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Choi YK, Sit RWS, Wang B, Cheuk C, Lee MK, Leung KWM. Clinical effectiveness of Finger gliding Exercise for patients with trigger fingers receiving steroid injection: a Randomized Clinical Trial. Sci Rep 2025; 15:5141. [PMID: 39934311 PMCID: PMC11814069 DOI: 10.1038/s41598-025-89436-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2024] [Accepted: 02/05/2025] [Indexed: 02/13/2025] Open
Abstract
Finger gliding exercises are believed to enhance flexor tendons excursion. This study assesses the effectiveness of finger gliding exercises in patients after receiving steroid injections for trigger fingers. Patients with trigger fingers who received corticosteroid injection were randomly assigned (1:1) to control and intervention group. The intervention group was required to do finger exercises and submit online exercise log regularly. The clinical outcomes of trigger fingers at 24 weeks and compliance with finger gliding exercises were assessed via online surveys. A total of 38 participants were allocated to each group. Baseline characteristics were similar, except for a longer duration of symptoms in the intervention group (5.2 ± 2.9 vs. 3.6 ± 2.6 months, P = 0.002). At 24 weeks, 34 (89.5%) control and 33 (86.8%) intervention group participants responded to online survey. No statistical significant differences were observed in Numerical Pain Rating Score, Quinelle grading, finger improvement rate, recurrence of triggering, need for repeated injection and occurrence of new trigger finger sites. The exercise log response rate and compliance rate were 85.6% and 68.6%. In conclusion, our study did not establish the clinical effectiveness of finger gliding exercise for trigger finger patients following steroid injections compared to usual care.
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Affiliation(s)
- Yue Kwan Choi
- Department of Family Medicine, New Territories East Cluster, Hospital Authority, New Territories, Hong Kong.
- Hong Kong Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, New Territories, Hong Kong.
| | - Regina Wing-Shan Sit
- Hong Kong Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, New Territories, Hong Kong.
| | - Bo Wang
- Hong Kong Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, New Territories, Hong Kong
| | - Christina Cheuk
- Department of Family Medicine, New Territories East Cluster, Hospital Authority, New Territories, Hong Kong
| | - Man Kei Lee
- Department of Family Medicine, New Territories East Cluster, Hospital Authority, New Territories, Hong Kong
| | - Kwan Wa Maria Leung
- Department of Family Medicine, New Territories East Cluster, Hospital Authority, New Territories, Hong Kong
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Kurata H, Hakozaki M, Yoshida S, Iwatsu J, Aizawa T. Trigger Finger Caused by a Solitary Osteochondroma of the Proximal Phalanx in an Adolescent: A Case Report. Cureus 2025; 17:e79691. [PMID: 40161098 PMCID: PMC11952160 DOI: 10.7759/cureus.79691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2025] [Indexed: 04/02/2025] Open
Abstract
Trigger finger is a common disease, and stenosing tenosynovitis is the most frequent cause of this condition in middle-aged women. We report a case of surgical excision in a 16-year-old adolescent male with trigger finger symptoms caused by a solitary osteochondroma at the proximal end of the proximal phalanx. Although tumorous lesions are a rare cause of trigger finger, a differential diagnosis is necessary because the treatment strategy and surgical technique employed to treat this condition differ from those employed for common causes, such as stenosing tenosynovitis and pediatric trigger thumb.
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Affiliation(s)
- Hirotaka Kurata
- Department of Orthopaedic Surgery, Tohoku University Hospital, Sendai, JPN
| | - Michiyuki Hakozaki
- Higashi-Shirakawa Orthopaedic Academy, Fukushima Medical University School of Medicine, Fukushima, JPN
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, JPN
| | | | - Jun Iwatsu
- Department of Orthopaedic Surgery, Tohoku University Hospital, Sendai, JPN
| | - Toshitake Aizawa
- Department of Orthopaedic Surgery, Iwaki City Medical Center, Iwaki, JPN
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Nelson JT, Gay SS, Diamond S, Gauger M, Singer RM. Warning Signs: Occult Diabetes and Dysglycemia in the Hand Surgery Patient Population. Hand (N Y) 2024; 19:837-844. [PMID: 36564989 PMCID: PMC11284987 DOI: 10.1177/15589447221142893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Diabetes mellitus often exists for many years prior to diagnosis, and very little is known about the role of the prediagnosis stage of metabolic impairment in contributing to hand and upper-extremity pathology. The goal of this study is to determine the prevalence of undiagnosed glucose dysregulation in patients presenting with the 2 most commonly treated conditions of the hand and wrist. METHODS A retrospective study was performed of hand surgery patients with no established diagnosis of prediabetes or diabetes referred for a 2-hour glucose tolerance test according to American Diabetes Association criteria. Patients were divided into 3 groups: peripheral neuropathies, trigger finger, and controls with various upper-extremity diagnoses. Rates of undiagnosed prediabetes and diabetes were compared between groups, including subgroup analysis of patients based on unilateral or bilateral presentation. Binary logistic regression analysis was also used to calculate odds ratios for multiple variables. RESULTS Patients with neuropathy had a significantly higher incidence of undiagnosed dysglycemia compared with the control group. Of those patients, 51.3% were prediabetic and 12.8% were diabetic. The control group had significantly lower rates. Within the bilateral neuropathy patients, 59.6% had prediabetes and 15.4% had diabetes, versus 34.6% with prediabetes and 7.7% with diabetes in the unilateral group. CONCLUSIONS Hand surgeons encounter a patient population with high rates of undiagnosed prediabetes and diabetes, with some presentations as much as 6 times higher than the general population. Certain patient presentations should prompt appropriate diagnostic testing and referral, especially those presenting with bilateral compression neuropathy and elevated body mass index.
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Saito T, Nakamichi R, Nakahara R, Nishida K, Ozaki T. The Effectiveness of Rehabilitation after Open Surgical Release for Trigger Finger: A Prospective, Randomized, Controlled Study. J Clin Med 2023; 12:7187. [PMID: 38002801 PMCID: PMC10671987 DOI: 10.3390/jcm12227187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/13/2023] [Accepted: 11/17/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND It is not clear whether rehabilitation after surgery for trigger finger is effective. The aim of this study was to reveal its effectiveness for trigger finger. METHODS This study was a randomized, controlled trial that included patients who underwent operations for trigger fingers. The patients in the rehabilitation group had postoperative occupational therapy (OT) for 3 months, while the patients in the control group were not referred for rehabilitation but received advice for a range of motion exercises. We evaluated the severity of trigger finger, Disability of Arm-Shoulder-Hand (DASH) score, pain-visual analogue scale (VAS), grip strength, whether they gained a full range of motion (ROM), and complications before and after surgery. RESULTS Finally, 29 and 28 patients were included in the control and rehabilitation groups, respectively. At final follow-up, the DASH score, grip strength, and ROM were significantly improved in the rehabilitation group compared to that preoperatively. At final follow-up, pain was significantly improved in both groups from that preoperatively. There were no significant differences in the results, including the DASH score, grip strength, ROM and pain-VAS between the control and rehabilitation groups at the final follow-up. Subgroup analysis showed that there is a significant difference in the DASH score of patients doing housework or light work and those with a duration of symptoms >12 months between the control and rehabilitation groups at the final follow-up.
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Affiliation(s)
- Taichi Saito
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1, Shikata-cho, Kitaku, Okayama 700-8558, Japan
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Shang X, Meng X, Zhu H. Suppurative tenosynovitis with chronic carpal tunnel syndrome due to corticosteroid injections: A case report. Int J Surg Case Rep 2023; 111:108716. [PMID: 37696106 PMCID: PMC10498192 DOI: 10.1016/j.ijscr.2023.108716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/20/2023] [Accepted: 08/21/2023] [Indexed: 09/13/2023] Open
Abstract
INTRODUCTION Steroid hormone blocking is a common treatment for tenosynovitis. However, local steroid hormone blocking requires careful attention to the local inflammatory response, as infection can cause severe local soft tissue inflammation and damage. PRESENTATION OF CASE A 46-year-old female patient received local steroid hormone blocking treatment for tenosynovitis of the right thumb at another hospital 3 months earlier. Five days later, the patient gradually experienced redness, swelling, and pain in her right hand. By day 7, the symptoms worsened with increased swelling, wrist pain, and finger numbness. After the carpal tunnel incision, the patient's symptoms improved upon admission to the local hospital's emergency department. However, 2 weeks post-operation, she experienced recurring numbness, pain, discomfort, and local sinus exudation in her right hand, which worsened over 2 months, prompting the patient to seek outpatient treatment at our hospital. DISCUSSION An increase in local content within the wrist joint content is a major cause of carpal tunnel syndrome. Repeated stimulation of the inflamed tissues often leads to the development of granulomatous hyperplasia. Hyperplastic granulomas often produce local compression. If located in the peripheral nerve duct, it may cause nerve entrapment and lead to peripheral nerve injury. Surgery is often required to excise the hyperplastic tissue and release the entrapped nerve. CONCLUSION Prompt and thorough debridement is necessary for addressing local soft tissue infections caused by suppurative tenosynovitis. Failure to do so may result in recurrent local granuloma hyperplasia and the development of local compression diseases, especially in wrist median nerve compression cases.
