effective in management of trigger finger.

Paediatric trigger finger is a rare condition distinct from paediatric trigger thumb and adult trigger digits. We performed a systematic review of paediatric trigger finger presentation and aetiology in order to guide workup and management. Fifty-one studies with 193 patients and 398 trigger fingers were included. Most patients had a single, unilateral trigger finger (54%). Fifty-five patients (29%) had an underlying condition, such as mucopolysaccharidosis; these cases appeared to be associated with multiple or bilateral trigger fingers or with carpal tunnel syndrome. All patients with mucopolysaccharidosis were treated surgically. Conservative management was reported in 33% of all patients, and two-thirds of these did not need further intervention. Patients undergoing surgical release infrequently had recurrence of triggering (6%). We propose an algorithmic approach for patients presenting with paediatric trigger finger. Presence of bilateral or multiple trigger digits or concomitant carpal tunnel syndrome should raise suspicion for an atypical underlying pathology.

Background Carpal tunnel syndrome is a prevalent mononeuropathy. Trigger finger is a flexor stenosing tenosynovitis. The aim of the study was to assess the concomitant occurrence of carpal tunnel syndrome and trigger finger in the same hand among patients presented with idiopathic carpal tunnel syndrome or idiopathic trigger finger. The study included 110 hands (75 patients) presented with carpal tunnel syndrome or trigger finger and 60 asymptomatic hands (46 apparently healthy individuals). Clinical assessment and neurophysiological evaluation were done. Results Regarding the presenting clinical complaints, there were 76 hands (69.1%) from 48 patients (64.0%) presented with idiopathic carpal tunnel syndrome. There 34 hands (30.9%) from 27 patients (36.0%) presented with idiopathic trigger finger. Classification of the patients into three groups depending on the final diagnosis: (I) carpal tunnel syndrome group, 57 hands (51.8%) with only carpal tunnel syndrome from 36 patients (48.0%); (II) trigger finger group, 25 hands (22.7%) with only trigger finger from 22 patients (29.3%); and (III) carpal tunnel syndrome with trigger finger group, 28 hands (25.5%) with both conditions from 24 patients (32.0%); and among them, seven patients had contralateral hand carpal tunnel syndrome only. The duration of complaints among the carpal tunnel syndrome with trigger finger group was significantly shorter than that in the other two groups. There were statistically significantly higher values of patient global assessment of hand symptoms and effect of hand symptoms on function and quality of life among the carpal tunnel syndrome with trigger finger group versus the other two groups. There was no statistically significant difference between the carpal tunnel syndrome with trigger finger group versus the carpal tunnel syndrome group regarding different classes of the Padua neurophysiological classification scale. The most common digit to have trigger finger was the middle finger in 19 hands (35.8%). Conclusions The concurrent presentation of idiopathic carpal tunnel syndrome and idiopathic trigger finger in the same hand is common. Each of them could be associated with the other one. The symptoms of one of them usually predominate the patient’s complaints. The identification of this association is essential for proper diagnosis and comprehensive management of patients presented with these conditions.

Summary Purpose Recently, local anaesthesia has become popular among hand surgeons. We hypothesized that using the “wide awake local anaesthesia no tourniquet” (WALANT) approach would result in lower global costs and in an increase in the operating room (OR)’s efficiency. Methods All cases of carpal tunnel (CTR) and trigger finger releases (TFR) performed over 2016 and 2017 were divided into four groups, following which the anaesthesia method was used. Total OR occupation time, surgical time and the “all but surgery” time were analysed. A common minimum bill per anaesthesia was generated. Results WALANT or local anaesthesia and tourniquet increase the OR's throughput by having shorter operation room occupation times than other methods (17.5–33%). Costs of the two procedures are reduced by 21–31% when using local anaesthesia methods. Conclusion Preferring those techniques for CTR and TFR has a notable beneficial impact on the costs and on the OR's efficiency. This effect is more evident on short surgical procedures. LOE Level of evidence III, economic analysis.

Objective. Stenosing tenosynovitis (Nott’s disease, "trigger finger") is one of the most common pathologies of the hand which hand surgeons and orthopedic surgeons have to deal with. A variety of conservative methods are used to treat “trigger finger", including individual splinting and corticosteroid injections. Surgical treatment consists of dissection of the A1 pulley. Traditionally, the operation starts with a small incision. However, in recent years, a number of articles have appeared that report that percutaneous ligamentotomy on II-V fingers is a safe and effective alternative to an open surgery. Due to anatomical features, some authors do not recommend performing a percutaneous ligamentotomy on the thumb, fearing the damage it can cause to the digital nerves.The purpose of this research is to show that the minimally invasive needle ligamentotomy of the thumb A1 pulley is a safe procedure and to conduct the approbation of the offered method.Material and methods. The research consisted of two parts - anatomical and clinical. In the anatomical part of the research (8 upper extremities of 4 unfixed corpses), we proposed the safe accesses in order to conduct percutaneous ligamentotomy of the thumb A1 pulley.In the clinical part of the study we tested a minimally invasive ligamentotomy and analysed the results of treatment in 109 patients with stenosing tenosynovitis of the thumb II-IV stage by Green aged from 28 to 80. All patients received minimally invasive ligamentotomy of the A1 pulley with 18g needle under local anaesthesia (120 surgeries). Average length of the operation was several minutes. All procedures were performed outpatiently. Evaluation of the results of treatment was performed using the Visual Analog Scale (VAS) and Gilberts questionnaire. The observation period was from 12 months up to 24 months.The results. In most cases both clinical and esthetical results were excellent. It was possible to eliminate the “trigger” of the finger intraoperatively for all patients. However, 6 (5.5%) patients complained about the presence of residual clicks due to incomplete dissection of the ligament at the control examination a week later. Percutaneous ligamentotomy was conducted again on all patients with successful outcomes. No recurrence of the disease was noted. 17% of patients tend to complain about pain in the A1 pulley localization during the first week after the operation.Conclusion. The empirical findings prove the efficiency and safety of percutaneous ligamentotomy of the thumb A1 pulley. One of the merits of this technique is a lower risk of postoperative complications and lower treatment expenses. This technique can be successfully used in the practice of hand surgeons in the outpatient setting that have the experience with the conduction of open operations.

