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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. [ABSTRACT FROM AUTHOR]

Background: Trigger finger release (TFR) is a commonly performed procedure. However, there is great variation in the setting, care pathway, anesthetic, and cost. We compared the institutional cost for isolated TFR before and after redesigning our clinical care pathway. Methods: Total direct cost to the health system (excluding the surgeon and anesthesiology costs) and time spent by the patient at the surgery center were collected for 1 hand surgeon's procedures at an ambulatory surgery center over a 3-year period. We implemented a redesigned pathway that altered phases of care and anesthetic use by transitioning from intravenous (IV) sedation to wide awake local anesthesia with no tourniquet. Cost data were reported as percentage change in the median and compared both pre- to post-implementation and with 2 control surgeons using the traditional pathway within the same center. Power analysis was based on prior work on a carpal tunnel pathway. Significance was defined by a P -value <.05. Results: Ten TFRs (90% local with IV sedation) and 44 TFRs (89% local alone) were performed pre- and post-implementation, respectively. From pre- to post-implementation, the study surgeon's total direct cost decreased by 18%, while the control surgeons decreased by 2%. Median time spent at the surgery center decreased by 41 minutes post-implementation with significantly shorter setup time in the operating room (OR), total time in the OR, and time spent in recovery prior to discharge. Conclusions: Redesigning the care pathway for TFR led to a decrease in institutional cost and patient time spent at the surgery center. [ABSTRACT FROM AUTHOR]

Introduction: Trigger 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. Methods: This 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. Results: There 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 < 0.001), SST (mean difference −1.4 (95%CI −1.8 to −1.0); p < 0.001) and VAS (mean difference −3.4 (95%CI −4.3 to −2.5); p < 0.001). There were no serious adverse events and patient satisfaction with the treatment was high. Conclusions: Despite 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. [ABSTRACT FROM AUTHOR]

INTRODUCTION: The purpose of this study is to compare the results of the open surgical procedure used in the treatment of the trigger finger surgeon and the percutaneous relaxation and to evaluate the advantages and disadvantages of each technique. METHODS: 55 patients (36 females, 19 males, mean age 54 years range: 19-77 years) were included in the study. 31 patients underwent percutaneous release and 24 patients underwent open surgery. Clinical, Quick Disabilities of the Arm, Shoulder and Hand (QDASH) scoring results and work start-up times were compared at 1 week, 1 month and 6 months after surgery. RESULTS: Recurrence was observed in 1 patient who underwent percutaneous release. Three of our patients who underwent open surgery had a long lasting pain due to the wound scar. A superficial infection developed in a patient. İn terms of time to return to work and cost, percutaneous release has yielded better results. DISCUSSION AND CONCLUSION: Percutaneous release is prefable method compared to open release in term of effective, easy release, low risk of complication and low cost.

The current paper presents în detail the defining elements of the etiopathogeny and surgical treatment of the trigger finger. The objective of the study is to identify the particular elements that can influence the post-operative prognosis, as well as to determine the impact they have on the recovery period and the professional integration of patients. The research was based on data obtained from 52 patients who received treatment in 2015-2019. The results of the study show that the surgical treatment of the trigger finger performed by transverse incision at the level of the distal palmar fold with local anesthesia is associated with a very good result from a functional point of view, a low rate of postoperative complications and favorable aesthetic appearance.

Surgical treatment of trigger finger involves release of A1 pulley. Some authors have theorized that the loss of A1 pulley can lead to ulnar subluxation of flexor tendons, which can be prevented by release of A1 pulley radially, even in a nonrheumatoid hand. However, there is no evidence in literature to either support or oppose this hypothesis. Occasionally, difficulty is encountered to precisely identify where A1 ends and A2 begins. While incomplete release of A1 can cause relapse of triggering, release of substantial A2 can cause bowstringing. Knowledge of the safe limit of concomitant A2 release is beneficial. The study was conducted in 12 cadaver upper extremity specimens. A1 pulleys of 48 fingers were divided at the radial (24 fingers) or ulnar (24 fingers) attachment. A 20lb traction force was applied on the flexor tendons. Any subluxation or bowstringing was noted. The experiment was repeated following serial release of the A2—initially 25%, followed by 50% and 100%. No bowstringing or subluxation was noted when A1 pulley was opened, either by radial or ulnar incision. The same was true for A1 + 25% A2 release. When A1 + 50% A2 pulley were released, bowstringing was observed in 3/48 fingers. When A1 + 100% of the A2 pulley were released, bowstringing occurred in all cases. The location of incision for release of the A1 pulley has no effect on bowstringing or tendon subluxation. Release of additional 25% of the A2 pulley can be performed safely, which corresponds to the level of palmar digital crease.