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Affiliation(s)
- Xiuchao Shang
- Department of Orthopedics, The First People's Hospital of Lianyungang, Lianyungang 222000, Jiangsu Province, China
| | - Xiangsheng Meng
- Department of Orthopedics, The First People's Hospital of Lianyungang, Lianyungang 222000, Jiangsu Province, China
| | - Haiquan Zhu
- Department of Orthopedics, The First People's Hospital of Lianyungang, Lianyungang 222000, Jiangsu Province, China.
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Tunçez M, Turan K, Aydın ÖD, Çetin Tunçez H. Ultrasound guided versus blinded injection in trigger finger treatment: a prospective controlled study. J Orthop Surg Res 2023; 18:459. [PMID: 37365603 DOI: 10.1186/s13018-023-03950-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/22/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Trigger finger is a common disease with a lifetime prevalence of 2%. One of the frequently preferred non-surgical treatments is blinded injection around the A1 pulley. This study aims to compare the clinical results of ultrasound-guided and blinded corticosteroid injection in the trigger finger. METHODS In this prospective clinical study, 66 patients who had persistent symptoms of a single trigger finger were included. Patients with similar baseline characteristics such as age, gender, triggering period, and comorbidities were randomized. 34 patients had ultrasound-guided (UG), and 32 had blinded injections (BG). QDASH, VAS, time to return to work, and complications were compared between the groups. RESULTS The mean age was 52,66 (29-73) years. There were 18 male and 48 female patients. In the UG, the triggering resolved faster, returning to work was earlier, and the medication period was shorter (p < 0.05). A total of 17 patients who had diabetes mellitus received re-injections, 11 of which were in BG and 6 in UG (p < 0.05). Although statistically significantly lower scores were obtained in UG at the 1st and 4th weeks in the QDASH and VAS scores (p < 0.05), at the 12th and 24 weeks, there was no significant difference (p > 0.05). CONCLUSION Using ultrasound guidance for corticosteroid injections is more effective for treating trigger fingers than the blinded method, leading to better results and a faster return to work in the early stages of treatment.
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Affiliation(s)
- Mahmut Tunçez
- Department of Orthopedics and Traumatology, Izmir Katip Celebi University Ataturk Training and Research Hospital, İzmir, Turkey.
| | - Kaya Turan
- Department of Orthopedics and Traumatology, Izmir Katip Celebi University Ataturk Training and Research Hospital, İzmir, Turkey
- Department of Orthopedics and Traumatology, Istinye University, İstanbul, Turkey
| | - Özgür Doğan Aydın
- Department of Orthopedics and Traumatology, Izmir Katip Celebi University Ataturk Training and Research Hospital, İzmir, Turkey
| | - Hülya Çetin Tunçez
- Department of Orthopedics and Traumatology, Izmir Katip Celebi University Ataturk Training and Research Hospital, İzmir, Turkey
- Department of Radiology, Izmir Bozyaka Education and Research Hospital, University of Health Sciences, İzmir, Turkey
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Zhu W, Zhou H, Hu Z, Chen H, Liu J, Li J, Feng X, Li X. The cross-sectional area ratio of a specific part of the flexor pollicis longus tendon- a stable sonographic measurement for trigger thumb: a cross-sectional trial. BMC Musculoskelet Disord 2023; 24:228. [PMID: 36973701 PMCID: PMC10041694 DOI: 10.1186/s12891-023-06316-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 03/13/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Trigger thumb is a pathologic condition of the digital pulleys and flexor tendons. To find a cutoff value of the cross-sectional area ratio of specific parts of the flexor pollicis longus tendon to diagnosis trigger thumb in the high-frequency ultrasound examination. METHODS We evaluated 271 healthy volunteers and 57 patients with clinical diagnosis of trigger thumb. The cross-sectional area of the metacarpophalangeal joint of flexor pollicis longus tendon (C1) and the cross-sectional area of the midpoint of the first metacarpal of flexor pollicis longus tendon (C2) were analyzed. RESULTS There is no difference between gender, age and left and right hands in the ratio of C1 to C2 (C1/ C2). The mean of C1/ C2 in the healthy thumb was 0.983 ± 0.103, which was significantly smaller in comparison to the diseased thumb (P < 0.05). Based on the receiver operating characteristic curve, we chose the diagnostic cut-off value for the C1/ C2 to be 1.362 and 1.153 in order to differ a trigger thumb from children and adults. CONCLUSIONS The C1/ C2 of the healthy thumb was relatively stable, with a mean value of 0.983 ± 0.103. The cutoff value of C1/C2 to distinguish healthy thumb from diseased thumb in children and adults were 1.362 and 1.153, respectively.
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Affiliation(s)
- Wenbin Zhu
- Ultrasonography department, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Huan Zhou
- The Children's Heart Center, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Zhe Hu
- Ultrasonography department, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Hongyan Chen
- Ultrasonography department, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Juan Liu
- Ultrasonography department, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Jin Li
- Ultrasonography department, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xiaoyuan Feng
- The Children's Heart Center, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xueqin Li
- Ultrasonography department, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Blough C, Najdawi J, Kuschner S. Patient preference for trigger finger treatment. World J Orthop 2022; 13:1006-1014. [PMID: 36439373 PMCID: PMC9685636 DOI: 10.5312/wjo.v13.i11.1006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/28/2022] [Accepted: 10/28/2022] [Indexed: 11/16/2022] Open
Abstract
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.
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Affiliation(s)
- Christian Blough
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States
| | - Jawad Najdawi
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States
| | - Stuart Kuschner
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States
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Pathak SK, Salunke AA, Menon PH, Thivari P, Nandy K, Yongsheng C. Corticosteroid Injection for the Treatment of Trigger Finger: A Meta-Analysis of Randomised Control Trials. J Hand Surg Asian Pac Vol 2022; 27:89-97. [PMID: 35135421 DOI: 10.1142/s242483552250014x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: The purpose of this meta-analysis is to provide an evidence-based overview of the effectiveness of corticosteroid injection for the treatment of stenosing tenosynovitis (trigger digits). We have analysed only randomised control trials (RCTs) which compared the effectiveness of corticosteroid injections with control injections. Methods: The Cochrane Library, PubMed, Medline, Web of Science and Scopus were searched to identify relevant studies. The keywords for search in the database were ('stenosing tenosynovitis' OR 'trigger finger') AND injections. After screening titles and abstracts of these studies, full-text articles of studies that fulfilled the selection criteria were obtained. For the meta-analysis, we determined the pooled mean failure rate, odds ratio (OR), relative risk (RR) and 95% confidence intervals (CI) for the risk of failure rate between the corticosteroid injection group and the control group through the random-effects model. Results: Six RCTs were found that involved 368 participants. The corticosteroid injection group included 190 patients and 178 patients were included in the control group. The pooled estimate of successful treatment in the corticosteroid injections group was 63.68 ± 5.32% and that in the control group was 27.53 ± 11.52%. The pooled RR of treatment failure between the corticosteroid injection group and the control group was 0.49 (95% CI 0.40-0.60). The pooled OR of treatment failure between the corticosteroid injection group and the control group was 0.18 (95% CI 0.08-0.44). All the included studies reported either mild or no complications with corticosteroids or placebo injections. Conclusions: In the treatment of stenosing tenosynovitis, the corticosteroid injections have better outcomes compared to the control injections and this meta-analysis provides significant evidence of the effectiveness of corticosteroid injection for stenosing tenosynovitis with minimal adverse effects. Level of Evidence: Level II (Therapeutic).