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

Trigger digits in children are rare and the vast majority of cases are primary and involve the thumb. Although there are isolated reports of trigger digits in children after trauma, we were unable to find any report of a trigger digit in a child caused by repetitive forceful gripping. We report a 14-year-old fencer who developed a trigger of his middle finger to highlight this unusual association. This was initially managed with a splint and analgesics and eventually required two intrathecal steroid injections for resolution of symptoms.

Background We have anecdotally noticed a higher rate of trigger fingers (TFs) developing in patients who have undergone carpal tunnel release (CTR). Questions/Objective Is the rate of TFs after CTR greater compared to the nonoperative hand? Is the thumb more commonly involved postoperatively compared with spontaneous TFs? Do particular associated comorbidities increase this risk? Patients and Methods We queried our institutional database for patients who had undergone open CTR during a 2-year period and recorded the development of an ipsilateral TF after a CTR or a contralateral TF in the nonoperative hand. Patient demographics, comorbidities, concurrent initial procedures, time to diagnosis, and finger involvement were recorded. Results A total of 435 patients underwent 556 CTRs during this period. Furthermore, 46 ipsilateral TFs developed in 38 of 556 cases (6.83%) at an average of 228.1 ± 195.7 days after surgery. The thumb was most commonly involved (37.0%) followed by the ring finger (28.3%). The incidence rate of TF in the nonoperative hand during this period was 2.7%, with the ring finger and middle finger most commonly involved (33.3 and 28.6%, respectively). Only history of prior TF in either hand was found to be a significantly associated on Chi-square analysis and multivariable regression (p Conclusion In patients with carpal tunnel syndrome, ipsilateral TFs occurred after 6.83% of CTRs, compared with a rate of 2.7% in the nonoperative hand, making it an important possible outcome to discuss with patients. The thumb was more commonly involved in triggering in the surgical hand compared with the nonoperative hand. Patients with a history of prior TFs in either hand were more likely to develop an ipsilateral TF after CTR. Level of Evidence This is a Level III, retrospective study.

BACKGROUND Pediatric trigger digit is a relatively rare condition with incompletely understood etiology. In our practice, we noted a series of children presenting with pediatric trigger digit after an associated local trauma to the hand, which has not been previously described. The aim of this study was to analyze the nature of presentation of trigger digits, the accuracy of initial diagnosis, and the impact on treatment strategies used. METHODS An institutional review board-approved retrospective review of our institution's experience with pediatric trigger finger from 2001 to 2015 was performed. RESULTS Twenty-two patients with 26 affected digits were identified. Eighty-eight percent of patients were diagnosed with trigger thumb, whereas 3 patients (12%) had small finger triggering. Thirteen patients (59%) presented as outpatients, whereas 9 (41%) presented through the emergency department. All patients presenting to the emergency department were in the setting of recent minor trauma. Of this subset of patients, 67% had an incorrect initial diagnosis, leading to an average delay in treatment of 60 days. Ten patients (45% of total) were initially treated with immobilization versus surgical release of the A1 pulley. However, all but 2 of these patients required eventual A1 pulley release for persistent or recurrent triggering (88%). CONCLUSIONS The cause of trigger digit in children remains incompletely understood and may be multifactorial. In this series, a traumatic component to presentation was found in a significant number of patients. This association with minor trauma may contribute to misdiagnosis and delay in definitive treatment. Although initial treatment with immobilization does not seem to impact surgical outcome, we found a high rate of failure with initial immobilization. Most patients required eventual surgical management, regardless of whether or not the initial presentation was associated with trauma. When performed, we found that A1 pulley release alone has safe, reliable results.

Background Trigger finger is a common hand complaint of the general population. Limited literature exists implicating a low-estrogen state in patients on aromatase inhibitor (AI) therapy for breast cancer who develop trigger finger. The authors’ objective was to determine the incidence and treatment outcomes of this population. Methods A single-center retrospective chart review was conducted on patients with a diagnosis of breast cancer on AI who developed trigger finger from 2010 to 2019. The total population of patients during this time served as our population, and patients with breast cancer not on AI with trigger finger served as our control. Primary outcomes included total number of injections and need for surgery. Secondary outcomes included risk factors for surgery. χ2 analysis and logistical regression model determined the significance of primary and secondary outcomes, respectively. Results In all, 192 patients of a population size of 664 751 met our study group criteria. The study group showed a higher incidence of trigger finger (5.1% vs 1.3%; P < .001) compared with our population. Patients treated with AI for breast cancer had both higher incidence of trigger finger (5.1% vs 1.5%, P < .001) and injections (77.1% vs 66.5%, P < .001) compared with patients not on AI therapy. Independent risk factors requiring surgical treatment were found in patients with diabetes (odds ratio [OR], 3.54; P = .01) and in patients with concomitant radiation therapy (OR, 3.17; P = .02). Conclusions This study demonstrates for the first time the incidence, treatment outcomes, and surgical risk factors of trigger finger in patients on AI therapy for breast cancer.

Resumo Objetivo Determinar a frequência do aparecimento de dedo em gatilho (DG) no pós-operatório da síndrome do túnel do carpo (STC) em duas técnicas: aberta (TA) e endoscópica (TE). Como desfecho secundário, comparar as taxas de remissão da parestesia e dor residual entre as duas técnicas. Métodos De forma prospectiva, verificamos o aparecimento de dedo em gatilho e taxa de remissão da parestesia e dor no território do nervo mediano em série de pacientes adultos operados pela TA (n = 34). Comparamos com coorte retrospectiva operada pela TE (n = 33), pela mesma equipe de cirurgiões. A avaliação dos pacientes ocorreu por meio de questionário estruturado em consulta de retorno, com mínimo de 6 meses de pós-operatório. Resultados Sessenta e sete pacientes foram avaliados. Não houve diferença quanto ao aparecimento de dedo em gatilho (TA, 26,5% versus TE, 27,3%; p = 0,94) e dor (TA, 76,5% versus TE, 84.8%; p = 0,38). Os pacientes operados pela TA apresentaram menos queixas de parestesia do que os operados pela TE (TA 5,9% versus TE 24,2%; p = 0,03). Conclusões Em nossa série, a técnica cirúrgica não influenciou o aparecimento de dedos em gatilho e dor residual. Os pacientes operados pela técnica aberta apresentaram menos queixa de parestesia residual pós-operatória.