Purpose: To determine the efficacy and safety of corticosteroid injection for trigger finger by performing a meta-analysis of all relevant studies. Methods: PubMed, EMBASE, and Cochrane Library databases were searched for randomized controlled trials (RCTs) comparing corticosteroid injection with other treatments for trigger finger. Pooled summary estimates for outcomes, including success rate, relapse rate, visual analogue score (VAS) and complications, were calculated as standardized mean difference (SMD) or relative risk (RR) either on a fixed- or random-effect model via Stata 12.0 software. Results: Ten literatures involving 806 patients (387 in corticosteroid injection group and 419 in control group) were included. Pooled analysis showed there were no differences in the success rate, VAS and complications between patients undergoing corticosteroid injection and others. However, the relapse rate was significantly higher in patients treated with corticosteroid injection than that of other treatments (RR = 19.53, 95% CI = 6.23–61.19). Subgroup analysis indicated the efficacy of corticosteroid injection was superior to other non-surgical treatments (success rate: RR = 1.54, 95% CI = 1.01–2.35), but inferior to surgery (success rate: RR = 0.55, 95% CI = 0.48–0.63; relapse rate: RR = 21.15, 95% CI = 6.06–73.85; VAS: SMD = 3.49, 95% CI = 2.84–4.14). Conclusions: Corticosteroid injection may be an effective strategy for management of trigger finger, although surgery may be needed for some patients due to recurrence.

Abstract We introduced criteria for the clinical diagnosis of dialysis-related amyloidosis (DRA) from the Amyloidosis Research Group study supported by a Grant-in-Aid from the Ministry of Health, Labour and Welfare of Japan. DRA exhibits various kinds of bone articular lesions, such as carpal tunnel syndrome, trigger finger, destructive spondyloarthropathy, spinal canal stenosis, and joint pains. These bone articular lesions, excluding destructive spondyloarthropathy, are observed in non-dialysis patients or dialysis patients without DRA. We carefully compared these lesions between DRA and non-DRA patients and summarized the differences between them. The incidence age, male to female ratio, and coincidence rate were distinct between these groups of patients. Biopsies from bone articular lesions are invasive and burdensome for dialysis patients; therefore, a precise clinical diagnosis is required for DRA. We discussed the validity and availability of our proposed criteria.

Introduction: Mucopolysaccharidosis is a rare and congenital autosomal recessive lysosomal storage disorder of glycosaminoglycans. An enzyme defect leads to cell, tissue and organ dysfunction. Carpal tunnel syndrome and trigger finger are the results of mucopolysaccharid deposition.Material and methods: We are treating 6 patients with mucopolysaccharide associated trigger fingers in an interdisciplinary setting with the department of pediatric hematology and oncology at Hannover Medical School, where each patient is examined inter alia for symptoms of trigger finger annually.Besides an interview of the parents about abnormalities with regard to hand function, pain and/or neurologic symptoms the children are examined by palpation and by assessment of the active and passive range of finger motion.In the case of finger locking due to an impaired excursion of the flexor tendons in the A2 and A3 pulley region, we performed a trap-door incision technique for A2 pulley widening and a simple release of the A3 pulley.Results: In 6 patients 43 fingers were affected. The average age was 10 years. Pulley thickening was palpated in 19 fingers of to the left hand and 24 fingers of the right hand. In 7 fingers the A1 pulley was affected, in 28 fingers the A2 pulley and in 25 fingers the A3 pulley. The A4 and A5 pulley were not affected in any case. Trigger symptoms were seen in 13 fingers. Five of the 6 children were given an operation indication. In these cases we performed carpal tunnel release, release of Loge de Guyon, and trigger finger release, either in combination or alone. In all cases the procedure led to pain relief and functional improvement.Conclusion: The treatment of trigger fingers in children with mucopolysaccharidosis as a rare disease is challenging with regard to diagnostics and indication.The main treatment goal is pain relief and improvement of hand function.

Point of care ultrasound (POCUS) is the use of ultrasound (US) imaging technology by non-sonographer, non-radiologist treating clinicians. Handheld US systems are increasing in popularity and becoming widely available and easily accessible to hand surgeons in clinical practice. Adapting POCUS into the repertoire of the hand surgeon can aid in the diagnosis of many common hand surgery presentations and shorten operative times. In this review, we outline the potential uses and advantages of incorporating POCUS into hand surgery practice incuding its use in emergencies such as trauma, infections, and foreign body localization, as well as elective presentations such as nerve compression, procedural guidance, and anesthesia. Finally, this review outlines the training and curriculum development required to ensure safe implementation of POCUS into a hand surgery practice. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to identify the main diseases related to trigger finger. Methods: A retrospective, observational study was performed with data obtained through a computerized record of 75 patients with trigger finger diagnosis between July 2011 and October 2015. The diagnosis of metabolic syndrome was performed following National Cholesterol Education Program Adult Treatment Panel III (2001). Results: Patients' ages ranged from 50 to 84 years, with a mean age of 63 years. The ring finger was the most affected, followed by the middle finger, index finger, and little finger. Most had a grade 2 trigger finger classified by Green; the right hand involvement was more prevalent, as was the dominant hand. The incidence in women was twice as high as in men. Arterial hypertension, diabetes mellitus, and dyslipidemia were shown to be important associated diseases, but metabolic syndrome was the main association found. Conclusions: Metabolic syndrome in the group of patients studied in this scientific article seems to be the main associated disease. [ABSTRACT FROM AUTHOR]