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Affiliation(s)
| | | | - Prem Haridas Menon
- Department of Orthopaedics, Government Medical College, Thiruvananthapuram, Kerala, India
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Leung LTF, Hill M. Comparison of Different Dosages and Volumes of Triamcinolone in the Treatment of Stenosing Tenosynovitis: A Prospective, Blinded, Randomized Trial. Plast Surg (Oakv) 2021; 29:265-271. [PMID: 34760843 DOI: 10.1177/2292550320969643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Stenosing tenosynovitis is a condition due to a size mismatch between the flexor tendons and the first annular pulley. Corticosteroid injection is the mainstay treatment. The purpose of this study is to compare different dosages and volumes of triamcinolone in the treatment of primary stenosing tenosynovitis. Methods Patients with primary Quinnell grades 1 or 2 stenosing tenosynovitis were recruited in this prospective, blinded, randomized trial. Patients were randomized into 1 of 2 groups. Group A received 0.25 mL of triamcinolone 40 mg/mL, mixed with 0.25 mL of 1% lidocaine with epinephrine (10 mg of triamcinolone, 0.5 mL in total volume). Group B received 0.5 mL of triamcinolone 40 mg/mL, mixed with 0.5 mL of 1% lidocaine with epinephrine (20 mg of triamcinolone, 1 mL in total volume). Patients were assessed by a blinded hand therapist at 2 and 4 weeks, and by a blinded hand surgeon at 6 weeks. The primary outcome was complete symptom resolution at 6 weeks. Both per-protocol and intention-to-treat analyses were performed. Results One hundred ninety-one patients were recruited from 2009 to 2018. Eighty-two and 77 patients had complete data in group A and B, respectively. There was no difference in success rates in complete symptom resolution at 6 weeks between group A (59.8%) and group B (62.3%). The mean visual analogue pain scores on injection were 4.31 ± 2.11 for group A and 4.30 ± 2.09 for group B. Conclusions Triamcinolone 10 mg was as effective as 20 mg in the resolution of symptoms of Quinnell grade 1 or 2 stenosing tenosynovitis at 6 weeks.
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Affiliation(s)
- Leslie Tze Fung Leung
- Division of Plastic and Reconstructive Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mark Hill
- Division of Plastic and Reconstructive Surgery, University of British Columbia, Vancouver, British Columbia, Canada
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Seigerman D, McEntee RM, Matzon J, Lutsky K, Fletcher D, Rivlin M, Vialonga M, Beredjiklian P. Time to Improvement After Corticosteroid Injection for Trigger Finger. Cureus 2021; 13:e16856. [PMID: 34522494 PMCID: PMC8425109 DOI: 10.7759/cureus.16856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2021] [Indexed: 11/20/2022] Open
Abstract
Purpose Trigger finger is a commonly occurring hand condition that presents with symptoms of pain, clicking, locking, and catching of the finger. A common non-operative management option is corticosteroid injection. The purpose of this study was to evaluate the short-term patient response to corticosteroid injections for trigger finger. Methods The patients of six fellowship-trained orthopedic hand surgeons who underwent a corticosteroid injection for trigger finger between June 2019 and October 2019 were invited to participate in this study. Patients were contacted by phone at one week, two weeks, and three weeks after the injection to complete a questionnaire regarding their pain and triggering symptoms. Medical records were also reviewed to collect basic demographic data. Results A total of 452 patients were included in the study. At the final follow-up, 82.4% of patients reported complete pain relief, 16.3% had partial relief, and 1.2% had no relief from their pain. For their triggering symptoms, 65.9% reported complete triggering relief, 30.4% had partial relief, and 3.5% had no triggering relief. It took an average of 6.6 days following injection for patients to experience complete pain relief, and an average of 8.1 days for patients to experience complete triggering relief. Conclusions This analysis found that most patients experience relief of pain and triggering at three weeks following corticosteroid injection. The majority of patients experienced some pain relief within the first week following corticosteroid injection, while improvement in triggering appeared to lag behind pain relief.
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Affiliation(s)
- Daniel Seigerman
- Orthopedic Surgery, Rothman Orthopedic Institute, New York City, USA
| | - Richard M McEntee
- Orthopedic Surgery, University of Kansas, Kansas City, USA.,Division of Hand Surgery, Rothman Orthopedic Institute, Philadelphia, USA
| | - Jonas Matzon
- Division of Hand Surgery, Rothman Orthopedic Institute, Philadelphia, USA
| | - Kevin Lutsky
- Division of Hand Surgery, Rothman Orthopedic Institute, Philadelphia, USA
| | - Daniel Fletcher
- Division of Hand Surgery, Rothman Orthopedic Institute, Philadelphia, USA
| | - Michael Rivlin
- Division of Hand Surgery, Rothman Orthopedic Institute, Philadelphia, USA
| | - Mason Vialonga
- Orthopedics, Rutgers Robert Wood Johnson University, New Brunswick, USA
| | - Pedro Beredjiklian
- Division of Hand Surgery, Rothman Orthopedic Institute, Philadelphia, USA
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Risk Factors Associated With Progression to Surgical Release After Injection of Trigger Digits. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2021; 5:01979360-202107000-00002. [PMID: 34232934 PMCID: PMC8265869 DOI: 10.5435/jaaosglobal-d-20-00159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 04/08/2021] [Indexed: 11/30/2022]
Abstract
Introduction: The mainstay of trigger finger treatment is a corticosteroid injection of the affected digits and is associated with a very high success rate. However, some patients do not respond to nonsurgical management and undergo subsequent surgical release. The purpose of this study is to investigate the comorbidities that predispose patients to progressing from injection to surgical release. Methods: Patient data were obtained from a national insurance database. All patients aged 20 years or older who underwent trigger digit injection were included. Any injection that did not specify the digit was excluded. Subsequent procedures, including repeat injection and surgical release, were identified using relevant Current Procedural Terminology codes. A multivariate model was constructed to evaluate potential risk factors for requiring release after prior injection of the same digit. Stepwise backward selection was used to retain significant variables. Results: A total of 42,537 trigger digits were identified in 31,830 patients, most of whom were female. The right hand was affected more commonly than the left. The middle and ring fingers were the most commonly affected digits. Over 80% of all trigger digits underwent only a single injection, and approximately 90% of injected digits did not require subsequent release. In the multivariate model, factors associated with higher risk of release were male sex, involvement of additional digits, multiple injections of the same digit, chronic pulmonary disease, HIV/AIDS, obesity, alcohol abuse, and depression. The model also found small fingers to be less likely to progress to release. Discussion: Patients with the risk factors identified in this study are more likely to progress to surgical release after trigger finger injection. Although prospective studies are required, the information may be beneficial in counseling patients and their treatment options.
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Abdoli A, Asadian M, Banadaky SHS, Sarram R. A cadaveric assessment of percutaneous trigger finger release with 15° stab knife: its effectiveness and complications. J Orthop Surg Res 2021; 16:426. [PMID: 34217345 PMCID: PMC8254281 DOI: 10.1186/s13018-021-02566-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 06/17/2021] [Indexed: 12/20/2022] Open
Abstract
Percutaneous release of the A1 pulley has been introduced as a therapeutic approach for trigger fingers and is suggested as an effective and safe alternative, where conservative treatments fail. The aim of the current study was to determine if percutaneous release with a 15° stab knife can effectively result in acceptable efficacy and lower complication rate. METHODS In the present study, the percutaneous release of the A1 pulley was evaluated by percutaneous release using a 15° stab knife in 20 fresh-frozen cadaver hands (10 cadavers). One hundred fingers were finally included in the present study. The success rate of A1 pulley release as well as the complications of this method including digital vascular injury, A2 pulley injury, and superficial flexor tendon injury was evaluated, and finally, the data were analyzed by the SPSS software. RESULTS The results showed a success rate of 75% for A1 pulley release in four fingers, followed by eleven fingers (90%) and eighty-five fingers (100%). Therefore, the A1 pulley was found to be completely released in eighty-five fingers (100%). Overall, the mean of A1 pulley release for these fingers was determined as 97.9%, indicating that percutaneous trigger finger release can be an effective technique using a 15° stab knife. Furthermore, our findings revealed no significant difference in the amount of A1 pulley release in each of the fingers in the right and left hands. Additionally, 17 fingers developed superficial scrape in flexor tendons, while 83 fingers showed no flexor tendons injuries and no other injuries (i.e., vascular, digital nerve, and A2 pulley injuries). CONCLUSIONS Percutaneous release of the A1 pulley using a 15° stab knife was contributed to acceptable efficacy and a relatively good safety in the cadaveric model.
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Affiliation(s)
- Abbas Abdoli
- Department of Orthopedics, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Majid Asadian
- Department of Orthopedics, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
| | | | - Rabeah Sarram
- Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Hong P, Song YG, Paek S. Possible effects of agent orange and posttraumatic stress disorder on hyperglycemia in Korean veterans from the US-Vietnam war. Medicine (Baltimore) 2021; 100:e26508. [PMID: 34160471 PMCID: PMC8238358 DOI: 10.1097/md.0000000000026508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 05/12/2021] [Indexed: 01/04/2023] Open
Abstract
This study was conducted to examine whether Korean veterans from the US-Vietnam War who had a diagnosis of type II diabetes mellitus (T2DM) as well as past history of exposure to agent orange (AO) are vulnerable to hyperglycemia when receiving intra-articular corticosteroid injection (IACI) for pain relief.The current study included a total of 49 patients (n = 49) who received an injection of triamcinolone 20 or 40 mg to the shoulder under sonographic guidance or did that of dexamethasone 10 mg or triamcinolone 40 mg combined with dexamethasone 20 mg to the spine under fluoroscopic guidance. Their 7-day fasting blood glucose (FBG) levels were measured and then averaged, serving as baseline levels. This is followed by measurement of FBG levels for 14 days of IACI. Respective measurements were compared with baseline levels. The patients were also evaluated for whether there are increases in FBG levels depending on insulin therapy as well as HbA1c ≥ 7% or HbA1c < 7%.Overall, there were significant increases in FBG levels by 64.7 ± 42.5 mg/dL at 1 day of IACI from baseline (P < .05). HbA1c ≥ 7% and HbA1c < 7% showed increases in FBG levels by 106.1 ± 49.0 mg/dL and 46.5 ± 3.8 mg/dL, respectively, at 1 day of IACI from baseline (P < .05). In the presence and absence of insulin therapy, there were significant increases in them by 122.6 ± 48.7 mg/dL and 48.0 ± 20.4 mg/dL, respectively, at 1 day of IACI from baseline (P < .05). But there were decreases in them to baseline levels at 2 days of IACI.Clinicians should consider the possibility of hyperglycemia when using corticosteroids for relief of musculoskeletal pain in Korean veterans from the US-Vietnam War who had a history of exposure to AO.
