Background: The trigger finger, also known as stenosing tenosynovitis of the flexor tendon, is a common cause of hand disability;This can result in significant limitations in certain daily living activities. It is pos...Background: The trigger finger, also known as stenosing tenosynovitis of the flexor tendon, is a common cause of hand disability;This can result in significant limitations in certain daily living activities. It is possible to treat this condition with conservative or surgical methods. Methods: This is a retrospective, observational, cross-sectional and descriptive study. The source population consisted of all patients with a diagnosis of trigger finger who had been treated in the department of plastic and reconstructive surgery of our institution between 2020 and 2023. The primary objective of this study is to determine the prevalence and characterize the clinical and surgical characteristics of the population affected by trigger finger in our hospital. Results: The total population was 237 patients, of which 165 were women (70%) and 72 men (30%). The most affected hand was the right hand, with a total of 158 patients (67%). In the right hand, the middle finger was the most affected (45%). Of the 237 patients, 80 of them had obesity (34%), 86 had type 2 diabetes mellitus (36%), 95 had systemic arterial hypertension (40%). Open technique was performed in 190 (80%) patients, while percutaneous technique was performed in 47 (20%) of them. Conclusion: The female sex was twice as frequent, and the middle finger and thumb were the most affected. Most of the patients received surgical treatment with open approach and percutaneous approach in 20% of them.展开更多
BACKGROUND Trigger finger is a common disorder of the hand that can cause disabling symptoms.Treatment options range from conservative management with observation and splinting,to surgical release,but there is current...BACKGROUND Trigger finger is a common disorder of the hand that can cause disabling symptoms.Treatment options range from conservative management with observation and splinting,to surgical release,but there is currently not a consensus on a treatment algorithm.AIM To determine patient preference for the treatment of trigger finger using an online survey.METHODS An online crowdsourcing platform,Amazon Mechanical Turk,was used to recruit participants for this study.Participants were led through a scenario in which they were diagnosed with trigger finger.They were then asked to rank their preference of treatment options from the following:Observation,splinting,corticosteroid injection,surgery.The results of the surveys were then analyzed using R software.RESULTS Of 323 participants completed the survey.7 participants were excluded because they failed to correctly answer the attention question,leaving 316 participants whose results were included.As a first choice for treatment 117(37%)of the included participants chose observation,86(27%)chose splinting,61(19%)chose corticosteroid injection,and 52(16%)chose surgery.The mean rank for observation was 2.26,for splinting was 2.30,for corticosteroid injection was 2.53,and for surgery was 2.91.The ranking of each treatment option was statistically different(P value<0.05)from the others except for observation and splinting.CONCLUSION The practice of shared decision making with patients is imperative to providing the best care possible.The results from this study,especially the preference for less invasive treatment,may help providers better frame discussion around treatment options of trigger fingers.This in turn,may increase patient satisfaction in the treatment of trigger finger.展开更多
BACKGROUND Trigger finger at the wrist,which occurs with finger movement,is an uncommon presentation.Few reports describing cases of trigger finger at the wrist have been published.Thus,we present a case of an intramu...BACKGROUND Trigger finger at the wrist,which occurs with finger movement,is an uncommon presentation.Few reports describing cases of trigger finger at the wrist have been published.Thus,we present a case of an intramuscular lipoma arising from an anomalous flexor digitorum muscle belly in a 48-year-old female patient causing painful finger triggering at the wrist and carpal tunnel syndrome(CTS).CASE SUMMARY A 48-year-old woman with complaints of a catching sensation during wrist motion and a progressive tingling sensation on the palmar aspect of the right hand for approximately 2 years was referred to our hospital.Triggering of the index to middle finger was evident