Supplemental digital content is available in the text. Wrist/hand pain is a prevalent musculoskeletal condition with a great spectrum of etiologies (varying from overuse injuries to soft tissue tumors). Although most of the anatomical structures are quite superficial and easily evaluated during physical examination, for several reasons, the use of ultrasound imaging and guidance has gained an intriguing and paramount concern in the prompt management of relevant patients. In this aspect, the present review aims to illustrate detailed cadaveric wrist/hand anatomy to shed light into better understanding the corresponding ultrasonographic examinations/interventions in carpal tunnel syndrome, trigger finger, de Quervain tenosynovitis, rhizarthrosis, and the radiocarpal joint arthritis. In addition, evidence from the literature supporting the rationale why ultrasound guidance is henceforth unconditional in musculoskeletal practice is also exemplified. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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 different trigger finger orthotic daily wear schedules on digital triggering and pain level in adults with trigger finger. Methods: Nine participants enrolled through convenience sampling were randomly assigned to a wear group: continuous, sleeping, or waking. Descriptive statistics were utilized to describe participant demographics and examine the data for changes across the six to ten weeks of study. Results: The study successfully obtained feasibility data regarding participant recruitment rate, demographics, methods as well as orthotic wear comfort, functionality, adverse effects and wearing compliance. The rate of recruitment was 1.9 participants per month. Conclusions: The results suggest it is feasible to perform a RCT, though recruitment was challenging. Recruitment for a RCT may be facilitated by broadening the inclusion/exclusion criteria to obtain participants. [ABSTRACT FROM AUTHOR]

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 < 0.001). The distance between the dorsal side of the A1 pulley and the palmar surface of the metacarpal head was also significantly increased by 0.57 mm (8.2%) in healthy volunteers (P < 0.001) and 0.81 mm (11%) in patients with trigger finger (P < 0.001).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. [ABSTRACT FROM AUTHOR]

Background: Many techniques for injection of trigger fingers exist. The purpose of this study was to determine whether the type of steroid or technique used for trigger finger injection altered clinical outcomes. Methods: Six hand surgeons at a single institution were surveyed regarding their injection technique, preferred steroid used, and protocol for repeat injection or indication for surgery for symptomatic trigger finger. A retrospective chart review of patients who underwent trigger finger injections was performed by randomly selecting 35 patients for each surgeon between January 2013 and December 2015. Demographic data at the time of presentation were collected. Outcome data during follow-up appointments were also recorded. Results: A total of 210 patient charts were reviewed. Demographic data and initial presenting grade of triggering were similar among all groups. There was no significant difference in clinical course or eventual outcomes noted with injection technique. There were 70 patients in each steroid cohort. Patients receiving triamcinolone required additional injections compared with those receiving methylprednisolone and dexamethasone. Eventual surgical intervention was significantly higher in those patients receiving methylprednisolone. The methylprednisolone group also underwent operative release significantly earlier. Conclusions: Trigger finger injections with triamcinolone demonstrate a higher rate of additional injections when compared with dexamethasone and methylprednisolone. Patients who underwent methylprednisolone injection had surgical release performed earlier and more frequently than the other 2 groups. The choice of corticosteroid significantly affected clinical outcome in this study population. Clinicians performing steroid injections for trigger finger may wish to consider these results when selecting a specific agent. [ABSTRACT FROM AUTHOR]

A retrospective study of patients with symptomatic trapeziometacarpal osteoarthritis was conducted to assess the prevalence of other disorders of the hand. Another disorder of the hand was associated in 49% of cases. A systematic clinical examination of the whole hand must be performed preoperatively., Competing Interests: Declaration of conflicting interestsThe authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Trigger finger is one of the most frequent causes of hand pain and disability. Recently, an endoscopic trigger finger release technique was developed, but outcomes have rarely been reported. Here, we present the outcomes of 2154 endoscopic trigger finger release procedures in a single center., Methods: In this retrospective study, 2154 endoscopic trigger finger release procedures were performed on 2034 patients. Outcome assessment at 90 days after surgery was classified as excellent, good, fair or poor according to a combination of patient satisfaction with the scar and pain at rest or under load on a numeric rating scale., Results: The therapeutic outcomes were: 1027 excellent, 607 good, 400 fair, and none poor. No major surgical complications were observed. Minor complications occurred in 231 fingers (10.7%)., Conclusions: All patients were satisfied with their outcome after endoscopic trigger finger release. Endoscopic release can be an effective and efficient therapeutic method for the treatment of trigger finger., (Copyright © 2024 SFCM. Published by Elsevier Masson SAS. All rights reserved.)