IntroductionTrigger finger is a common and functionally limiting disorder. Finger immobilization using an orthotic device is one of the conservative treatment options for treating this condition. The most common orthosis previously described for trigger finger is metacarpophalangeal joint immobilization. There are limited studies describing the effectiveness of proximal interphalangeal joint orthosis for treatment of trigger finger.MethodsThis study was a single group pretest-posttest design. Adult patients with single digit idiopathic trigger finger were recruited and asked to wear a full-time orthoses for 6 weeks. The pre- and post-outcome measures included Quick-DASH score, the Stages of Stenosing Tenosynovitis (SST), the Visual Analogue Scale (VAS) for pain, the number of triggering events in ten active fists, and participant satisfaction with symptom improvement. Orthotic devices were made with thermoplastic material fabricated with adjustable Velcro tape at the dorsal side. All participants were given written handouts on this disease, orthotic care and gliding exercises. Paired t-tests were used to determine changes in outcome measures before and after wearing the orthosis.ResultsThere were 30 participants included in this study. Evaluation after the use of PIP joint orthosis at 6 weeks revealed that there were statistically significant improvements in Quick-DASH score from enrolment (mean difference −29.0 (95%CI −34.5 to −23.4); p ConclusionsDespite our small study size, the use of proximal interphalangeal joint orthosis for 6 weeks resulted in statistically significant improvements in function, pain and triggering, and also high rates of acceptance in patients with isolated idiopathic trigger finger.

Background Isometric exercises for a flexed finger have been reported to be effective for treating trigger finger as the flexor tendon widens the space under the first annular (A1) pulley towards the palmar destination during the exercise. This study aimed to evaluate the structural changes during the A1 pulley stretch in healthy volunteers and patients with trigger finger using ultrasonography. Methods We enrolled 25 male and 14 female patients (39 middle fingers). The thickness of the subcutaneous tissue (parameter a), A1 pulley (parameter b), and the flexor tendon (parameter c) and the distance between the dorsal surface of the flexor tendon and the palmar surface of the metacarpal head (parameter d) were measured using ultrasonography of the metacarpophalangeal joint of the middle finger flexed at 45° at rest (pattern A) and under isometric contraction of the flexor tendon against an extension force of the proximal interphalangeal joint (pattern B). Results The average differences between patterns A and B in the healthy volunteers were 0.29 mm (parameter a; P = 0.02), 0.017 mm (parameter b; P = 0.63), 0.16 (parameter c; P = 0.26), and 0.41 (parameter d; P = 0.004), and those in patients with trigger finger were 0.22 mm (parameter a; P = 0.23), 0.019 mm (parameter b; P = 0.85), 0.03 mm (parameter c; P = 0.82), and 0.78 mm (parameter d; P P P Conclusions In this study, the space under the A1 pulley was expanded under isometric contraction of the flexor tendon. These findings support the effectiveness of pulley stretch exercises for the trigger finger condition.

Background: Trigger finger is the most common disease that causing pain in the adult population. Trigger finger may occur at any finger, which usually occurs in the thumb and ring finger. A1 pulley sheath or metacarpal-phalangeal joint. There is a different recommendation toward treatment options for trigger fingers in adults and pediatrics. Method: This paper is done by reviewing and searching journals with “trigger finger”, “treatment”, “pediatric trigger finger”, and “adult trigger finger” on the search engines. The authors found 45 journals that were suitable for our references. Outcome: Trigger finger treatments vary as there are many acceptable treatment options. There is a different choice of therapy that should be considered in adult and pediatric trigger fingers. This should be considered to get better treatment outcomes. Cost analysis is also important to choose the most cost-effective treatment for trigger finger patients. Conclusion: There is no exact consensus recommendation for choosing the exact treatment. pediatric trigger finger is caused by a multifactorial aspect resulting in unpredictable conservative treatment outcomes unlike in adults. The majority of trigger fingers in pediatrics will need surgical procedures while some cases of adult trigger fingers may resolve naturally. Further large studies are needed to develop a treatment algorithm in these two age groups that trigger fingers. Keywords: adult trigger finger, trigger finger, pediatric trigger finger, treatment.

Introduction: Trigger finger is frequently encountered in outpatient department, mostly idiopathic but seen especially in diabetic, hypothyroid or gout patients, the cause being, stenosing tenosynovitis at the A1 pulley, which is usually progressive. There are various treatment options available for this problem.Objective: The aim of this study was to compare the efficacy of USG guided corticosteroid injection, USG guided percutaneous pulley release and open surgery for the treatment of trigger finger in view of cure, relapse and complication rates.Methods: Sixty patients, >20 years of age with a trigger on any finger of the hand (Quinnell Type II - IV) were randomly categorized into one of the 3 treatment groups, each consisting of 20 patients, with one of the 3 treatment modalities allocated equally, from 60 sealed nontransparent envelopes, were studied and followed up for at least 6 months for cure, relapse and failure rates. Group A (N = 20) – Patients to be treated with conservative steroid injection under USG guidanceGroup B (N = 20) – Patients to be treated with percutaneous pulley release under USG guidance andGroup C (N = 20) – Patients to be treated with open surgery as minor OT procedure.Results: Cure rate for first (steroid inj.) group of patients was 60%, and in some patients second injection was repeated, which escalated the cure rate to 85%.For USG guided percutaneous release and open surgery groups, there was complete remission in all cases.Conclusions: The percutaneous release and open surgery methods were equally effective and proved superior to local steroid injections method in terms of trigger cure and relapse rates.

Background Trigger finger or stenosing tenosynovitis is a disproportion between the volume of the tendon sheath and its contents. This disproportion prevents gliding of the tendon as it moves freely through the annular pulley. The technique of percutaneous release of the annular pulley for trigger finger has been described well in the literature, which has undergone several modifications, like use of hypodermic needle, tenotome or specially designed knives. Method We performed percutaneous trigger finger release using a 20-gauge hypodermic needle to know the outcome and efficacy of the technique post release. A Prospective cohort study was conducted in 80 consecutive trigger fingers of 67 patients who were treated by percutaneous release using 20-gauge hypodermic needle. Quinell’s grading system was used to quantify severity of triggering and pain was assessed using visual analogue scale (VAS) before and after the procedure. Patients were evaluated based on these two parameters at timely interval and final outcome was assessed at the end of one year. Results Out of 80 digits treated, most of the subjects were in the age group 40–50 years (39.07%). Most common grade of trigger finger observed was Grade 3 (60%) followed by Grade 4 (30%) with VAS score of 8 (46%) followed by VAS score of 7 (24%) before release. At a year follow-up 95% of patients improved to grade 0 and mean VAS score was 0.44. Three patients developed scar tenderness, which gradually subsided by analgesics and physiotherapy with no other major complications. Conclusion Our technique of percutaneous release of trigger digit with 20 G needle is effective and can be performed safely with ease. It is cost efficient and has a short learning curve with great acceptance being an outpatient procedure.