with a palpable and audible clunk over the carpal tunnel during passive motion.Tinel’s sign was positive over the carpal tunnel of the right wrist with a positive Phalen’s test.Nerve conduction studies of the median nerve demonstrated a right CTS.Ultrasound examination revealed a 2.5 cm×2.0 cm subcutaneous hyperechoic mass with no obvious blood flow at the wrist of the right arm.Surgical excision of the tumor and muscle mass led to a resolution of the patient’s symptoms,and any triggering or discomfort disappeared.The patient has had no evidence of recurrence at more than 1 year of follow-up.CONCLUSION Triggering of the fingers at the wrist is rare. It must be noted that there are manypossible causes and types of triggering or clicking around the wrist. Accuratediagnosis is mandatory to avoid inaccurate treatment of patients with triggerwrist. During the diagnosis and treatment of CTS, attention should be paid to thevariation of tendon tissue in the carpal tunnel, to avoid only focusing on therelease of transverse carpal ligament and ignoring the removal of anomalousmuscle belly.展开更多
AIM To investigate the effectiveness of ultrasound-guided release of the first annular pulley and compare results with the conventional open operative technique.METHODS In this prospective randomized, single-center, c...AIM To investigate the effectiveness of ultrasound-guided release of the first annular pulley and compare results with the conventional open operative technique.METHODS In this prospective randomized, single-center, clinical study, 32 patients with trigger finger or trigger thumb, grade Ⅱ-Ⅳ according to Green classification system, were recruited. Two groups were formed; Group A(16 patients) was treated with an ultrasound-guided percutaneous release of the affected A1 pulley under local anesthesia. Group B(16 patients) underwent an open surgical release of the A1 pul ey, through a 10-15 mm incision. Patients were assessed pre- and postoperatively(follow-up:2,4 and 12 wk) by physicians blinded to the procedures. Treatment of triggering(primary variable of interest) was expressed as the "success rate" per digit. The time for taking postoperative pain killers, range of motion recovery, QuickD ASH test scores(Greek version), return to normal activities(including work), complications and cosmetic results were assessed.RESULTS The success rate in group A was 93.75%(15/16) and in group B 100%(16/16). Mean times in group A patients were 3.5 d for taking pain killers, 4.1 d for returning to normal activities, and 7.2 and 3.9 d for complete extension and flexion recovery, respectively. Mean Quick DASH scores in group A were 45.5 preoperatively and, 7.5, 0.5 and 0 after 2, 4, and 12 wk postoperatively. Mean times in group B patients were 2.9 d for taking pain killers, 17.8 d for returning to normal activities, and 5.6 and 3 d for complete extension and flexion recovery. Mean QuickD ASH scores in group B were 43.2 preoperatively and, 8.2, 1.3 and 0 after 2, 4, and 12 wk postoperatively. The cosmetic results found excellent or good in 87.5%(14/16) of group A patients, while in 56.25%(9/16) of group B patients were evaluated as fair or poor.CONCLUSION Treatment of the trigger finger using ultrasonography resulted in fewer absence of work days, and better cosmetic results, in comparison with the open surgery technique. It is a promising method that represents excellent results without major complications, so that it could be possibly be established as a first-line treatment in the trigger finger's disease.展开更多
Gout is a form of inflammatory arthritis caused by hyperuricemia characterized by painful, hot and swollen joints. However, tophi involving carpal tunnel with concomitant presence of finger movement dysfunction as the...Gout is a form of inflammatory arthritis caused by hyperuricemia characterized by painful, hot and swollen joints. However, tophi involving carpal tunnel with concomitant presence of finger movement dysfunction as the first presentation of gout is rare. This suggests the involvement of flexor tendon inside the carpal tunnel. Here, we report a case of infiltration of tophi at the flexor tendon of the hand presented as the first clinical manifestation of gout causing trigger finger like symptoms. Patient underwent surgery to confirm the diagnosis and improve flexor tendon excursion. Our patient’s finger movement improved dramatically after operation.展开更多