Trigger finger is a common condition. Surgery most frequently involves opening the A0 and A1 pulleys. However, this shows limited effectiveness in correcting proximal interphalangeal joint fixed flexion deformity. The present study aimed to compare clinical outcomes between two surgical techniques for trigger finger treatment. This retrospective study included 127 patients, 72 of whom underwent resection of the ulnar slip of the flexor superficialis, and 55 underwent opening of the pulleys. Study data comprised patient characteristics, range of motion, proximal interphalangeal fixed flexion deformity measurement, Quick-DASH and PRWE scores, and overall satisfaction. There were no significant differences between the two groups in terms of Quick-DASH or PRWE scores. Fixed flexion deformity correction was slightly but not significantly better with resection of the ulnar slip of the flexor superficialis (100%) compared to opening of the pulleys (88%). LEVEL OF EVIDENCE: : Level IV., (Copyright © 2024 SFCM. Published by Elsevier Masson SAS. All rights reserved.)

Duplication of the flexor digitorum profundus (FDP) tendon is an extremely uncommon anatomical anomaly found within the flexor digitorum superficialis (FDS) muscle, with minimal documentation in the current literature. We present the case of a 45-year-old female manual laborer who exhibited symptoms suggestive of trigger finger in her right middle finger. Surgical exploration uncovered a duplicated FDP tendon, a previously unreported anatomical anomaly in this context. Despite attempting conservative treatment initially, surgical intervention involving release of the A1 pulley, excision of the A1 pulley, and identification of the duplicated tendon was performed. The unusual nature of this anatomical variation highlights the need for additional research into its clinical significance and treatment options. This case highlights the significance of conducting comprehensive anatomical assessments to diagnose and treat uncommon variations within the FDS muscle. It underscores the continued need for collaborative research to enhance treatment approaches, especially in instances where trigger finger symptoms are present., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Lyrtzis et al.)

Purpose: Trigger finger, a stenosing tenosynovitis of the flexor tendon at the A1 pulley, can cause pain and impair daily activities. Despite common surgical interventions, postsurgical complications are frequent, prompting the search for less invasive techniques., Methods: An experimental study was conducted on fresh cadavers to compare three techniques: the first using a PulleyCut without ultrasound guidance, the second using a PulleyCut with ultrasound guidance, and the third using a percutaneous needle technique. The complete release of the A1 pulley, integrity of the A2 pulley, flexor tendons, and neurovascular bundles were assessed., Results: The new device group and the ultrasound-guided group demonstrated 100% complete release of the A1 pulley, whereas the needle group achieved only 38% success. There were no A2 pulley injuries in any group. Flexor tendons were injured in 7% of cases in the new device group and 77% in the needle group. A neurovascular injury occurred in the needle group., Conclusions: Compared with the percutaneous needle technique, the new device proved safe and effective for A1 pulley release, minimizing damage to flexor tendons and neurovascular structures. Ultrasound did not provide significant advantages, suggesting that the new device can be confidently used without ultrasound assistance. The PulleyCut represents a promising percutaneous technique for trigger finger treatment, demonstrating superiority over the needle technique in terms of efficacy and safety. These results encourage future clinical investigations to validate its practical application., Type of Study/level of Evidence: Therapeutic IIc., Competing Interests: No benefits in any form have been received or will be received related directly to this article., (© 2024 The Authors.)

Background: The primary concerns with operating on patients in the office setting are insufficient sterility and lack of appropriate resources in case of excessive bleeding or other surgical complications. This study serves to investigate these concerns and determine whether in-office hand surgeries are safe and clinically effective., Methods: A retrospective review of patients who underwent minor hand operations in the office setting between December 2020 and December 2021 was performed. The surgical procedures included in this analysis are needle aponeurotomy, trigger finger release, foreign body removal, mass removal, and reduction in a finger fracture with or without percutaneous pinning. All fractures, which primarily included metacarpal and phalangeal fractures, were subsequently splinted. Sterility and hemostatic support were achieved via the Wide-Awake Local Anesthesia No Tourniquet (WALANT) method. Major complications were defined as infection, major bleeding, and neurological deficits. Minor complications were defined as prolonged pain, prolonged inflammation, residual symptoms, and recurrence of symptoms within 1 month., Results: Five patients (3.8%) returned to the office for pain, inflammation, or stiffness of the affected finger, with two of the five returning with symptoms associated with osteoarthritis or pseudogout flare-ups. Five additional patients returned due to residual symptoms or recurrence of the primary complaint within 1 month of surgery. No patients experienced exogenous infection., Conclusion: The absence of major complications and high success rate for minor hand procedures shows the high degree of safety and efficacy that can be achieved via the in-office setting for select procedures. While proper patient selection is key, our result shows the in-office procedure room setting can offer the necessary elements of sterility and hemostatic support for several common hand surgeries., (© 2024 Society for Indian Hand Surgery and Micro Surgeons. Published by Elsevier B.V. All rights reserved.)