Background: Primary treatment of trigger digits is conservative including stretching, night splinting and combination of heat and ice. When these methods fail, invasive methods such as corticosteroid injection, percutaneous release and open surgery are used. The purpose of this study is to compare the efficacy of two outpatient methods of percutaneous trigger finger release (PTFR) and corticosteroid injection (CI). Methods: This study is a randomized clinical trial that was performed with 6-month follow up. A total of 83 patients with trigger finger treated either with corticosteroid injection (n:40) or percutaneous release of the A1 pulley (n:43) were enrolled in this study. Demographic data were recorded before intervention. Pain score (VAS criterion), disease stage (Quinnell criteria), patient satisfaction and complications such as paresthesia, scarring, and stiffness (decrease in the range of motion) were recorded after the intervention. We used SPSS program (statistical package for the social science SPSS version 16) to perform the analysis. Results: There were 18 male (21.7%) and 65 female (78.3%) patients, whose mean age was 52.54 ± 11.45 (28–85) years. There was a significant difference between the degree of pain at the time of the third, sixth weeks and sixth months in two groups. The degree of pain was lower in the CI group in the third and sixth weeks but it was lower in the PTFR group in the sixth month. Satisfaction of the patients in the sixth month was significantly higher in the PTFR group. The incidence of stiffness was also significantly lower in the PTFR group in the sixth month. Conclusions: Patients in PTFR group had greater recovery and satisfaction level and lower recurrence rate and pain. Therefore PTFR may be used as a substitute for CI in the treatment of trigger finger from the beginning especially in patients who do not want to have open surgery.

INTRODUCTION: Bowling is an immensely popular, but scarcely researched sport associated with overuse injuries in its participants. The purpose of this study was to investigate and report on the incidence of common upper extremity complaints in elite bowling athletes. MATERIALS AND METHODS: All Malaysian national level bowlers (n=39) were evaluated via questionnaire on their upper limb symptoms. A focused, relevant clinical examination was performed on each subject to exclude de Quervain’s tenosynovitis, tennis and golfer's elbow, carpal tunnel syndrome and trigger finger. The athletes were then allowed to resume bowling for two hours before completing another symptom-related questionnaire. RESULTS: Pain was the predominantly observed symptom, with a predilection for the wrist, ring and middle fingers, and thumb. De Quervain’s tenosynovitis was found in 53.8% (n=21) of the subjects, with 52.4% and 42.9% of them experiencing pain during and after training, respectively. Other repetitive injury-related disorders were also considerably more common than in their non-playing limb and the general population. CONCLUSION: The incidence of de Quervain’s tenosynovitis was exceptionally high in this population. Further studies on sports kinematics are needed to prevent long term morbidities in these athletes.

A locked metacarpophalangeal joint (LMCP) is a rare condition often confused with trigger finger. Its causes are numerous and typically divided into two broad categories: acquired LMCP in younger patients, and degenerative LMCP in older patients. This pathology usually affects only one MCP. Even though several external reduction techniques have been described, the main risk of non-surgical reduction treatment is recurrence. Thus, its management is most often surgical. We report the case of a 60-year-old woman with 3 simultaneous LMCP (3rd, 4th, and 5th rays of the left hand) due to degenerative metacarpal heads. Surgical treatment was performed and found that locking was due to entrapment of the radial collateral ligament on metacarpal head osteophytes. Full extension was regained at the end of the surgery. The follow-up was uneventful, no recurrence occurred. This case highlights the need for careful examination to prevent medical and surgical wandering for a rare but well-described and easy to treat condition.

Introduction: Trigger finger is caused by irritation of the flexor tendon as it slides through the fibro-osseous sheath. Its surgical options include open and percutaneous minimally invasive methods. Aim: This study is aimed at elucidating the efficacy of percutaneous release of trigger finger. Materials and Methods: This is a prospective study carried out in our institution Shri Guru Ram Rai Medical College Dehradun, India over a period of 2 years from June 2015 to august 2017. This study includes 68 trigger finger and thumb of 58 patients between 28 to 64 years. Here percutaneous trigger finger release of A1 pulley was done with the help of 18G hypodermic needle under local anaesthetic cover as a day care procedure. Subsequently the patient was followed up at least for 3 months. Results: Symptoms were resolved completely in all patients. None had any serious complication. Only a few patients had minor temporary wound related complicationsand temporary stiffness. Conclusions: Percutaneous release of trigger finger is effective, convenient, cost effective day care surgery without any significant complications in skilled hands. Keywords: Trigger finger, Percutaneous.

Aim: This randomized prospective pre-post test, single-subject, case series (NCT04094389) feasibility study evaluated the feasibility of conducting a clinical trial to compare the effect of three d...

Introduction Epinephrine and sodium bicarbonate (NaHCO3) used in wide-awake local anesthesia no tourniquet (WALANT) affect many areas such as hemostasis, injection pain, anesthetic effect and others. However, few clinical trials have focused on injection pain and the duration of anesthetic effect, and no prospective studies have reported the benefits of WALANT post operation. This study compared WALANT with conventional local anesthesia with tourniquet in minor hand surgeries, and aimed to answer following questions: (1) Does WALANT have enough benefits for injection pain and duration of anesthetic effect?; (2) How does WALANT affect postoperative management (such as postoperative pain and use of analgesics)?; (3) How satisfied are the patients with the surgery? Hypothesis We hypothesized that WALANT had advantages in injection pain, duration of anesthetic effect, and postoperative management compared to conventional local anesthesia. Materials and methods The present study is designed as a randomized prospective one center study. This study included 185 patients who received surgical treatment for the diagnosis of carpal tunnel syndrome, trigger finger, or de Quervain's disease between 2017 and 2019. We randomly allocated the patients to either the WALANT group or the conventional group. We inquired and recorded patients’ injection pain, duration of anesthetic effect, postoperative pain, the use of analgesics, and satisfaction with the surgery. Results The injection pain was significantly lower in the WALANT group in all procedures (p Discussion Our study showed better results in WALANT than in the conventional method, with no tourniquet pain, lower injection pains, longer anesthetic duration, and less postoperative pain. It provided patients with great satisfaction. In addition, WALANT has the potential benefits of no time limit due to tourniquet pain and long anesthetic effect. Therefore, WALANT is comfortable and cost effective, and could be a good alternative to conventional local lidocaine anesthesia. Level of evidence II.