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Affiliation(s)
- Pa Hong
- Department of Radiology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon
| | - Yun Gyu Song
- Department of Radiology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon
| | - Sungwoo Paek
- Department of Rehabilitation Medicine, Konkuk University Chungju Hospital, Konkuk University School of Medicine, Chungju, Korea
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Quinet MT, Raghavan M, Morris E, Smith T, Cook H, Walter N, Shuler M. Effectiveness of Amniotic Fluid Injection in the Treatment of Trigger Finger: A Pilot Study. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2020; 2:301-305. [PMID: 35415511 PMCID: PMC8991634 DOI: 10.1016/j.jhsg.2020.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/25/2020] [Indexed: 11/28/2022] Open
Abstract
Purpose To assess the efficacy and safety of amniotic fluid therapy injections in patients with mild to moderate trigger finger. Methods All participants received 1 mL of amniotic fluid injected into the tendon sheath of the affected tendon. Pretreatment and posttreatment data were collected for triggering frequency, Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire scores, and numerical pain rating scale scores. Results Of 111 digits from 96 patients, 51% experienced clinically notable improvement and did not receive an alternative treatment. Average length of follow-up was 11 months. From baseline to end of follow-up, average pain score (0–10) decreased from 5.19 to 1.19 (P < .001), median triggering per day decreased from 5 to 0 (P < .001), and median DASH score (1–100) decreased from 20 to 6.03 (P < .001). There was a 50% success rate in patients with diabetes and a 52.6% success rate in digits diagnosed with concomitant Dupuytren contracture in the same hand. Conclusions Amniotic fluid therapy injections may offer a biologic alternative for conservative treatment of trigger finger, particularly for patients with diabetes. Decreased pain, decreased triggering, and improved DASH scores offer preliminary evidence supporting the use of amniotic injections for stenosing tenosynovitis. Type of study/level of evidence Therapeutic IV.
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Affiliation(s)
- Michael T. Quinet
- Department of Medicine, Augusta University/Medical College of George Partnership, Athens, GA
| | | | - Emily Morris
- Department of Medicine, Augusta University/Medical College of George Partnership, Athens, GA
| | | | - Haley Cook
- Department of Medicine, Augusta University/Medical College of George Partnership, Athens, GA
| | - Nathan Walter
- Department of Medicine, Augusta University/Medical College of George Partnership, Athens, GA
| | - Michael Shuler
- Athens Orthopedic Clinic, Athens, GA
- Corresponding author: Michael Shuler, MD, Athens Orthopedic Clinic, 1765 Old West Broad Street, Building 2, Suite 200, Athens, GA 30606.
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Lunsford D, Valdes K, Hengy S. Conservative management of trigger finger: A systematic review. J Hand Ther 2020; 32:212-221. [PMID: 29290504 DOI: 10.1016/j.jht.2017.10.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 10/16/2017] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Systematic review INTRODUCTION: Trigger finger (TF) is a common condition in the hand. The primary purpose of this systematic review was to evaluate the current evidence to determine the efficacy of orthotic management of TF. A secondary purpose was to identify the characteristics of the orthotic management. The tertiary purpose of this study was to ascertain if the studies used a patient-reported outcome to assess gains from the patient's perspective. METHODS All studies including randomized controlled trials, prospective, and retrospective cohort studies were included in this review due to limited high-level evidence. RESULTS Four authors demonstrated moderate to large effect sizes ranging from 0.49 to 1.99 for pain reduction after wearing an orthotic device. Two authors demonstrated a change in the stages of stenosing tenosynovitis scale scores showing a clinically important change with a large effect size ranging from 0.97 to 1.63. Seven authors immobilized a single joint of the affected digit using a variety of orthoses. CONCLUSION All authors reported similar results regardless of the joint immobilized; therefore for orthotic management of the TF, we recommend a sole joint be immobilized for 6-10 weeks. In assessing TF, most authors focused on body structures and functions including pain and triggering symptoms, 2 authors used a validated functional outcome measure. In the future therapists should use a validated patient report outcome to assess patient function that is sensitive to change in patients with TF. Furthermore, more randomized controlled trials are needed.
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What Patient-related Factors are Associated with an Increased Risk of Surgery in Patients with Stenosing Tenosynovitis? A Prospective Study. Clin Orthop Relat Res 2019; 477:1879-1888. [PMID: 31335606 PMCID: PMC7000032 DOI: 10.1097/corr.0000000000000818] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Numerous patient-related risk factors have been identified as contributors to patient progression to operative treatment of stenosing tenosynovitis (STS). Identifying patients most at risk of undergoing surgery after receiving a corticosteroid injection would enable health care providers to identify patients most likely to benefit from nonsurgical treatment. QUESTIONS/PURPOSES (1) What proportion of prospectively enrolled patients with a new diagnosis of STS did not require further intervention after a first, second, or third injection when offered up to three corticosteroid injections? (2) Which identifiable risk factors present at the initial evaluation in patients with STS are associated with the patient opting for surgical release after a trial of one, two, or three corticosteroid injections? METHODS One hundred ninety-six patients with a presumed diagnosis of STS were evaluated between March 2014 and June 2015, and 160 patients with 186 affected fingers were prospectively enrolled after a new diagnosis of STS was made during the study period. STS was diagnosed by assessing for tenderness at the A1 pulley, passive or active triggering, and the absence of other confounding diagnoses. Only the affected finger received a corticosteroid injection, and these patients were followed up during the study period. Patients were followed for 2 years, and 135 of the 160 patients (84%) completed the final followup. Patients with recurrent symptoms were treated with up to three corticosteroid injections before undergoing A1 pulley release, although patients could elect to undergo surgery at any time. Bivariate comparisons and a multivariate logistic regression analysis were used for independent fingers (one per participant) to identify independent variables associated with progression to surgery after injection. The time between treatments (between injection and subsequent injection or between injection and surgery) for those with recurrent symptoms was also calculated. Information collected from the last time the patient could be contacted was carried forward in the analysis for all 160 patients. RESULTS No further treatment was sought after the first, second, and third injections by 81 of 160 (51%), 16 of 45 (37%), and three of 10 patients (30%), respectively; 100 of 160 patients (63%) did not pursue further intervention. After the first, second, and third injections, 36 of 160 patients (23%), 17 of 43 patients (40%), and seven of 10 of patients, respectively, did not respond to treatment. After controlling for 21 potentially confounding patient- and disease-related variables, we found that only two risk factors at the initial presentation were protective against eventual progression to surgery: osteoarthritis in the fingers (odds ratio [OR], 0.26 [95% CI, 0.085-0.786]; p = 0.017) and a longer duration of symptoms (OR, 0.58 [95% CI, 0.38-0.89]; p = 0.012). There was no association between progression to surgery and hand dominance, finger type (thumb or other), whether the patient had diabetes, or whether the affected finger was one of multiple affected fingers. Patients who presented again for intervention (injection or surgery) did so at a mean of 153 ± 94 days. CONCLUSIONS Although patients should be counseled that their risk of progressing to surgery after an initial corticosteroid injection is lower than for subsequently administered injections for recurrent symptoms, nonoperative treatment should not be bypassed for patients with any of the studied risk factors. LEVEL OF EVIDENCE Level II, therapeutic study.