Background: Trigger finger is characterized by the inability to smoothly flex and extend the digit. Corticosteroids are an accepted non-surgical treatment option and can be delivered via two techniques. While the palm...Background: Trigger finger is characterized by the inability to smoothly flex and extend the digit. Corticosteroids are an accepted non-surgical treatment option and can be delivered via two techniques. While the palmar approach is more commonly used, some have suggested that the mid-axial approach may be less painful for patients and yield higher intrasheath injection rates. The purpose of this study is to compare the accuracy of the palmar and midaxial approaches for delivery of corticosteroids into the flexor tendon sheath using radio-opaque dye in a cadaver model. Methods: A total of 50 injections were performed, 25 via midaxial technique and 25 via palmar technique. A one inch, 25-gauge needle was used to inject 1 mL of Isovue contrast dye into the flexor tendon sheath under live fluoroscopy. The fluoroscopic images were examined after injection to determine intrasheath versus extrasheath delivery of the dye, with visualization of contrast filling the sheath defining a successful injection. Results: The midaxial approach had a success rate of 52% compared to the conventional palmar approach success rate of 36%, p=0.5. The ring finger is the most common location of trigger finger and the rates of success were equal between groups for this digit (80%). Conclusions: Based on our findings, there is no statistical difference in the accuracy of intrasheath injection between the midaxial technique and palmar technique. The midaxial technique can be considered as an alternative to the palmar technique for trigger finger injection.展开更多
Triggering,locking,clicking,and crepitus of the fingers are common symptoms patients present with.Even though crepitus and triggering can occur as part of the same underlying diagnosis,it is important to differentiate...Triggering,locking,clicking,and crepitus of the fingers are common symptoms patients present with.Even though crepitus and triggering can occur as part of the same underlying diagnosis,it is important to differentiate between them,as they usually indicate different possible diagnoses.The differential diagnoses that should be considered include trigger finger,metacarpophalangeal joint(MCPJ)arthritis,fractures or dislocations,extensor digitorum communis subluxation or dislocation,locked MCPJ,avascular necrosis of the metacarpal head,and Dupuytren’s disease.A thorough clinical examination with appropriate special investigations can permit the clinician to make the correct diagnosis.Appropriate management of a confirmed diagnosis is successful in providing symptomatic improvement.展开更多
目的探讨中西医治疗扳机指研究现状及前沿分析。方法运用CiteSpace5.7.R5软件对中国知识资源总库(CNKI)及Web of Science核心集建库至2022年7月29日的中西医治疗扳机指文献进行文献计量学分析,分别对中英文文献的年发文量、作者及机构...目的探讨中西医治疗扳机指研究现状及前沿分析。方法运用CiteSpace5.7.R5软件对中国知识资源总库(CNKI)及Web of Science核心集建库至2022年7月29日的中西医治疗扳机指文献进行文献计量学分析,分别对中英文文献的年发文量、作者及机构合作关系、关键词共现、聚类与突现进行分析及可视化展现。结果共纳入文献1194篇,核心作者共189位,发文量462篇,发文机构1244个。得出关键词248个,突现词16个。结论国内外对扳机指已有成熟的认识和丰富的临床经验。目前主流治疗是经皮松解术和封闭治疗。研究趋势是引进超声和内窥镜技术以使各类治疗更加可视化、精确化且安全有效。展开更多
文摘Background: The trigger finger, also known as stenosing tenosynovitis of the flexor tendon, is a common cause of hand disability;This can result in significant limitations in certain daily living activities. It is possible to treat this condition with conservative or surgical methods. Methods: This is a retrospective, observational, cross-sectional and descriptive study. The source population consisted of all patients with a diagnosis of trigger finger who had been treated in the department of plastic and reconstructive surgery of our institution between 2020 and 2023. The primary objective of this study is to determine the prevalence and characterize the clinical and surgical characteristics of the population affected by trigger finger in our hospital. Results: The total population was 237 patients, of which 165 were women (70%) and 72 men (30%). The most affected hand was the right hand, with a total of 158 patients (67%). In the right hand, the middle finger was the most affected (45%). Of the 237 patients, 80 of them had obesity (34%), 86 had type 2 diabetes mellitus (36%), 95 had systemic arterial hypertension (40%). Open technique was performed in 190 (80%) patients, while percutaneous technique was performed in 47 (20%) of them. Conclusion: The female sex was twice as frequent, and the middle finger and thumb were the most affected. Most of the patients received surgical treatment with open approach and percutaneous approach in 20% of them.