Objectives: The aim of this study was to investigate the amyloid deposition in patients with trigger finger disease, to analyze the factors affecting amyloid deposition. In addition, we aimed to research the presence of cardiac amyloidosis in patients with amyloid deposition in flexor pulleys. Methods: Consecutive 68 patients with trigger finger treated by open release between September 2018 and November 2019 in two different hospitals were included in this study. Idiopathic trigger fingers were solely included. Patients with systemic rheumatoid diseases, chronic renal failure under hemodialysis, gout, tuberculous synovitis and previously diagnosed systemic amyloidosis including familial amyloid poly- neuropathy or multiple myeloma, pregnant patients, patients who were previously had steroid injected injections were excluded. Demographic data, other concomitant diseases and previous carpal tunnel surgeries were recorded. Immunoperoxidase and immunofluorescence methods were used to determine the amyloid presence and subtype in pathological A1 pulley specimens. Patients with amyloid deposition in biopsy specimen were further evaluated for cardiac involvement of amyloidosis. Results: The study population consisted of 18 men and 50 women with a mean age of 57,6 ± 12,2 years. Of 68 patients with trigger finger, 6 (8,8%) showed amyloid deposition in the tenosynovial tissue; and all amyloid deposits were specifically immunolabeled only with the anti-TTR antibody. No evidence of cardiac amyloidosis is found in patients with localized amyloid deposition. Conclusion: Hand surgeons should be aware of the association trigger finger and amyloidosis and consider biopsy of tenosynovial tissue particularly in patients with older age, DM, prior carpal tunnel release surgery and multi-finger involvement. Tenosynovial biopsy is a low-risk procedure that may guide to cardiologic examination of patients with positive biopsy and it will contribute to early diagnosis of cardiac amyloidosis. [Hand Microsurg 2020; 9(3.000): 120-127]

BackgroundTrigger finger (TF), a painful condition involving a finger flexor tendon, is a common problem with a prevalence of ~2-3% in the general population. However, the TF prevalence is higher among diabetic patients-ranges from 6.7% to 10%. We have analyzed the expression of the extracellular matrix, inflammation, and epigenetic related genes in diabetic and non-diabetes TF. We hypothesized that Diabetes condition induces alter the expression of epigenetic modification genes in diabetic patients and one of the underlying determinants for more prevalence of TF in diabetic patients.MethodTissues from the fingers of patients with symptomatic trigger fingers were collected. We had three groups: carpal tunnel syndrome (as a control), trigger finger, and diabetic trigger finger. A quantitative real-time polymerase chain reaction was performed. The gene expression of Extracellular matrix (ECM) components [COL-I, COL-II, COL-X, Aggrecan], DNA methyltransferases enzymes (DNMT1, DNMT3), growth factors (TGF-b, IGF), and Histone deacetylase enzymes (HDAC1, HDAC2) were evaluated in all groups.ResultsThe mRNA expression of COL-I, COL-II, Aggrecan was significantly higher in the pully A1 of diabetic patients (p= 0.0164, p=0.0351, p=0.0399, respectively) as compared to non-diabetic TF patients. Diabetes was associated with a significant increase in the DNMT3 expression compared to non-diabetic TF patients (p=0.0485). HDAC1 and HDAC2 gene expression were up-regulated in diabetic TF than non-diabetic TF.ConclusionThe chronic state of hyperglycemia induces epigenetic modification of gene expressions in trigger fingers. This seems to have a significant impact on the development, recurrence, and progression of trigger finger in diabetic patients.

The surgical referral policies for patients with trigger finger, ganglion removal and Dupuytren’s disease were collected for all Clinical Commissioning Groups in England. The aim was to assess whether there was variation in the policies across England, resulting in inequality in patients’ access to surgery. Data were collected between October 2018 and January 2019 and compared with national guidelines. Analysis of the results showed that for all three conditions, surgical commissioning policies varied depending on the locality. The results also show that despite the existence of national guidelines, they are not implemented. This has the potential to lead to variation in surgical referral and access to services for patients in different localities in England. Level of evidence: III

Introduction The aim of the study was to estimate recurrence rates, time to recurrence, and predisposing factors for recurrence of trigger finger when treated with corticosteroid (CS) injection as primary treatment. Materials and Methods In a retrospective chart review, we identified primary trigger fingers treated with CS injection as primary treatment. Affected hand and finger, recurrence, time to recurrence, duration of symptoms, secondary treatment type, and comorbidities were recorded. A total of 539 patients were included with a mean follow-up of 47.6 months Results In total, 330/539 (61%) recurrences were registered. Mean time to recurrence was 312 days. Increased risk of recurrence was seen after treatment of the third finger (relative risk [RR]: 1.22; 95% confidence interval [CI]: 1.06–1.39). Several comorbidities were associated with increased risk of recurrence: carpal tunnel syndrome (RR: 1.27; 95% CI: 1.07–1.52), thyroid disease (RR: 1.45; 95% CI: 1.15–1.83), or shoulder diseases (RR: 1.58; 95% CI: 1.36–1.83). Conclusion We found a recurrence rate after primary treatment of CS injection for trigger finger of 61%. Most recurrences happened within 2 years and we found treatment of third finger, carpal tunnel syndrome, shoulder, or thyroid disease to be associated with an increased risk of recurrence of symptoms.