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Ho SWL, Chia CY, Rajaratnam V. Characteristics and Clinical Outcomes of Open Surgery for Trigger Digits in Diabetes. J Hand Microsurg 2019; 11:80-83. [PMID: 31413490 PMCID: PMC6692150 DOI: 10.1055/s-0038-1670927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 07/24/2018] [Indexed: 10/28/2022] Open
Abstract
Introduction Trigger digit is a common condition of the hand. Diabetes has a known association with the development of trigger digit. It is thought to influence the clinical presentation and efficacy of open surgical release. This study aimed to assess the differential characteristics of trigger digits and the clinical outcomes of open surgery for trigger digits in diabetics. Materials and Methods This was a retrospective study of all patients who underwent open surgical release of trigger digits in a single institution from 2012 to 2013. Patients were divided into two groups with group 1 consisting of all patients with a history of diabetes. Group 2 consisted of all patients without diabetes. Demographics and clinical presentation were reviewed. All patients were reviewed via a telephone questionnaire at least 2 years after the initial surgery and were assessed for patient-reported outcomes. Results There were 201 patients who met the inclusion criteria, of which 191 patients were recruited. This included 87 (45.5%) males and 104 (54.5%) females. A total of 260 open releases were performed. Sixty-one (31.9%) patients were diabetic, and 130 (68.1%) patients were nondiabetic. The diabetic group was significantly older than the nondiabetic group ( p = 0.002). The dominant hand was not significantly more affected than the nondominant hand ( p = 0.51). The middle finger was most commonly involved (43.5%), and the little finger was the least commonly involved (1.2%). There was no significant increase in multiple-digit presentation in the diabetic population when compared with the nondiabetic population ( p = 0.52). There was a low complication rate and a high rate of postoperative satisfaction after open surgery in both groups. Conclusion Diabetes does not predispose patients to increased rates of multiple trigger digit presentation or increased clinical severity on presentation. Open surgery for trigger digit is an effective and safe treatment modality for diabetics.
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Affiliation(s)
- Sean Wei Loong Ho
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
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Efficacy and Safety of Subacromial Corticosteroid Injection in Type 2 Diabetic Patients. PAIN RESEARCH AND TREATMENT 2018; 2018:9279343. [PMID: 30327731 PMCID: PMC6171213 DOI: 10.1155/2018/9279343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 06/21/2018] [Indexed: 11/17/2022]
Abstract
Purpose In type 2 diabetic patients affected by chronic shoulder pain, subacromial injection with corticosteroid could be an effective treatment. The aim of this study was to measure the risk-benefit ratio of this treatment. Methods Twenty patients with well-controlled diabetes were included in a prospective study. In a first preinjection phase, patients were asked to measure glycemia for 7 days, before breakfast and dinner, and then 2 hours after lunch and dinner. Baseline data including Constant Score (CS), Subjective Shoulder Value (SSV), and Numerical Rating Scale (NRS) for pain were collected. Patients were treated with subacromial injection with 40 mg of Methylprednisolone Acetate and 2 ml of Lidocaine. At discharge, patients were asked to remeasure glycemia for the following week. Results The overall pain improved and patients graded their shoulder as "greatly improved". At 30-day follow-up, the SSV and the CS improved, considering pain but not ROM. The average daily glycemia was 136 mg/dl before injection, 161 mg/dl the day of the injection (p<0.001), and 170 mg/dl one day after injection (p<0.001). Glycemia was not statistically different 3 days after injection. Conclusion Subacromial injection is an effective short-term treatment in type 2 diabetic patients affected by shoulder pain, but a closed follow-up is recommended in all these patients. This trial is registered with NCT03652480. The Protocol ID is SHOULDERDM2013.
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Kosiyatrakul A, Loketkrawee W, Luenam S. Different Dosages of Triamcinolone Acetonide Injection for the Treatment of Trigger Finger and Thumb: A Randomized Controlled Trial. J Hand Surg Asian Pac Vol 2018; 23:163-169. [PMID: 29734896 DOI: 10.1142/s2424835518500157] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND This study was designed to compare the efficacy and complications between 3 different dosages of triamcinolone acetonide for the treatment of trigger finger. METHODS Ninety-three patients with a total of 120 trigger digits were included in the study. The involved digits were randomized to 3 groups. Each group received treatment consisting of injection with 5, 10 or 20 mg triamcinolone acetonide. The clinical response to the steroid was evaluated during the first six weeks after injection. The success rate was determined at 3, 6, 9 and 12 months after injection. RESULTS After the injections, pain and triggering improved gradually and nearly resolved completely at 6 weeks in all dosages. A dose related pattern was found at 3 and 6 months after the injection. The 20 mg group had a significant higher success rate when compared to the 5 and 10 mg at 3 and 6 months. The 10 mg group has significant higher success rate when compare to 5 mg at 3 months. There were no differences of success rate between groups at 9 and 12 months. At 12 months, 7 of 40 digits (17.5%) in the 5 mg group, 7 of 40 digits (17.5%) in the 10 mg group, and 9 of 40 digit (22.5%) in the 20 mg group were without triggering (p = 0.806). CONCLUSIONS A dose-response characteristic was demonstrated in the treatment of trigger finger with triamcinolone acetonide. Triamcinolone acetonide 5 mg seems to have the lowest success rate.
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Affiliation(s)
- Arkaphat Kosiyatrakul
- * Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Wittawat Loketkrawee
- * Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Suriya Luenam
- * Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
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Chang CJ, Chang SP, Kao LT, Tai TW, Jou IM. A Meta-analysis of Corticosteroid Injection for Trigger Digits Among Patients With Diabetes. Orthopedics 2018; 41:e8-e14. [PMID: 28776635 DOI: 10.3928/01477447-20170727-02] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 04/17/2017] [Indexed: 02/03/2023]
Abstract
A majority of patients with diabetes have trigger digits. Initial management of symptomatic trigger digits commonly involves corticosteroid injection. However, varying outcomes have been reported for patients with diabetes who receive corticosteroid injections. The authors conducted a meta-analysis to evaluate the effect of diabetes on outcome after corticosteroid injection for trigger digit. PubMed and other Internet databases were searched for the period 1977 to 2015. Five articles, involving 381 diabetic digits and 449 non-diabetic digits, were included in the meta-analysis. The authors found treatment failure rates of 78% for patients with insulin-dependent diabetes, 47% for patients with non-insulin-dependent diabetes, and 49% for patients without diabetes when a single injection of corticosteroid was administered for trigger digit. After 3 injections, the failure rates were 57%, 39%, and 30%, respectively. The pooled data showed that patients with insulin-dependent diabetes and patients with non-insulin-dependent diabetes had worse prognoses after corticosteroid injection for trigger digit than patients without diabetes. Furthermore, the patients with insulin-dependent diabetes had a trend toward multiple digit involvement and much worse treatment outcomes than the patients with non-insulin-dependent diabetes. The authors conclude that more aggressive treatment, such as surgical intervention, should be considered for those patients expected to have high failure rates after injection. [Orthopedics. 2018; 41(1):e8-e14.].
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Grandizio LC, Speeckaert A, Brothers J, Graham J, Klena JC. Predictors of Recurrence After Corticosteroid Injection for Trigger Digits. Hand (N Y) 2017. [PMID: 28644937 PMCID: PMC5484445 DOI: 10.1177/1558944716668862] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND We aimed to identify risk factors for recurrence of trigger digit following corticosteroid injection. METHODS A retrospective review identified patients 18 years and older who presented to a single fellowship-trained hand surgeon with a symptomatic trigger digit during a 1-year period. Baseline demographic data were recorded. Patients with persistent trigger digit after a single injection were offered a second injection. Patients refusing a second injection were excluded from our analysis. Patients with persistent symptoms after 2 injections were offered surgery. For patients with diabetes mellitus, additional information regarding method of disease control and hemoglobin A1c level was recorded. RESULTS The overall success of corticosteroid injection was 84% with 16% of patients requiring surgical release. Of the 240 patients successfully treated with injection, 99 (41%) required a second injection. Injections resulted in persistent triggering in 15% of patients with diabetes and 17% of patients without diabetes. A multivariate regression analysis revealed that the 2 strongest risk factors for requiring surgical release were patient age and patients whose fourth digit of the right hand was injected. Diabetes was not a risk factor for persistent triggering after corticosteroid injection. CONCLUSIONS Our findings can be used to counsel patients prior to their initial injection and suggest that patients with diabetes can be managed with corticosteroid injection with equal efficacy compared with patients without diabetes.
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Affiliation(s)
- Louis C. Grandizio
- Geisinger Medical Center, Danville, PA, USA,Louis C. Grandizio, Department of Orthopaedic Surgery, Geisinger Medical Center, 21-30, 100 N. Academy Ave, Danville, PA 17822, USA.