Trigger finger (TF) disorder is a sudden release or locking of a finger during flexion or extension. Treatments for this disease are conservative and surgical, including NSAIDs, hand splints, corticosteroid injections, physical therapies and percutaneous or open surgery. However, the effectiveness about the optimal treatment of TF is still in lack of evidence. The aim of this study is to investigate the effectiveness of physical therapies as conservative treatment for trigger finger. A comprehensive literature search of the MEDLINE (via PubMed), Cochrane Library Databases and PEDro databases has been conducted without limits because few papers were published about this argument. The literature search identified four papers in PubMed. Two types of physical therapies were used in the conservative management of trigger finger: external shock wave therapy (ESWT) in three papers, and ultrasound therapy (UST) in one paper. ESWT is an effective and safe therapy for the conservative management of TF. It seems to reduce pain and trigger severity and to improve functional level and quality of life. UST has proven to be useful to prevent the recurrence of TF symptoms. Even if the results suggest the effectiveness of ESWT and UST for TF, future studies are necessary to understand the characteristics of the optimal treatment protocol for trigger finger.

Background and purpose: Evidence suggest high prevalence of trigger finger (TF) in diabetic patients. Corticosteroid injection in the area of tendon sheath thickening is the first-line treatment of choice for TF. However, some studies indicated low efficacy of this method in diabetic patients. This study aimed at investigating the effectiveness of oral corticosteroids in diabetic patients with TF. Materials and methods: In a clinical trial, 50 diabetic patients with trigger finger (n=106 digits) enrolled. The patients were treated with oral prednisolone 5 mg, three times a day for 2 weeks. They were then followed up based on Quinnell grading at 3 and 6 weeks, and 3 months. Data analysis was done in SPSS V17 applying Repeated measures ANOVA. Results: At the end of the three-month follow-up, 84 fingers (79.3%) of patients who took oral prednisolone improved. The reduction of Quinnell grading was significant after medication (p

In recent decades, there has been a steady increase in the prevalence of diabetes mellitus (DM) worldwide, including Russia. Much attention has been customarily focused on micro- and macrovascular complications in DM; however, in its long and/or severe course, the complications may involve other organs, including the musculoskeletal system and skin. The involvement of these tissues in DM is largely explained by excessive production of advanced glycation end products. The paper considers the main rheumatic manifestations of DM: limited joint mobility syndrome, cheiroarthopathy, Dupuytren's contracture, trigger finger, adhesive capsulitis of the shoulder joint, rotator cuff injury, carpal tunnel syndrome, Charcot neuro-osteoarthropathy, osteoporosis, muscle infarction, and diabetic scleredema. The pathogenesis and diagnosis of DM and its possible therapy options are discussed.

A SLE patient with persistent small hand joint pain for 2 years despite on different disease modifying anti-rheumatic drugs. Ultrasound of the hands was performed and the diagnosis and management of the condition was revised.

Supplemental digital content is available in the text. Objective: Trigger finger at the A1 pulley is a common cause of hand pain leading to functional limitations. This study evaluated the outcomes of patients treated with a microinvasive ultrasound-guided trigger finger release technique using an 18 blade and described three tests that confirm a complete release. Design: A retrospective chart review and cross-sectional study of 46 cases of A1 pulley trigger finger releases in 28 patients performed at a private, sports medicine clinic using this technique were completed, meeting power criteria. The primary outcome measure was the resolution of mechanical catching/locking; secondary outcome measures were reduction in visual analog scale for pain and improvement of function in the modified Nirschl scale. Results: Complete release was achieved in all patients, with no recurrence of catching/locking during the first year (P < 0.0001). Ninety-eight percent of patients had significant pain and functional improvement (P < 0.0001). There were no complications perioperatively and postoperatively. The three confirmatory tests ensured that all cases obtained a successful outcome. Conclusion: This technique combined with confirmatory tests resulted in full resolution of the locking for all patients and statistically significant reduction in pain and improvement in function. [ABSTRACT FROM AUTHOR]

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 [ABSTRACT FROM AUTHOR]