Objective Corticosteroid injections into tendon sheaths are common in clinical practice for treatment of a variety of tendon disorders. Previous systematic reviews have been performed on injections for stenosing tenosynovitis (DeQuervain tenosynovitis and trigger finger), but little high-level evidence remains for other tendon sheath injections. This systematic review analyzes the available literature on improvements in pain and function after these injections. Design This systematic review of MEDLINE and Embase databases, as well as article bibliographies, examined studies of adult tendon sheath injections, excluding DeQuervain and trigger finger injections. Studies with and without comparison groups were examined. Risk of bias assessment was additionally performed. Results Abstracts from 1293 records were screened, and 187 full-text articles were reviewed. Seven articles met final inclusion criteria, of which five were prospective trials and none were compared with a placebo. The proximal biceps, peroneal, finger flexor, and posterior tibialis tendons were explicitly examined. All articles reported at least short-term improvements in pain, and some reported improvement in function. Conclusions Low-quality studies exist that suggest tendon sheath injections may provide at least short-term improvement in pain. Controlled studies are required to fully demonstrate efficacy.

Background Complications in the fingers and hand after arthroscopic rotator cuff repair (ARCR) have been reported to include carpal tunnel syndrome (CTS), flexor tenosynovitis (TS), and complex regional pain syndrome. These studies were conducted retrospectively; however, the reported complications have not been examined prospectively. The aim of this study was to evaluate the outcomes of early detection and treatment of the complications after ARCR. Methods Forty-six patients (48 shoulders) who underwent ARCR were prospectively examined to investigate complications in the fingers and hand after ARCR. We attempted to immediately detect and proactively treat these complications. We evaluated the outcomes of the early detection and treatment of the complications. Results Complications were observed in 17 hands (35%) and occurred an average of 1.5 months after ARCR. The symptoms in 3 hands resolved spontaneously, 2 hands were diagnosed with CTS, and 12 hands were diagnosed with TS. Of the 12 hands with TS, 11 exhibited no triggering of the fingers. Among the 14 hands diagnosed with CTS or TS, 13 hands (CTS: 2 hands, TS: 11 hands) were treated with corticosteroid injections; the mean interval between treatment initiation and symptom resolution was 1.0 months (0.5-3.0 months). None exhibited complex regional pain syndrome. Conclusions When symptoms occur in the fingers and hand after ARCR, CTS or TS should be primarily suspected. The diagnosis of TS must be made carefully because most patients with TS have no triggering. For patients with CTS or TS after ARCR, rapid corticosteroid injection administration can lead to improvement in these symptoms.

We report a case of hand soft tissue tumor-proliferative fasciitis (PF)-in a 12-year-old patient that presented as a painful lump causing trigger finger. After meticulous diagnostic workup, a surgical excision led to immediate amelioration of symptoms. PF is a rare benign pseudosarcomatous lesion arising typically in the subcutaneous tissue and fascia in adults. It is very uncommon in the hand. To the best of our knowledge, this is the first report of a trigger finger being caused due to this pathology. In this report, the authors review PF lesions on hands, advice careful evaluation of magnetic resonance imaging features, and recommend surgical management.

BACKGROUND Evidence-based practices in medicine are linked with a higher quality of care and lower health care cost. For trigger finger, identifying patient factors associated with nonadherence to evidence-based practices will aid physicians in treatment decisions. The objectives were to (1) determine patient factors associated with treatment nonadherence, (2) examine the success rates of steroid injections, and (3) evaluate the economic consequences of nonadherence to treatment recommendations. METHODS The authors used data from the Clinformatics DataMart database from 2010 to 2017 to conduct a population-based analysis of patients with single-digit trigger finger. The authors calculated rates of steroid injection success and examined associations between injection success and patient factors using chi-square tests. In addition, the authors analyzed differences in the cost to the insurer, the cost to the patient, and total cost. RESULTS A total of 29,722 patients were included in this analysis. Injection success rates were similar for diabetic (72 percent) and nondiabetic patients (73 percent), women (73 percent), and men (73 percent). Nonetheless, diabetics (OR, 1.4; 95 percent CI, 1.4 to 1.5; p < 0.001) and women (OR, 1.2; 95 percent CI, 1.1 to 1.2; p < 0.001) were significantly more likely to receive nonadherent treatment. In total, $23 million (U.S. dollars) were spent on nonadherent trigger finger care. CONCLUSIONS Diabetics and women have increased odds of having surgery without a prior steroid injection, despite similar success rates of steroid injections compared to nondiabetics and men. Because performing surgical release before any steroid injections may represent a higher cost treatment option, providers should provide steroid injections before surgery for all patients regardless of diabetes status or sex to minimize overtreatment. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.

Background: Trigger finger release (TFR) is one of the most commonly performed hand procedures and typically results in restoration of normal finger function. However, uncommon postoperative complications such as deep infection can have devastating consequences. The goal of this study was to evaluate the incidence, risk factors, and characteristics of infectious flexor tenosynovitis occurring after TFR. Methods: We searched billing records for the Current Procedural Terminology code for TFR to identify all adult patients who underwent TFR at our institution over a 10-year period. We defined infectious tenosynovitis as any case where the patient underwent tendon sheath drainage or postoperative wound debridement within 6 months of the index TFR procedure. Medical records were reviewed to obtain patient demographic information, body mass index (BMI), tobacco use, history of diabetes mellitus, surgical setting (clinic vs outpatient surgery center), and surgical digit for all patients. In those patients treated for infection, we recorded hospital length of stay, number of operative procedures, and any culture results. Results: We identified a total of 18 infections out of 2307 procedures (1827 patients), for an incidence of 0.99%. Current smokers had a significantly higher incidence of infection than nonsmokers (1.77% vs 0.29%). On univariate analysis, smoking was closely associated with infection ( P ≤ .05). All infections occurred in overweight or obese patients by BMI criteria, but there was no difference in average BMI between patients with and without infection. History of diabetes, in-office surgery, patient age, and patient sex were not associated with a higher incidence of infection. Patients with infections spent an average of 4.1 days in the hospital, and 40% required multiple surgical procedures. The most common infectious organism cultured was Staphylococcus aureus, which was present in 67% of infections. Patients with isolated methicillin-sensitive S aureus on culture showed signs of infection within 3 weeks of the index procedure, whereas polymicrobial, coagulase-negative staphylococci or beta hemolytic streptococci were identified in patients presenting with infectious symptoms later. Conclusion: Infections after TFR are uncommon but are more likely to occur in patients who are current smokers and overweight or obese by BMI criteria. Methicillin-sensitive S aureus is the most likely causative organism, especially in patients presenting during the early postoperative course.