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Hansen RL, Søndergaard M, Lange J. Open Surgery Versus Ultrasound-Guided Corticosteroid Injection for Trigger Finger: A Randomized Controlled Trial With 1-Year Follow-up. J Hand Surg Am 2017; 42:359-366. [PMID: 28341069 DOI: 10.1016/j.jhsa.2017.02.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 02/09/2017] [Accepted: 02/17/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE Trigger finger is a common condition with a lifetime prevalence of 2%. Corticosteroid injection is a treatment often considered as a first-line intervention with reported cure rates between 60% and 90% in observational cohorts. Nevertheless, open surgery remains the most effective treatment with reported cure rates near 100%. Head-to-head trials on these treatments are limited. We investigated the efficacy of open surgery compared with ultrasound-guided corticosteroid injections. METHODS The study was performed as a single-center, randomized, controlled trial with a 1-year follow-up. A total of 165 patients received either open surgery (n = 81) or ultrasound-guided corticosteroid injection (n = 84). Follow-up was conducted at 3 and 12 months. If the finger had normal movement or normal movement with discomfort at latest follow-up, the outcome was considered a success. Secondary outcomes were postprocedural pain and complications. RESULTS The groups were similar at baseline except for lower alcohol consumption in the open surgery group. At 3 months, 86% and 99% were successfully treated after corticosteroid injection and open surgery, respectively. At 12 months, 49% and 99% were considered successfully treated after corticosteroid injection and open surgery, respectively. The pain score at latest follow-up was significantly higher in the corticosteroid injection group. Complications after open surgery were more severe and included 3 superficial infections and 1 iatrogenic nerve lesion. After corticosteroid injection 11 patients experienced a steroid flare and 2 had fat necrosis at the site of injection. CONCLUSIONS Open surgery is superior to ultrasound-guided corticosteroid injections. Complications after open surgery are more severe; this must be taken into account when advising patients with regard to treatment. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic I.
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Affiliation(s)
- Rehne L Hansen
- Center for Planned Surgery, Regional Hospital Silkeborg, Silkeborg, Aarhus C, Denmark; Orthopaedic Research Unit, Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus C, Denmark
| | - Morten Søndergaard
- Center for Planned Surgery, Regional Hospital Silkeborg, Silkeborg, Aarhus C, Denmark
| | - Jeppe Lange
- Center for Planned Surgery, Regional Hospital Silkeborg, Silkeborg, Aarhus C, Denmark; Interdisciplinary Research Unit, Center for Planned Surgery, Regional Hospital Silkeborg, Silkeborg, Aarhus C, Denmark; Orthopaedic Research Unit, Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus C, Denmark.
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Waterbrook AL, Balcik BJ, Goshinska AJ. Blood Glucose Levels After Local Musculoskeletal Steroid Injections in Patients With Diabetes Mellitus: A Clinical Review. Sports Health 2017; 9:372-374. [PMID: 28394710 PMCID: PMC5496704 DOI: 10.1177/1941738117702585] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Context: Diabetes mellitus (DM) has become an epidemic in the United States and is associated with increased risk of multiple comorbidities, including painful musculoskeletal conditions. A common treatment for many of these painful musculoskeletal conditions is local soft tissue and intra-articular corticosteroid injection (CSI). These local injections have the potential to cause elevated blood glucose levels (BGLs) and cause complications in patients with DM. Therefore, it was the objective of this investigation to review the currently available evidence that directly addresses the effects of local CSIs used for painful musculoskeletal conditions on BGL in patients with DM. Evidence Acquisition: PubMed, Google Scholar, EMBASE, CINAHL, and Cochrane Review databases were searched with a combination of the terms corticosteroid, glucocorticoid, steroid, injection, musculoskeletal, and diabetes. Search limits included the English language. Bibliographic references from these articles were also examined to identify pertinent literature. Study Design: Clinical review. Level of Evidence: Level 3. Results: Ten studies that met the inclusion criteria were reviewed. All these studies showed significant but transient increases in postinjection BGL after a single local CSI in patients with DM. There were no adverse reactions or complications reported. Conclusion: Single, local soft tissue and intra-articular musculoskeletal CSIs are most likely safe in patients with well-controlled DM.
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Affiliation(s)
- Anna L Waterbrook
- Department of Emergency Medicine, The University of Arizona, Tucson, Arizona
| | - Brenden J Balcik
- Department of Emergency Medicine, West Virginia University, Morgantown, West Virginia
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Long-Term Effectiveness of Repeat Corticosteroid Injections for Trigger Finger. J Hand Surg Am 2017; 42:227-235. [PMID: 28372638 PMCID: PMC5382803 DOI: 10.1016/j.jhsa.2017.02.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 01/23/2017] [Accepted: 02/02/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To quantify the long-term success of repeat injections for trigger fingers and to identify predictors of treatment outcomes. METHODS This retrospective case series analyzed 292 repeat corticosteroid injections for trigger fingers administered by hand surgeons at a single tertiary center between January 2010 and January 2013. One hundred eighty-seven patients (64%) were female, 139 patients (48%) had multiple trigger fingers, and 63 patients (22%) were diabetic. The primary outcome, treatment failure, was defined as receiving a subsequent injection or surgical treatment. Patients without either documented failure or a return office visit in 2015 or 2016 were surveyed by telephone to determine if they had required subsequent treatment. Kaplan-Meier analyses with log-rank testing assessed the median time to treatment failure and the effect of demographic and disease-specific characteristics on injection success rate and predictors of injection outcome (success vs failure) were assessed with multivariable logistic regression. RESULTS Second injections provided long-term treatment success in 39% (111 of 285) of trigger fingers with 86 receiving an additional injection and 108 ultimately undergoing surgical release. Thirty-nine percent (24 of 62) of third injections resulted in long-term success, with 22 receiving an additional injection, and 23 ultimately undergoing surgery. Median times-to-failure for second and third injections were 371 and 407 days, respectively. Success curves did not differ significantly according to any patient or disease factor. Logistic regression identified that advancing patient age and injection for trigger thumb were associated with success of second injections. CONCLUSIONS Thirty-nine percent of second and third corticosteroid injections for trigger finger yield long-term relief. Although most patients ultimately require surgical release, 50% of patients receiving repeat trigger injections realize 1 year or more of symptomatic relief. Repeat injections of trigger fingers should be considered in patients who prefer nonsurgical treatment. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Abate M, Salini V, Schiavone C, Andia I. Clinical benefits and drawbacks of local corticosteroids injections in tendinopathies. Expert Opin Drug Saf 2016; 16:341-349. [PMID: 28005449 DOI: 10.1080/14740338.2017.1276561] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION local glucocorticoids injections are widely administered for the treatment of tendinopathies. positive results have been observed in some tendinopathies but not in others. moreover, worsening of symptoms, and even spontaneous tendon ruptures has been reported. the characteristics of the tendinopathies, the clinical peculiarities of the patient, and the technique used to administer glucocorticoids, can influence the therapeutic response. Areas covered: After reviewing the pertinent literature on the clinical results, basic information, both on the pathogenesis of tendinopathies and the effects of glucocorticoids on tendons, is reported. The pharmacological properties of glucocorticoids are useful to counteract some pathogenetic mechanisms of tendinopathies. However, several experimental studies suggest that the direct action of glucocorticoids on tendons is detrimental. Loss of collagen organization, impaired viability of fibroblasts, depletion of stem cells pool, and reduced mechanical properties have been observed. Expert opinion: Drawbacks of local glucocorticoids injections could be predicted on an individual basis, after a careful appraisal of patient characteristics and concomitant medications, along with the specific stage of tendon disease.
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Affiliation(s)
- Michele Abate
- a Department of Medicine and Science of Aging , University G. d'Annunzio, Chieti-Pescara , Chieti Scalo , Italy
| | - Vincenzo Salini
- a Department of Medicine and Science of Aging , University G. d'Annunzio, Chieti-Pescara , Chieti Scalo , Italy
| | - Cosima Schiavone
- a Department of Medicine and Science of Aging , University G. d'Annunzio, Chieti-Pescara , Chieti Scalo , Italy
| | - Isabel Andia
- b BioCruces Health Research Institute , Cruces University Hospital , Barakaldo , Spain
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Cost of Immediate Surgery Versus Non-operative Treatment for Trigger Finger in Diabetic Patients. J Hand Surg Am 2016; 41:1056-1063. [PMID: 27671766 DOI: 10.1016/j.jhsa.2016.08.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 07/24/2016] [Accepted: 08/10/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE As health care costs continue to rise, providers must increasingly identify and implement cost-effective practice measures without sacrificing quality of care. Corticosteroid injections are an established treatment for trigger finger; however, numerous clinical trials have documented the limited efficacy of these injections in the diabetic population. Furthermore, the most cost-effective treatment strategy for diabetic trigger finger has not been determined. The purpose of this study was to perform a decision analysis to identify the least costly strategy for effective treatment of diabetic trigger finger using existing evidence in the literature. METHODS Four treatment strategies for diabetic trigger finger were identified: (1) 1 steroid injection followed by surgical release, (2) 2 steroid injections followed by surgical release, (3) immediate surgical release in the operating room, and (4) immediate surgical release in the clinic. A literature review was conducted to determine success rates of the different treatment strategies. Costing analysis was performed using our institutional reimbursement from Medicare. One-way sensitivity and threshold analysis was utilized to determine the least costly treatment strategy. RESULTS The least costly treatment strategy was immediate surgical release in the clinic. In patients with insulin-dependent diabetes mellitus, this strategy results in a 32% and a 39% cost reduction when compared with treatment with 1 or 2 corticosteroid injections, respectively. For 1 or 2 corticosteroid injections to be the most cost-effective strategy, injection failure rates would need to be less than 36% and 34%, respectively. The overall cost of care for immediate surgical release in the clinic was $642. CONCLUSIONS Diabetic trigger finger is a common problem faced by hand surgeons, with a variety of acceptable treatment algorithms. Management of diabetic trigger finger with immediate surgical release in the clinic is the most cost-effective treatment strategy, assuming a corticosteroid injection failure rate of at least 34%. TYPE OF STUDY/LEVEL OF EVIDENCE Economic/decision III.