The United Kingdom National Institute for Health and Care Excellence considers a procedure to be cost-effective if the cost per quality-adjusted life year gained falls below a threshold of £20,000–£30,000 (€22,600–33,900; US$24,600–$36,900). This study used cost per quality-adjusted life year methodology to determine the cost-utility ratio of A1 pulley release. Pre- and postoperative EuroQol 5 Dimensions 5 Likert scores were collected prospectively over 6 years from 192 patients. The median pre- and postoperative indices derived from the EuroQol 5 Dimensions 5 Likert scores were significantly different at 0.77 and 0.80. The mean life expectancy was 21 years. The mean number of quality-adjusted life years gained was 1 per patient. The mean cost-utility ratio per patient was £32,308 (€36,508; US$39,730) and £16,154 (€18,254; US$19,869) at 1 and 2 years, respectively. Provided the benefit of surgery was maintained over the remaining life expectancy, the cost-utility ratio decreased to £1537 (€1737; US$1891) per patient. A1 pulley release is cost-effective provided the benefit is maintained for 2 years. The procedure is also associated with a statistically significant improvement in quality of life. Level of evidence: III [ABSTRACT FROM AUTHOR]

We compared the functional outcomes, health-related quality of life, and satisfaction in diabetic and non-diabetic patients undergoing A1 pulley release for trigger finger in 192 patients. Preoperative and postoperative Quick Disabilities of the Arm, Shoulder and Hand questionnaire (Quick DASH), EuroQol-5 dimensions, and satisfaction scores were collected prospectively over a 6-year period. These patients had a mean follow-up of 14 months (range 11–40) after surgery. There were 143 patients (143 trigger fingers) without diabetes and 49 patients (49 trigger fingers) with diabetes. We found overall QuickDASH improvement was the same in both groups (–4.5 points). Patient satisfaction rates were comparable in both groups (90% versus 96%), and no significant difference in postoperative health-related quality of life was observed. No complications were reported in either group. We conclude from this study that A1 pulley release leads to similar functional improvement and high patient satisfaction at one year postoperatively in diabetic and non-diabetic patients. Level of evidence : III [ABSTRACT FROM AUTHOR]

Introduction: Trigger finger is a common hand disorder characterized by locking, catching, or clicking with range of motion of the affected finger. Purpose: The aim of this study was to compare the effectiveness of combined therapy of extracorporeal shockwave therapy (ESWT) and ice massage to the combined therapy of therapeutic ultrasound (US) and paraffin wax bath in treating trigger finger. Method: 19 patients were assigned to the US + wax bath group while the remaining 10 were assigned to ESWT + ice massage group. The effectiveness of the treatment was assessed using visual analog scale (VAS) to measure pain score and Quick-Disabilities of the Arm, Shoulder, and Hand (Quick DASH) questionnaire to assess the functionality of the affected limb at 1st, 2nd, 3rd and 4th week after the initial treatment. Results: The US + wax bath group had reduced more pain and improved more hand function than the ESWT + ice massage group for all visits. Conclusion: This study was not able to prove the hypothesis that ESWT + ice massage group was better than US + wax bath in treating trigger finger. However, a similar study like this but with larger sample size, individualized protocols for ESWT participants, longer study durations and conducted by experts in ESWT is able to show which treatment is better in treating trigger finger. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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Psychological measures are used increasingly in outcome studies. The Pain Catastrophizing Scale is a 13-item questionnaire used to measure coping skills and negative feelings of pain. In the existing literature it is suggested that the Pain Catastrophizing Scale could be associated with the outcome following surgery. The aim of this study was to examine the effect of catastrophic thinking on postoperative satisfaction after treatment for hand conditions where pain is not the predominant symptom (Dupuytren's disease, trigger finger and wrist ganglia), and further to estimate cut-points on the Pain Catastrophizing Scale. A total of 413 patients (53% females) with a mean age of 59 years were included in this one-year prospective follow-up study. The patients were diagnosed with either Dupuytren's disease (N = 133), trigger finger (N = 365), or wrist ganglia (N = 147). Preoperative data included disability (Disability of the Arm, Shoulder and Hand questionnaire (DASH)), quality of life (EuroQol-5D (EQ-5D)), and pain catastrophizing (Pain Catastrophizing Scale (PCS)). One year postoperative, data on DASH score, EQ-5D, and patient satisfaction were collected. We used a classification tree to define the most important cut-points, which could classify patients as low-risk or high-risk of low postoperative satisfaction. These cut-points and the 75th percentile cut-point was then used in logistic regression models with postoperative satisfaction as outcome variable. The median DASH score improved from 13.5 to 2.6 (p < 0.01), and the median EQ-5D score improved from 0.82 to 1.00, and 90.3% of patients were satisfied or very satisfied with the surgery.Using the 75th percentile (≤12) we did not find a predictive effect of PCS. However, when using the two cut-points from the classification tree (≤27.5 & ≤2.9) all tested models were statistically significant with odds ratios for risk of low satisfaction ranging from 2.81 to 6.44. Only the model using PCS ≤27.5 adjusted for both demographics and disability was insignificant. This study suggests that PCS can be a valuable tool in predicting postoperative satisfaction in hand conditions where pain is not the predominant symptom, and that ≤27.5 and ≤ 2.9 are the optimal cut-point on the preoperative PCS. [ABSTRACT FROM AUTHOR]