Design: This is a prospective cohort study. Introduction: Evidence is emerging that advanced practice hand therapy clinics improve patient outcomes. Purpose of the Study: The aim of this study was to evaluate an advanced practice hand therapy model of care for patients with chronic hand conditions on surgical outpatient waiting lists at eight Australian public hospitals. Methods: Nonurgent and semiurgent patients were screened and treated, as required, by an advanced practice hand therapist and then discharged from the surgical outpatient waiting list as appropriate. Outcomes included patient safety, impact on the waiting list, patient satisfaction, and patients' perception of change as measured by Global Rating of Change (GROC). The GROC score was also compared across diagnoses. The relationship between the waiting time and need for surgical review during hand therapy treatment was also assessed. As appropriate, T-tests and analysis of variance were used for statistical analyses. Results: A total of 37.2% of patients who commenced hand therapy were removed or discharged from the surgical outpatient waiting lists. Of the subset of patients who completed hand therapy (n = 1116), 28.4% were discharged without requiring surgical follow-up. A further 7.53% requested return to the waiting list despite discharge being recommended. The model of care was safe, and patient satisfaction was above 90%. The mean GROC score was +2.09 (±3.58) but varied across diagnoses with trigger finger or trigger thumb showing the greatest improvement (+4.21 ± 2.92, P

Objective: To compare the efficacy of various strategies in the treatment of trigger finger. Data sources: A systematic literature search for randomized controlled trials to compare treatments for trigger finger was conducted through three online databases, Pubmed, Embase and Cochrane Library, from their inception dates to 22 May 2020. Methods: Relative risk (RR) with 95% confidence interval (CI) was used to evaluate the effect sizes in success rate for included articles. Results: Sixteen articles ( n = 1185) were included in our meta-analysis. The results showed that the efficacy of steroid injection was significantly better than the placebo group at short-term follow-ups (RR = 19.00, 95% CI = 1.17–309.77 for one-week; RR = 3.70, 95% CI = 3.70, 95% CI = 1.61–8.53 for one-month), and then became non-significant at four months (RR = 3.21, 95% CI = 0.88–11.79). There was no significant difference in success rate between steroid injection and nonsteroidal anti-inflammatory drug injection, and between open surgery and percutaneous release at all the follow-ups. Only surgical treatment had significantly better efficacy in success rate than steroid injection at all follow-ups (RR = 0.48, 95% CI = 0.34–0.66 for one-month; RR = 0.87, 95% CI = 0.80–0.96 for three-month; RR = 0.58, 95% CI = 0.48–0.68 for six-month; RR = 0.38, 95% CI = 0.20–0.72 for 12-month). Conclusion: There were no differences in efficacy between steroid injection and shockwave or nonsteroidal anti-inflammatory drug injection. The surgical treatments had the best efficacy among these treatments.

One hundred and sixty patients were enrolled in a prospective randomized controlled trial to assess whether a steroid injection through the dorsal web space was less painful than the palmar midline technique in the treatment of trigger digits and whether they were equally effective. There were 116 women and 44 men with a mean age of 60 years. The mean visual analogue score for pain during the injection was 3.6 in the dorsal web space group and 5.4 in the palmar midline group on a scale of 0–10. The overall success of treatment in the dorsal group was 67%, whereas it was 56% in the palmar group. No complications were noted. We concluded from this study that the dorsal web space technique is less painful and at least as effective as the palmar midline technique. Level of evidence: I

Background: Trigger finger has a prevalence of 2% to 3% in the general population. Although anecdotal evidence exists, there is a lack of conclusive data that prove a relationship between repetitive power grip and flexion with triggering. Ocean rowing is becoming a popular sport, with the race across the Atlantic alone attracting more than 100 participants annually. Anecdotal reports suggest ocean rowing may be a significant cause of trigger finger. We aimed to identify whether the sport causes an increased prevalence of triggering, whether there were any alleviating or compounding factors, and, finally, whether there was any effect on performance. Methods: A prospective observational study was carried out. A questionnaire was sent to all participants of the Talisker Whisky Atlantic Challenge 2018, which included a trigger finger self-scoring system and the Oslo Sports Trauma Center Overuse Injury Questionnaire. Results: Responses were received from 67 rowers (83% response rate). Age ranged from 21 to 62 years, with a mean of 40 years. In all, 49.3% had clinical triggering, with 79.3% reporting bilateral symptoms. The length of continuous rest time had a significant impact on the incidence of finger triggering and disease stage ( P = .0275 and .0353, respectively; multivariate logistic regression). High-grade triggering had a more negative effect on rowing performance than low grade or no triggering (not significant). Conclusion: Ocean rowers suffered a 15-fold increase in trigger finger prevalence compared with the general population. This was increased in those who took shorter, more frequent rest periods. This study provides new conclusive evidence that the repetitive power grip and flexion involved in rowing increase the prevalence of trigger finger.

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. 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). The VAS pain scores for corticosteroid needle insertion in both SSIDB groups were significantly lower than the VAS pain scores in control group (p

Background Carpal tunnel release (CTR) is acknowledged as a predisposing factor for the development of the trigger finger. However, the incidence of new-onset trigger finger after CTR surgery has been inconsistently reported. In this study, we aimed to evaluate the prevalence of CTR as a risk factor of the development of the trigger finger. Methods In a retrospective study, 57 consecutive patients who underwent surgery for the treatment of trigger finger were included. The severity of carpal tunnel syndrome (CTS) was determined using the electromyogram test and nerve conduction study. The clinical and demographic characteristics of the patients were extracted from their medical profiles and compared between patients who did and did not develop a trigger finger after CTR. Results Post-CTR trigger finger was detected in 15 (26.3%) patients. The trigger finger occurred approximately six months after CTR surgery. The thumb and ring fingers were the most commonly involved fingers. Ten out of 15 (66.7%) patients who developed a post-CTR trigger finger had mild-to-moderate CTS, and five (33.3%) patients had severe CTS. No significant difference was found between the patients who did and did not develop a trigger finger after CTR. Conclusion The rate of developing a post-CTR trigger finger was remarkable in our study. Therefore, the potential sequelae should be discussed with patients, preoperatively.