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Sears ED, Swiatek PR, Chung KC. National Utilization Patterns of Steroid Injection and Operative Intervention for Treatment of Common Hand Conditions. J Hand Surg Am 2016; 41:367-373.e2. [PMID: 26774548 PMCID: PMC4769917 DOI: 10.1016/j.jhsa.2015.11.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 11/21/2015] [Accepted: 11/24/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To conduct a population-level analysis of practice trends and probability of surgery based on the number of steroid injections for common hand conditions. METHODS Patients aged at least 18 years receiving injection or surgery for carpal tunnel syndrome (CTS), trigger finger (TF), or de Quervain tenovaginitis (DQ) were identified for inclusion using the 2009 to 2013 Truven MarketScan databases. The researchers counted the number of injections performed and calculated the time between injection and operation for patients receiving both treatments. A multivariable logistic regression model was created to evaluate the odds of undergoing surgery based on the number of injections performed, controlling for patient age, sex, comorbidities, and insurance type. RESULTS The study sample included 251,030 patients who underwent steroid injection or operative release for CTS (n = 129,917), TF (n = 102,778), and DQ (n = 18,335). Most patients with CTS were managed with immediate surgery (71%), whereas most patients with TF and DQ were managed initially with injection (74% and 84%, respectively). Among patients receiving both an injection and an operation, a single injection was the most common practice before surgery (69%, 58%, and 67% of patients with CTS, TF, and DQ, respectively). Multiple injections for DQ and TF were associated with relatively low predicted probability of surgery (17% and 26%, respectively, after 2 injections). However, the predicted probability of surgery after 2 injections was higher in patients with CTS (44%). CONCLUSIONS Given the associated probability of surgery after multiple injections for the 3 hand conditions examined, the practice of repeat injections should be critically examined to determine whether underuse or overuse is present and whether efficiency and use of resources can be improved upon. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic II.
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Affiliation(s)
- Erika D. Sears
- Assistant Professor, Department of Surgery, Section of Plastic Surgery, University of Michigan Health System and VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI
| | - Peter R. Swiatek
- Medical Student, University of Michigan Medical School, Ann Arbor, MI
| | - Kevin C Chung
- Professor of Surgery, Department of Surgery, Section of Plastic Surgery, Assistant Dean for Faculty Affairs, University of Michigan Medical School, Ann Arbor, MI
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Kloeters O, Ulrich DJO, Bloemsma G, van Houdt CIA. Comparison of three different incision techniques in A1 pulley release on scar tissue formation and postoperative rehabilitation. Arch Orthop Trauma Surg 2016; 136:731-7. [PMID: 26926477 PMCID: PMC4842220 DOI: 10.1007/s00402-016-2430-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Indexed: 01/09/2023]
Abstract
INTRODUCTION The optimal surgical approach for trigger finger release remains controversial in hindsight of postoperative rehabilitation as well as scar tissue formation. In this study, we comparatively evaluated the outcome of three different types of skin incision by employing the "Disability of the Arm Shoulder and Hand Score" (DASH) and by quantitative ultrasound measurements of scar tissue volume. MATERIALS AND METHODS Thirty patients (32 triggerfingers) were enrolled in this study and randomly assigned to one of three groups: incision placed (1) transversal in distal palmar crease, (2) transversal and 2 mm distal from distal palmar crease, (3) longitudinally over MCP joint without crossing the distal palmar crease. Patients characteristics were noted and DASH scores were retrieved at four time points, (1) preoperatively (baseline), (2) 1 month, (3) 3 months, (4) 12 months postoperatively. Scar volume formation was assessed by ultrasound at 3 months postoperatively in 28 patients. RESULTS All groups showed a significant reduction in DASH values at 3 and 12 months postoperatively when compared to their own baseline levels. Group 3 showed the fastest and most pronounced reduction in DASH values at 1 month. Scar tissue formation was almost 57 % increased in group 1 vs group 2 and 3, however, not significant. CONCLUSION There is no clear benefit of one incision technique over another. However, based on scar volume parameters, the significant faster recovery in the first month and the surgical ease of exposure and wound closure inclines us to favor the longitudinal incision (group 3) in future patients.
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Affiliation(s)
- Oliver Kloeters
| | - Dietmar J. O. Ulrich
| | - Gijs Bloemsma
| | - Claire I. A. van Houdt
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Chopra A, Rowbotham EL, Grainger AJ. Radiological intervention of the hand and wrist. Br J Radiol 2015; 89:20150373. [PMID: 26313500 PMCID: PMC4985953 DOI: 10.1259/bjr.20150373] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 08/18/2015] [Accepted: 08/26/2015] [Indexed: 11/05/2022] Open
Abstract
The role of radiological guided intervention is integral in the management of patients with musculoskeletal pathologies. The key to image-guided procedures is to achieve an accurately placed intervention with minimal invasion. This review article specifically concentrates on radiological procedures of the hand and wrist using ultrasound and fluoroscopic guidance. A systematic literature review of the most recent publications relevant to image-guided intervention of the hand and wrist was conducted. During this search, it became clear that there is little consensus regarding all aspects of image-guided intervention, from the technique adopted to the dosage of injectate and the specific drugs used. The aim of this article is to formulate an evidence-based reference point which can be utilized by radiologists and to describe the most commonly employed techniques.
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Affiliation(s)
- Annu Chopra
- X-Ray department, Musculoskeletal Centre, Leeds Teaching Hospitals, Chapel Allerton Hospital, Chapeltown Road, Leeds, UK
| | - Emma L Rowbotham
- X-Ray department, Musculoskeletal Centre, Leeds Teaching Hospitals, Chapel Allerton Hospital, Chapeltown Road, Leeds, UK
| | - Andrew J Grainger
- X-Ray department, Musculoskeletal Centre, Leeds Teaching Hospitals, Chapel Allerton Hospital, Chapeltown Road, Leeds, UK
- Leeds Musculoskeletal Biomedical Research Unit, University of Leeds, Chapel Allerton Hospital, Leeds, UK
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Liu DH, Tsai MW, Lin SH, Chou CL, Chiu JW, Chiang CC, Kao CL. Ultrasound-Guided Hyaluronic Acid Injections for Trigger Finger: A Double-Blinded, Randomized Controlled Trial. Arch Phys Med Rehabil 2015; 96:2120-7. [PMID: 26340807 DOI: 10.1016/j.apmr.2015.08.421] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 08/04/2015] [Accepted: 08/18/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To investigate the effects of ultrasound-guided injections of hyaluronic acid (HA) versus steroid for trigger fingers in adults. DESIGN Prospective, double-blinded, randomized controlled study. SETTING Tertiary care center. PARTICIPANTS Subjects with a diagnosis of trigger finger (N=36; 39 affected digits) received treatment and were evaluated. INTERVENTIONS Subjects were randomly assigned to HA and steroid injection groups. Both study medications were injected separately via ultrasound guidance with 1 injection. MAIN OUTCOME MEASURES The classification of trigger grading, pain, functional disability, and patient satisfaction were evaluated before the injection and 3 weeks and 3 months after the injection. RESULTS At 3 months, 12 patients (66.7%) in the HA group and 17 patients (89.5%) in the steroid group exhibited no triggering of the affected fingers (P=.124). The treatment results at 3 weeks and 3 months showed similar changes in the Quinnell scale (P=.057 and .931, respectively). A statistically significant interaction effect between group and time was found for visual analog scale (VAS) and Michigan Hand Outcome Questionnaire (MHQ) evaluation (P<.05). The steroid group had a lower VAS at 3 months after injection (steroid 0.5±1.1 vs HA 2.7±2.4; P<.001). The HA group demonstrated continuing significant improvement in MHQ at 3 months (change from 3wk: steroid -2.6±14.1 vs HA 19.1±37.0; P=.023; d=.78). CONCLUSIONS Ultrasound-guided injection of HA demonstrated promising results for the treatment of trigger fingers. The optimal frequency, dosage, and molecular weight of HA injections for trigger fingers deserve further investigation for future clinical applications.