This is a prospective cohort study. Evidence is emerging that advanced practice hand therapy clinics improve patient outcomes. 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. 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. 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 <.01). Patients who did not require surgical consultation during hand therapy had a shorter wait time for their initial hand therapy appointment (P <.001). The advanced practice hand therapy model of care was safe and effective in reducing hospital surgical outpatient waiting lists. Patients reported high satisfaction. • There is emerging evidence that advanced scope of practice occupational therapy–led hand clinics improve patient and organizational outcomes. • This is the first large-cohort, multisite study that describes and evaluates a model of care for an occupational therapy–led advanced practice hand clinic for patients with chronic hand conditions on surgical outpatient waiting lists. • The advanced scope of the practice model enabled more than 37% of patients with chronic hand conditions who commenced hand therapy to be removed or discharged from the surgical outpatient waiting lists. • The heterogeneity of the patient cohort supports the need for advanced clinical reasoning provided by an advanced scope of practice occupational therapist/physiotherapist. [ABSTRACT FROM AUTHOR]

Background: Steroid injection is a proven treatment for trigger digits. The time taken for resolution of triggering following an injection is a question often asked by patients and one that has not been adequately addressed in existing literature. The aim of this study was to determine the time taken for triggering to resolve after a single steroid injection in patients presenting for the first time with a trigger digit. Methods: A prospective study was conducted in patients with first presentation of a grade II or grade III trigger digit(s) that received a steroid injection. Data with regards to age, gender, digit(s) involved, duration of symptoms, trigger grade, and presence of diabetes were collected. They were given a stamped addressed postcard with instructions to fill in the date that the triggering resolved and mail the postcard back to us. If the postcard was not received at three weeks, we contacted the patient by telephone to ask for the date of resolution of trigger. Results: 56 patients with 66 trigger digits were included in the study. 52 out of 66 digits (79%) had resolution of the trigger at one month. The mean duration for resolution of trigger was 8.8 days (range 1–30 days). Conclusions: Patients can be counselled that a steroid injection is effective in resolving the trigger in 79% of trigger digits presenting for the first time and that the mean time taken for resolution of triggering is 8.8 days. It is recommended to wait for at least one month before considering another injection or alternative treatments. [ABSTRACT FROM AUTHOR]

Le doigt à ressaut est une pathologie bénigne pouvant être handicapante ; elle touche 2,6 % de la population générale. L'échographie a révolutionné la prise en charge diagnostique et thérapeutique de cette pathologie. Les infiltrations cortisonées constituent le traitement de 1re intention du doigt à ressaut. Des techniques micro-invasives, percutanées sous contrôle échographique, sont désormais disponibles dans le traitement des formes réfractaires aux infiltrations cortisonées. Ces techniques offrent des suites postopératoires plus simples que la chirurgie classique. Le développement d'outils dédiés pourrait simplifier la procédure de section de poulie A1. Trigger finger is a common and benign disease, which can be disabling and that occurs in 2.6% of the general population. Ultrasound becomes very useful in the diagnostic and therapeutic management of trigger finger. Corticosteroid injections are the first treatment of this pathology. New percutaneous treatment under ultrasound are now available for trigger finger that didn't improve with corticosteroid injections. These techniques offer simpler postoperative suites than conventional surgery. The development of dedicated tools could simplify the A1 pulley section procedure. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To compare the clinical effectiveness of ultrasound-guided corticosteroid injection with and without needle release of the A1 pulley in treating trigger finger. METHODS: A total of 60 patients with trigger finger were enrolled in this retrospective study. Among them, 30 patients were treated with ultrasound-guided needle release of the A1 pulley with corticosteroid injection (group A) and 30 patients were treated with single ultrasound-guided corticosteroids injection (group B). The following parameters were evaluated including clinical parameters (pain degree, function of joint, finger tendon function, postoperative satisfaction), and ultrasound parameter (thickness of A1 pulley). RESULTS: The postoperative visual analogue scale (VAS) and Quinnell scores in two groups were significantly lower than that before operation (p < 0.05). The postoperative Quinnell score of group A was significantly lower than that in group B (p < 0.05). The TAM results showed that the postoperative overall excellent and good rate of group A was significantly higher than that in group B (p < 0.05). The postoperative survey showed that more than 80% patients reported satisfaction in the two groups. The ultrasound imaging results showed that the postoperative thickness of A1 pulley in two groups were thinner than that before operation (p < 0.05). There were no adverse effects and complications in the two groups. CONCLUSIONS: Both approaches had treatment benefit in trigger finger. Ultrasound-guided needle release of the A1 pulley with corticosteroid injection had better treatment benefits than single ultrasound-guided corticosteroids injection in improving finger tendon function and joint function. [ABSTRACT FROM AUTHOR]