文摘BACKGROUND Trigger finger is a common disorder of the hand that can cause disabling symptoms.Treatment options range from conservative management with observation and splinting,to surgical release,but there is currently not a consensus on a treatment algorithm.AIM To determine patient preference for the treatment of trigger finger using an online survey.METHODS An online crowdsourcing platform,Amazon Mechanical Turk,was used to recruit participants for this study.Participants were led through a scenario in which they were diagnosed with trigger finger.They were then asked to rank their preference of treatment options from the following:Observation,splinting,corticosteroid injection,surgery.The results of the surveys were then analyzed using R software.RESULTS Of 323 participants completed the survey.7 participants were excluded because they failed to correctly answer the attention question,leaving 316 participants whose results were included.As a first choice for treatment 117(37%)of the included participants chose observation,86(27%)chose splinting,61(19%)chose corticosteroid injection,and 52(16%)chose surgery.The mean rank for observation was 2.26,for splinting was 2.30,for corticosteroid injection was 2.53,and for surgery was 2.91.The ranking of each treatment option was statistically different(P value<0.05)from the others except for observation and splinting.CONCLUSION The practice of shared decision making with patients is imperative to providing the best care possible.The results from this study,especially the preference for less invasive treatment,may help providers better frame discussion around treatment options of trigger fingers.This in turn,may increase patient satisfaction in the treatment of trigger finger.
文摘BACKGROUND Trigger finger at the wrist,which occurs with finger movement,is an uncommon presentation.Few reports describing cases of trigger finger at the wrist have been published.Thus,we present a case of an intramuscular lipoma arising from an anomalous flexor digitorum muscle belly in a 48-year-old female patient causing painful finger triggering at the wrist and carpal tunnel syndrome(CTS).CASE SUMMARY A 48-year-old woman with complaints of a catching sensation during wrist motion and a progressive tingling sensation on the palmar aspect of the right hand for approximately 2 years was referred to our hospital.Triggering of the index to middle finger was evident with a palpable and audible clunk over the carpal tunnel during passive motion.Tinel’s sign was positive over the carpal tunnel of the right wrist with a positive Phalen’s test.Nerve conduction studies of the median nerve demonstrated a right CTS.Ultrasound examination revealed a 2.5 cm×2.0 cm subcutaneous hyperechoic mass with no obvious blood flow at the wrist of the right arm.Surgical excision of the tumor and muscle mass led to a resolution of the patient’s symptoms,and any triggering or discomfort disappeared.The patient has had no evidence of recurrence at more than 1 year of follow-up.CONCLUSION Triggering of the fingers at the wrist is rare. It must be noted that there are manypossible causes and types of triggering or clicking around the wrist. Accuratediagnosis is mandatory to avoid inaccurate treatment of patients with triggerwrist. During the diagnosis and treatment of CTS, attention should be paid to thevariation of tendon tissue in the carpal tunnel, to avoid only focusing on therelease of transverse carpal ligament and ignoring the removal of anomalousmuscle belly.
文摘AIM To investigate the effectiveness of ultrasound-guided release of the first annular pulley and compare results with the conventional open operative technique.METHODS In this prospective randomized, single-center, clinical study, 32 patients with trigger finger or trigger thumb, grade Ⅱ-Ⅳ according to Green classification system, were recruited. Two groups were formed; Group A(16 patients) was treated with an ultrasound-guided percutaneous release of the affected A1 pulley under local anesthesia. Group B(16 patients) underwent an open surgical release of the A1 pul ey, through a 10-15 mm incision. Patients were assessed pre- and postoperatively(follow-up:2,4 and 12 wk) by physicians blinded to the procedures. Treatment of triggering(primary variable of interest) was expressed as the "success rate" per digit. The time for taking postoperative pain killers, range of motion recovery, QuickD ASH test scores(Greek version), return to normal activities(including work), complications and cosmetic results were assessed.RESULTS The success rate in group A was 93.75%(15/16) and in group B 100%(16/16). Mean times in group A patients were 3.5 d for taking pain killers, 4.1 d for returning to normal activities, and 7.2 and 3.9 d for complete extension and flexion recovery, respectively. Mean Quick DASH scores in group A were 45.5 preoperatively and, 7.5, 0.5 and 0 after 2, 4, and 12 wk postoperatively. Mean times in group B patients were 2.9 d for taking pain killers, 17.8 d for returning to normal activities, and 5.6 and 3 d for complete extension and flexion recovery. Mean QuickD ASH scores in group B were 43.2 preoperatively and, 8.2, 1.3 and 0 after 2, 4, and 12 wk postoperatively. The cosmetic results found excellent or good in 87.5%(14/16) of group A patients, while in 56.25%(9/16) of group B patients were evaluated as fair or poor.CONCLUSION Treatment of the trigger finger using ultrasonography resulted in fewer absence of work days, and better cosmetic results, in comparison with the open surgery technique. It is a promising method that represents excellent results without major complications, so that it could be possibly be established as a first-line treatment in the trigger finger's disease.
