INTRODUCTION: Trigger finger is one of the most common causes of hand pain and disability. Surgical treatment consists of release of the A-1 pulley by open or percutaneous techniques. Many authors have noted that percutaneous release is convenient and cost-effective with a low complication rate. Only few studies have published results on combination of percutaneous release and steroid injection. OBJECTIVE: To compare the differences of outcomes in adults with trigger finger treated with combination of percutaneous release and corticosteroid injection to those treated with percutaneous release alone METHODS: We included all patients older than 18 years old in the UP-PGH Department of Orthopedics with a diagnosis of trigger finger who have consented to participate in this study. They were randomized into two treatment groups. One group was treated with percutaneous release only and the other group was treated with combined percutaneous release and corticosteroid injection. Outcomes measured were total active motion (TAM), postoperative pain, time to return-to-work, patient satisfaction, and complications. RESULTS: Post-procedure, both groups showed significant improvement in motion of the fingers (p = 0.034) and pain relief (p = 0.001). TAM scores of the combination group were better compared to the control at all time intervals (p = 0.03, 0.008, 0.004, 0.019) and better pain VAS scores in the 1st week (p = 0.009). Patients who received the combination treatment showed a trend toward better patient satisfaction, shorter duration of post-release pain and earlier return-to-work. CONCLUSION: significantly improves TAM and pain VAS scores.
Trigger Finger Disorder ; Tendon Entrapment ; Steroids

OBJECTIVE: To explore the efficacy of ultrasound-guided needle-knife with precise three-dimensional stereotactic localization of points for stenosing tenosynovitis of flexor tendon (trigger finger). METHODS: A total of 74 patients were randomly divided into an observation group and a control group, 37 cases in each group. The patients in the observation group were treated with ultrasound-guided intrathecal injection and releasing method of needle-knife, while the patients in the control group were treated with ultrasound-guided intrathecal injection. The self-made 9-score scale of trigger finger was recorded before treatment, immediately after treatment, 1 month and 3 months after treatment; the curative effect of the two groups was evaluated. RESULTS: The results of self-made 9-score scale in the observation group immediately after treatment, 1 month and 3 months after treatment were lower than that before treatment (all <0.01); the scores in the observation group were lower than those in the control group at each time point after treatment (all <0.01). The excellent and good rate immediately after treatment was 100.0% (37/37) in the observation group, which was superior to 8.1% (3/37) in the control group (<0.05); the cured rates in the observation group were 100.0% (37/37) 1 month after treatment and 97.3% (36/37) 3 months after treatment, which were superior to 13.5% (5/37) and 10.8% (4/37) in the control group, respectively (<0.05). CONCLUSION The needle-knife with three-dimensional stereotaxic location of point could significantly improve the symptoms of trigger finger, with superior immediate and long-term efficacy.
Humans ; Needles ; Tendons ; Trigger Finger Disorder ; therapy ; Ultrasonography

PURPOSE: The aim of this study was to elucidate whether intrasynovial corticosteroid injections for trigger digit reduced the volume of the tendon and pulley on high-resolution ultrasonography. METHODS: Twenty-three digits of 20 patients with trigger digit were included. Each affected finger was graded clinically according to the following classification: grade I for pre-triggering, grade II for active triggering, grade III for passive triggering, and grade IV for presence of contracture. Axial ultrasound examinations were performed before an intrasynovial corticosteroid injection and at an average of 31 days after the injection. The transverse diameter, thickness, and cross-sectional area of the tendon and the thickness of the pulley were measured by two independent, blinded researchers. RESULTS: At least 1 grade of improvement was achieved in this study group by the time of the second examination. The transverse diameter and cross-sectional area of the tendon and the thickness of the pulley significantly decreased (P < 0.05). CONCLUSION: The injection of a single dose of betamethasone improved clinical symptoms by reducing the volume of both the tendon and pulley, which may be related to the fact that tendon and pulley ruptures are delayed by corticosteroid injections.
Adrenal Cortex Hormones ; Betamethasone* ; Classification ; Contracture ; Fingers ; Humans ; Rupture ; Tendons* ; Trigger Finger Disorder* ; Ultrasonography*