Background: Open surgical release of the A1 pulley is the definitive treatment for the common hand condition of trigger finger, or inflammatory stenosing tenosynovitis. Anecdotal evidence among hand surgeons has questioned whether or not recent steroid injection may be related to complications following open trigger finger release, particularly wound infection, but no studies have primarily studied this connection to date. We aimed to determine whether recent steroid injection was associated with postoperative surgical infections. Methods: We performed a retrospective chart review of 780 adult patients who had undergone open trigger finger release of 999 digits by 6 fellowship-trained hand surgeons at three affiliated hospital settings from January 1, 2014, to January 1, 2016. Data on timing of steroid injections relative to surgery, number of steroid injections, concomitant conditions, use of antibiotics, and postoperative complications including infections were gathered. Results: Steroid injection timing relative to subsequent operative intervention correlated with postoperative surgical site infection in trigger finger release. Older age and decreasing days between steroid injection and surgery correlated with infection rates. Other factors found to be associated with infection rates included smoking, use of preoperative antibiotics, and use of lidocaine with epinephrine. The other factors examined did not correlate with infection rates. Conclusions: Steroid injection, smoking, increasing age, lesser number of days between steroid injection and surgery, and use of lidocaine with epinephrine are risk factors for postoperative trigger surgical infections. We recommend careful preoperative counseling regarding higher wound healing risks for smokers, avoidance of steroid injections immediately prior to an operative date, and scheduling operative dates that tend to be greater than 80 days from the date of last steroid injection. We also recommend avoidance of epinephrine in the local anesthetic solution, as this may minimize surgical site infection risks. [ABSTRACT FROM AUTHOR]

Background: Trigger finger is a common hand disease, which is caused by a mismatch in diameter between the tendon and the pulley. Ultrasound images are typically used to diagnose this disease, which are also used to guide surgical treatment. However, background noise and unclear tissue boundaries in the images increase the difficulty of the process. To overcome these problems, a computer-aided tool for the identification of finger tissue is needed.Results: Two datasets were used for evaluation: one comprised different cases of individual images and another consisting of eight groups of continuous images. Regarding result similarity and contour smoothness, our proposed deeply supervised dilated fully convolutional DenseNet (D2FC-DN) is better than ATASM (the state-of-art segmentation method) and representative CNN methods. As a practical application, our proposed method can be used to build a tendon and synovial sheath model that can be used in a training system for ultrasound-guided trigger finger surgery.Conclusion: We proposed a D2FC-DN for finger tendon and synovial sheath segmentation in ultrasound images. The segmentation results were remarkably accurate for two datasets. It can be applied to assist the diagnosis of trigger finger by highlighting the tissues and generate models for surgical training systems in the future.Methods: We propose a novel finger tendon segmentation method for use with ultrasound images that can also be used for synovial sheath segmentation that yields a more complete description for analysis. In this study, a hybrid of effective convolutional neural network techniques are applied, resulting in a deeply supervised dilated fully convolutional DenseNet (D2FC-DN), which displayed excellent segmentation performance on the tendon and synovial sheath. [ABSTRACT FROM AUTHOR]

A1 pulley stretching is recognized as a clinically beneficial treatment for trigger finger. It is thought to lead to an increase in the cross-sectional area of the A1 pulley luminal region, thus improving trigger finger symptoms. The purpose of the present study was thus to evaluate the resultant forces during stretching that increase the CSA of the A1 pulley luminal region using fresh-frozen cadavers. Using seven fingers from three fresh-frozen cadavers to replicate A1 pulley stretching, we investigated the resultant forces during stretching that increase the cross-sectional area of the A1 pulley luminal region. The traction forces of the flexor digitorum profundus tendons were increased in steps to 150 N, and the cross-sectional area and height of the A1 pulley luminal region were measured using ultrasonography. The cross-sectional area of the A1 pulley luminal region increased with step-wise increases in the flexor digitorum profundus traction. On average, the cross-sectional area and height of the A1 pulley luminal region showed increases of 31.4% and 43.6%, respectively, compared to the unloaded condition. These results confirmed that A1 pulley stretching increases the cross-sectional area of the A1 pulley luminal region. A1 pulley stretching has the potential to reduce the severity of trigger finger in patients facing surgery. • A1 pulley stretching is recognized as a clinically beneficial treatment for trigger finger. • A1 pulley stretching was confirmed to increases the cross-sectional area of the A1 pulley luminal region using cadavers. • A1 pulley stretching has the potential to reduce the severity of trigger finger. [ABSTRACT FROM AUTHOR]

Trigger digit, Dupuytren's disease, and ganglion cysts are 3 common disorders treated by hand surgeons. Despite the varying nature of their pathology, these 3 entities can all present as a mass at the flexor crease in the distal palm. The regional similarity of these presentations can make diagnosis more difficult. In this paper, we describe a simple clinical exam method that can assist in distinguishing between trigger digit, Dupuytren's disease, and flexor sheath ganglion cysts. [ABSTRACT FROM AUTHOR]