Background Carpal tunnel syndrome is the most common peripheral neuropathy affecting patients at productive age and has an important economical impact on those who suffer it. This study assessed the diagnostic performance of carpal tunnel syndrome´s signs and described the epidemiology at a tertiary care center in Mexico City. Methods All patients diagnosed with carpal tunnel syndrome during a five-year period were included. Demographic data, electromyography results, positive clinical signs and the severity score according to the Italian scale were recorded. Diagnostic accuracy of Tinel and Phalen´s signs were calculated via odds ratio. Results Totally, 650 patients were diagnosed and treated during a five-year period, 84% were female and 16% male, and the mean age was 55.8 years. The associated comorbidities were trigger finger (36.1%), thyroid disease (25.6%) and diabetes (20%). Diagnosis yielded for Phalen and Tinel signs were variable in each of the study groups (males and females) and showed to be beneficial in diagnosis of the disease. Conclusion Carpal tunnel syndrome is a complex disease in which clinical signs remain the cornerstone of diagnosis. Extension studies are useful to assess the severity of the disease.

Purpose To determine the risk for infection in trigger finger release surgery after preoperative corticosteroid injection. Methods We retrospectively evaluated all patients undergoing trigger finger release by 16 surgeons over a 2-year period. Data collected included demographic information, medical comorbidities, trigger finger(s) operated on, presence of a prior corticosteroid injection, date of most recent corticosteroid injection, postoperative signs of infection, and need for surgery owing to deep infection. Superficial infection was defined per Centers for Disease Control criteria. Deep infection was defined as the need for surgery related to a surgical site infection. Results In this cohort of 2,480 fingers in 1,857 patients undergoing trigger release surgery, 53 (2.1%) developed an infection (41 superficial [1.7%] and 12 deep [0.5%]). Before surgery, 1,137 fingers had no corticosteroid injection. These patients developed 1 deep (0.1%) and 17 superficial (1.5%) infections. In contrast, 1,343 fingers had been given a corticosteroid injection before surgery. These patients developed 11 deep (0.8%) and 24 superficial (1.8%) infections. Median time from corticosteroid injection to trigger release surgery was shorter for fingers that developed a deep infection (63 days) compared with those that developed no infection (183 days). The risk for developing a deep infection in patients who were operated on within 90 days of an injection (8 infections in 395 fingers) was increased compared with patients who were operated on greater than 90 days after an injection (3 infections in 948 fingers). Conclusions Preoperative corticosteroid injections are associated with a small but statistically significantly increased rate of deep infection after trigger finger release surgery. The risk for postoperative deep infection seems to be time dependent and greater when injections are performed within 90 days of surgery, especially in the 31- to 90-day postinjection period. Type of study/level of evidence Therapeutic IV.

This compilation presents a comprehensive review of the literature on common chronic pain conditions of the hand. It briefly presents these common conditions with their biological background, diagnosis, and common management options. It then presents and compares the latest literature available for injection techniques to treat these diagnoses and compares the available evidence. A comprehensive literature review was performed in MEDLINE, PubMed, and Cochrane databases from 1996 to 2019 using the terms “hand pain”, “injection techniques”, “steroid injection”, “chronic pain”, “osteoarthritis”, “rheumatoid arthritis”, “carpal tunnel syndrome”, “De Quervain’s tenosynovitis”, “ganglion cyst”, “gout”, “Raynaud’s”, and “stenosing tenosynovitis”. Hand pain is a common condition with 9.7% prevalence in men and 21.6% in women and can cause significant morbidity and disability. It also carries a significant cost to the individuals and the healthcare system, totaling in $4 billion dollars in 2003. Injection therapy is an alternative when conservative treatment fails. Osteoarthritis is the most common chronic hand pain syndrome and affects about 16% of the population. Its mechanism is largely mechanic, and as such, there is controversy if steroid injections are of benefit. Hyaluronic acid (HA) appears to provide substantial relief of pain and may increase functionality. More studies of HA are required to make a definite judgment on its efficacy. Similarly, steroid ganglion cyst injection may confer little benefit. Carpal tunnel syndrome is a compressive neuropathy, and only temporarily relieved with injection therapy. US-guidance provides significant improvement and, while severe cases may still require surgery, can provide a valuable bridge therapy to surgery when conservative treatment fails. Similar bridging treatments and increased efficacy under US-guidance are effective for stenosing tenosynovitis (“trigger finger”), though, interestingly, inflammatory background is associated with decreased effect in this case. When the etiology of the pain is inflammatory, such as in RA, corticosteroid (CS) injections provide significant pain relief and increased functionality. They do not, however, change the course of disease (unlike DMARDs). Another such example is De-Quervain tenosynovitis that sees good benefit from CS injections, and an increased efficacy with US-guidance, and similarly are CS injections for gout. For Raynaud’s phenomenon, Botox injections have encouraging results, but more studies are needed to determine safety and efficacy, as well as the possible difference in effect between primary and secondary Raynaud’s. Chronic hand pain is a prevalent and serious condition and can cause significant morbidity and disability and interferes with independence and activities of daily living. Conservative treatment remains the first line of treatment; however, when first-line treatments fail, steroid injections can usually provide benefit. In some cases, HA or Botox may also be beneficial. US-guidance is increasing in hand injection and almost ubiquitously provides safer, more effective injections. Hand surgery remains the alternative for refractory pain.

Trigger finger is a stenosing tenosynovitis producing triggering/ clicking on finger movements along with pain and swelling. This condition although most often involves the thumb, however, any finger of the hand can be involved. Fibrocartilaginous metaplasia of the tendon near the A1 pulley causes nodule formation, resulting in triggering of the finger on finger movements. Treatment of this condition starts with NSAIDS, activity modification to the open surgical release of the A1 pulley. We present our outpatient-based, hypodermic needle release of A1 pulley of triggering finger for chronic trigger finger with functional recovery. In our 30 digits with triggering complaints for more than 6 months, 20 patients were females. Thumb was involved in 19 cases and Age ranged from 25 to 68 years. Using a hypodermic 18 G needle, the average duration of the procedure including local anaesthesia application was 6 minutes. We observed successful results in 97% of cases, one trigger finger needed open release after the persistence of symptoms. No complication was observed in any case during the follow-up period. Hypodermic Needle based release of A1 pulley for trigger finger is a safe, cost-effective, reliable, reproducible procedure with acceptable functional outcome, and we recommend this procedure for chronic trigger finger management.