Pulleys are thickened regions in flexor tendons sheaths of the digits. They are essential and act as fulcrum for the flexion and extension of the digits. The arrangement and number of pulley system differs greatly between the thumb and other digits. There is paucity of literature regarding the pulley system of thumb. We aimed to study the morphometry of the pulley system of the thumb in Indian cadavers. Dissection was carried out in 55 adult human cadaveric thumbs. The most common morphologic pattern of pulley observed in the thumb is type III (30 thumbs). The least observed is type I (4 thumbs). The mean width and standard deviation of A1, Av, oblique, and A2 pulleys are 5.06±0.87, 5.38±1.22, 4.68±1.13, and 6.04±1.41 mm, respectively. The gap distances between the pulleys were also measured. The results obtained from the present study may be helpful in surgical treatment of trigger thumb with less complication and also in reconstruction of the closed rupture of the pulley of the thumb.
Adult ; Cadaver ; Humans ; Rupture ; Tendons ; Thumb* ; Trigger Finger Disorder

Acupuncture Points ; Acupuncture Therapy ; Fingers ; physiopathology ; Humans ; Male ; Thumb ; physiopathology ; Trigger Finger Disorder ; physiopathology ; therapy

PURPOSE: Trigger thumb is a common condition with a prevalence rate up to 3% among the adults. The main pathophysiology is locking of the flexor tendon at the A1 pulley. Treatments include nonsteroidal anti-inflammatory drug, steroid injection, and surgical A1 pulley release. The purpose of this study was to evaluate the safety and effectiveness of ultrasound-guided percutaneous release of trigger thumb. METHODS: The author prospectively reviewed 37 patients who had undergone ultrasound-guided percutaneous release by the same surgeon from January 2012 to June 2014. The effect of ultrasound-guided A1 pulley release was evaluated by using visual analogue scale (VAS) score, disabilities of arm, shoulder, and hand (DASH) score, and grip and pinch strengths preoperatively and at 12weeks after the surgery. In addition, complications related with the procedure were evaluated. RESULTS: Triggering and locking were resolved in all patients after surgery. VAS and DASH improved from 5.0±1.8 and 45.8±16.9 preoperatively to 0.3±0.6 and 16.2±6.3 at 12 weeks, respectively (p=0.019 and p=0.021). Grip and pinch strengths statistically improved from33.5±8.6 kg and 36.7±8.1 kg, preoperatively 46.2±6.1 kg and 47.1±7.4 kg, respectively (p=0.026 and p=0.041). Complications such as incomplete resection, neurologic symptoms or wound infection were not found throughout the period of the study. CONCLUSION: Ultrasound-guided percutaneous A1 pulley release provides complete relief of symptoms with no major complication in trigger thumb.
Adult ; Arm ; Hand ; Hand Strength ; Humans ; Neurologic Manifestations ; Pinch Strength ; Prevalence ; Prospective Studies ; Shoulder ; Tendons ; Trigger Finger Disorder* ; Ultrasonography ; Wound Infection

Trigger finger is one of the most common causes of hand pain and disability. Persistent trigger finger after conservative treatment has been managed with surgical release of the A1 pulley. Percutaneous A1 pulley release is being increasingly performed and many authors have reported comparable outcomes with open surgical release. However, complications have been reported, including incomplete release, flexor tendon injury, and neurovascular injury due to the blind nature of the procedure. We report on a case of a 49-year-old female who presented with features of a type I complex regional pain syndrome (CRPS) following percutaneous A1 pulley release. CRPS is a relatively common complication occurring after trauma and surgical procedures of the upper extremities. We experienced a case of CRPS following percutaneous A1 pulley release which was treated effectively following early diagnosis and through a multidisciplinary approach including physical therapy and medication.
Complex Regional Pain Syndromes ; Early Diagnosis ; Female ; Fingers ; Hand ; Humans ; Middle Aged ; Reflex Sympathetic Dystrophy ; Tendon Injuries ; Trigger Finger Disorder* ; Upper Extremity