文摘Gout is a form of inflammatory arthritis caused by hyperuricemia characterized by painful, hot and swollen joints. However, tophi involving carpal tunnel with concomitant presence of finger movement dysfunction as the first presentation of gout is rare. This suggests the involvement of flexor tendon inside the carpal tunnel. Here, we report a case of infiltration of tophi at the flexor tendon of the hand presented as the first clinical manifestation of gout causing trigger finger like symptoms. Patient underwent surgery to confirm the diagnosis and improve flexor tendon excursion. Our patient’s finger movement improved dramatically after operation.
文摘Background: Trigger finger is characterized by the inability to smoothly flex and extend the digit. Corticosteroids are an accepted non-surgical treatment option and can be delivered via two techniques. While the palmar approach is more commonly used, some have suggested that the mid-axial approach may be less painful for patients and yield higher intrasheath injection rates. The purpose of this study is to compare the accuracy of the palmar and midaxial approaches for delivery of corticosteroids into the flexor tendon sheath using radio-opaque dye in a cadaver model. Methods: A total of 50 injections were performed, 25 via midaxial technique and 25 via palmar technique. A one inch, 25-gauge needle was used to inject 1 mL of Isovue contrast dye into the flexor tendon sheath under live fluoroscopy. The fluoroscopic images were examined after injection to determine intrasheath versus extrasheath delivery of the dye, with visualization of contrast filling the sheath defining a successful injection. Results: The midaxial approach had a success rate of 52% compared to the conventional palmar approach success rate of 36%, p=0.5. The ring finger is the most common location of trigger finger and the rates of success were equal between groups for this digit (80%). Conclusions: Based on our findings, there is no statistical difference in the accuracy of intrasheath injection between the midaxial technique and palmar technique. The midaxial technique can be considered as an alternative to the palmar technique for trigger finger injection.
文摘Triggering,locking,clicking,and crepitus of the fingers are common symptoms patients present with.Even though crepitus and triggering can occur as part of the same underlying diagnosis,it is important to differentiate between them,as they usually indicate different possible diagnoses.The differential diagnoses that should be considered include trigger finger,metacarpophalangeal joint(MCPJ)arthritis,fractures or dislocations,extensor digitorum communis subluxation or dislocation,locked MCPJ,avascular necrosis of the metacarpal head,and Dupuytren’s disease.A thorough clinical examination with appropriate special investigations can permit the clinician to make the correct diagnosis.Appropriate management of a confirmed diagnosis is successful in providing symptomatic improvement.
文摘目的探讨中西医治疗扳机指研究现状及前沿分析。方法运用CiteSpace5.7.R5软件对中国知识资源总库(CNKI)及Web of Science核心集建库至2022年7月29日的中西医治疗扳机指文献进行文献计量学分析,分别对中英文文献的年发文量、作者及机构合作关系、关键词共现、聚类与突现进行分析及可视化展现。结果共纳入文献1194篇,核心作者共189位,发文量462篇,发文机构1244个。得出关键词248个,突现词16个。结论国内外对扳机指已有成熟的认识和丰富的临床经验。目前主流治疗是经皮松解术和封闭治疗。研究趋势是引进超声和内窥镜技术以使各类治疗更加可视化、精确化且安全有效。