BACKGROUND: Trigger finger is one of the most common reasons for referral to a hand specialist clinic. The purpose of this study is to investigate the efficacy of steroid injections for treating trigger digits. METHODS: Ninety digits were investigated with at least a year follow up. The study mainly focused on the efficacy of the injections, as well as co-morbidities, presence of a nodule, actual digit injected and the severity at presentation using Green's classification. RESULTS: The study found that 66% of trigger digits were effectively treated using steroid injections. There was a difference between the efficacy of the injection in the different digits, with a statistical significance between the thumb and the fingers. The results also showed that there was no statistical relationship between the severity of the condition, the presence of a nodule or co-morbidities and the efficacy of the steroid injections. CONCLUSIONS: The study found that steroid injections are an effective first-line intervention for the treatment of trigger digit. It also found an increased efficacy for treating the thumb compared to other digits. Both the severity of the condition at presentation and the presence of a nodule had no significant impact on the efficacy of the injections.
Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Injections ; Male ; Middle Aged ; Retrospective Studies ; Steroids/*administration & dosage ; Treatment Outcome ; Trigger Finger Disorder/*drug therapy

BACKGROUND: Pediatric trigger thumb is due to deformed flexion of the interphalangeal joint. We previously reported that pediatric trigger thumb can spontaneously resolve in > 60% of patients at the median follow-up of 48 months. The purpose of this study was to determine whether there were any more cases of resolution with a follow-up of more than 5 years and whether any residual deformities remain, and so to confirm the natural history of pediatric trigger thumb. METHODS: We prospectively followed 87 thumbs in 67 patients with pediatric trigger thumb and these patients didn't receive any treatment such as passive stretching, splinting or surgery. The date of the first visit ranged from April 1994 to March 2005. The patients were evaluated every six-months prior to resolution and annually after resolution. The median duration of follow-up was 87.3 months (range, 60 to 156 months). RESULTS: Of the 87 trigger thumbs, 66 (75.9%) resolved spontaneously. The median time from the initial visit to resolution was 49.0 months (95% confidence interval, 41.1 to 56.9). There were no residual deformities that resolved beyond 48 months. Although complete resolution did not occur in the remaining 21 thumbs, the flexion deformities did improve in all 21 thumbs. There were no other differences between the two groups besides the average duration of follow-up. There was no difference in resolution based on gender. CONCLUSIONS: Pediatric trigger thumb can spontaneously resolve in > 75% of the cases after a follow-up period of at least 5 years. An operation may be delayed or avoided in the majority of cases. This may help both the families and the surgeons make decisions regarding the proper treatment of pediatric trigger thumb.
Adolescent ; Child ; Child, Preschool ; Female ; Follow-Up Studies ; Humans ; Infant ; Kaplan-Meier Estimate ; Male ; *Remission, Spontaneous ; Statistics, Nonparametric ; Time Factors ; Trigger Finger Disorder/*physiopathology

PURPOSE: To report the clinical outcomes of percutaneous A1 pulley release for the surgical treatment of locked trigger thumb in children. MATERIALS AND METHODS: Twenty-six trigger thumbs in 24 patients with a average of 14.2 months follow-up after percutaneous release were enrolled. There were 15 females and 9 males with an average age of 39 months. The mean time from first presentation to surgery was 16 months. Procedures were performed under local anesthesia. Postoperative examinations at immediate, 3 months and 1-year recorded pain, triggering and range of motion and presence of complications. RESULTS: All thumbs had a satisfactory result without digital nerve injury. Eleven patients(46%) had a mean 14.3degrees extension loss of the interphalangeal joint and 12.0degrees hyperextension of the metacarpophalangeal joint of the thumb, compared to the contralateral thumb. At final follow-up, all but 1 patient were completely resolved. The duration of symptoms and age were higher in the group with thumb deformity (p<0.05). CONCLUSION: Temporary thumb deformity is possible after surgical treatment of trigger thumb in children with a long duration of symptoms. Percutaneous release can be a safe and satisfactory treatment option in pediatric trigger thumb.
Anesthesia, Local ; Child ; Congenital Abnormalities ; Female ; Follow-Up Studies ; Hand Deformities ; Humans ; Joints ; Male ; Metacarpophalangeal Joint ; Range of Motion, Articular ; Thumb ; Trigger Finger Disorder