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Affiliation(s)
- Ding-Hao Liu
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Yuanshan Branch, Yilan, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Mei-Wun Tsai
- Institute of Physical Therapy and Assistive Technology, School of Biomedical Science and Engineering, National Yang-Ming University, Taipei, Taiwan
| | - Shan-Hui Lin
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Yuanshan Branch, Yilan, Taiwan
| | - Chen-Liang Chou
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Yuanshan Branch, Yilan, Taiwan; Department of Physical Medicine and Rehabilitation, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jan-Wei Chiu
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Yuanshan Branch, Yilan, Taiwan
| | - Chao-Ching Chiang
- Division of Orthopaedic Trauma, Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chung-Lan Kao
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Yuanshan Branch, Yilan, Taiwan; Institute of Physical Therapy and Assistive Technology, School of Biomedical Science and Engineering, National Yang-Ming University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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Ricci JA, Parekh NN, Desai NS. Release of the A1 Pulley for Trigger Finger Complicated by Flexor Tenosynovitis. J Hand Microsurg 2015; 7:220-3. [PMID: 26078548 DOI: 10.1007/s12593-015-0171-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Accepted: 01/02/2015] [Indexed: 10/24/2022] Open
Affiliation(s)
- Joseph A Ricci
- Division of Plastic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, WACC 435, Boston, MA 02114 USA
| | - Nirav N Parekh
- The Department of Physical Medicine and Rehabilitation, Thomas Jefferson University Hospital, Philadelphia, PA USA
| | - Naman S Desai
- The Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA USA
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Long-term effectiveness of corticosteroid injections for trigger finger and thumb. J Hand Surg Am 2015; 40:121-6. [PMID: 25443167 DOI: 10.1016/j.jhsa.2014.09.006] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 09/01/2014] [Accepted: 09/02/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To analyze the long-term response to corticosteroid injection in the management of trigger digit. METHODS This was an observational study of a prospectively recruited series of patients with first-time diagnosis of trigger finger. Efficacy of the injections, comorbidities, digit injected, and related complications were compared and statistically analyzed. RESULTS A total of 71 digits were included in the study. The median (interquartile range) duration of follow-up was 8 years (range, 7.0-8.3 y). At final follow-up, complete remission of symptoms was obtained in 69% of cases. There were 37 trigger thumbs (52%), with a success rate of 81% compared with 56% in the other the digits. There were 11 patients with diabetes mellitus, and 16 fingers developed trigger finger after carpal tunnel syndrome surgery. We found no complications. CONCLUSIONS Steroid injections were an effective first-line intervention for the treatment of trigger finger. At long-term follow-up, the success incidence may be as high as 69%. In this study, the efficacy of this treatment increases when treating the thumb compared with other digits.
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Cecen GS, Gulabi D, Saglam F, Tanju NU, Bekler HI. Corticosteroid injection for trigger finger: blinded or ultrasound-guided injection? Arch Orthop Trauma Surg 2015; 135:125-31. [PMID: 25381472 DOI: 10.1007/s00402-014-2110-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Trigger digit is one of the most common causes of pain and disability in the hand. The mainstay of conservative treatment of this disease has been local steroid injection into the tendon sheath. The aim of this study was to investigate the clinical benefit of an ultrasound-guided corticosteroid injection compared to a blinded application. MATERIALS AND METHODS 74 patients, who suffered from persistent or increasing symptoms of a single trigger digit, were enroled in this prospective, randomised case-control study. All patients were treated with an injection of 40 mg/1 ml methylprednisolone acetate into the flexor tendon sheath at the level of the A1 pulley. Half of the patients had their injections under ultrasound control (USG) and half without (blinded injection group, BIG). Associated metabolic diseases were recorded. At the 6-week and 6-month follow-up examinations, the complication rate and the need for a second injection were assessed. The outcome was rated using the Quinnell grading. The pain level was assessed using the visual analogue scale. RESULTS Four patients were excluded due to lack of follow-up. Both study groups were comparable in respect of age, hand dominance and associated diseases. There were significantly more female patients in the USG group (32 versus 23 %). After the corticosteroid injections, all patients improved significantly in terms of pain level and the Quinnell grading at 6 weeks and 6 months after the intervention in comparison to the pre-injection status. There were no significant differences between the groups. 9 patients (13 %) needed a second injection (6 of BIG, 3 of USG), all of whom had diabetes mellitus. No local complications were seen after the injections. CONCLUSION The use of ultrasound-guided injection of corticosteroid may be associated with extra time and effort, with no superior clinical benefits compared to the blinded technique. LEVEL OF EVIDENCE Level 1(prospective randomised study).
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Affiliation(s)
- G S Cecen
- Dr. Lütfi Kırdar Kartal Training and Research Hospital, Semsi Denizer Cad. E5, Yanyol Cevizli Kavsagı Kartal, İstanbul, 34890, Turkey,
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Ferree S, Neuhaus V, Becker SJE, Jupiter JB, Mudgal CS, Ring DC. Risk factors for return with a second trigger digit. J Hand Surg Eur Vol 2014. [PMID: 23186861 DOI: 10.1177/1753193412469129] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to determine predictors of return to the same practice with a second idiopathic trigger digit. A total of 2234 patients with Quinnell grade 2 or greater (objective triggering) of one or more digits were retrospectively analysed. A total of 490 of 2234 (22%) patients returned to the same practice with a second trigger digit, with an average follow-up time of 2.1 years (range, 7 days to 10 years). Predictors of return with a second trigger digit included carpal tunnel syndrome, Type 1 diabetes mellitus and duration of follow-up in years. Patients diagnosed with idiopathic trigger digit can be advised that about one in five will return to the same practice with another trigger digit, with approximately double the risk in patients that have carpal tunnel syndrome or Type 1 diabetes.
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Affiliation(s)
- S Ferree
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA, USA
| | - V Neuhaus
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA, USA
| | - S J E Becker
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA, USA
| | - J B Jupiter
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA, USA
| | - C S Mudgal
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA, USA
| | - D C Ring
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA, USA
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Uchihashi K, Tsuruta T, Mine H, Aoki S, Nishijima-Matsunobu A, Yamamoto M, Kuraoka A, Toda S. Histopathology of tenosynovium in trigger fingers. Pathol Int 2014; 64:276-82. [DOI: 10.1111/pin.12168] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2013] [Accepted: 04/14/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Kazuyoshi Uchihashi
- Department of Pathology and Microbiology; Faculty of Medicine, Saga University; Saga Japan
| | | | | | - Shigehisa Aoki
- Department of Pathology and Microbiology; Faculty of Medicine, Saga University; Saga Japan
| | | | - Mihoko Yamamoto
- Department of Pathology and Microbiology; Faculty of Medicine, Saga University; Saga Japan
| | - Akio Kuraoka
- Department of Anatomy and Physiology; Faculty of Medicine, Saga University; Saga Japan
| | - Shuji Toda
- Department of Pathology and Microbiology; Faculty of Medicine, Saga University; Saga Japan
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Blood glucose levels in diabetic patients following corticosteroid injections into the hand and wrist. J Hand Surg Am 2014; 39:706-12. [PMID: 24679910 PMCID: PMC3971392 DOI: 10.1016/j.jhsa.2014.01.014] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 01/13/2014] [Accepted: 01/14/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To quantify diabetic patients' change in blood glucose levels after corticosteroid injection for common hand diseases and to assess which patient-level risk factors may predict an increase in blood glucose levels. METHODS Patients were recruited for this case-crossover study in the clinic of fellowship-trained hand surgeons at a tertiary care center. Patients with diabetes mellitus type 1 or 2, who received a corticosteroid injection, recorded the morning fasting blood glucose levels for 14 days after the injection. Fasting glucose levels on days 1 to 7 after injection qualified as case data; levels on days 10 to 14 provided control data. A mixed model with a priori contrasts was used to compare postinjection blood glucose levels with baseline levels. We used a linear regression model to determine patient predictors of a postinjection rise in blood glucose levels. RESULTS Of 67 patients recruited for the study returned, 40 (60%) completed blood glucose logs. There was a significant increase in fasting blood glucose levels after injection limited to postinjection days 1 and 2. Among patient risk factors in the linear regression model, type 1 diabetes and use of insulin each predicted a postinjection increase in blood glucose levels from baseline, whereas higher glycated hemoglobin levels did not predict increases. CONCLUSIONS Corticosteroid injections in the hand transiently increase blood glucose levels in diabetic patients. Patients with type 1 diabetes and insulin-dependent diabetics are more likely to experience this transient rise in blood glucose levels. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic III.
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Abstract
BACKGROUND Stenosing flexor tenosynovitis of the digital flexor tendon (trigger digit) is a common condition encountered by hand surgeons. Our purpose was to determine the efficacy of corticosteroid injections and review the demographic profile of patients with trigger digits. METHODS We reviewed the records of 362 patients (577 trigger digits) treated with steroid injections (8 mg of triamcinolone acetonide in 1 % lidocaine) from 1998 through 2011. Follow-up (intervention to last visit) averaged 66.4 months. We assessed patient demographics (e.g., gender, age, diabetes mellitus, hand dominance, trigger digit distribution) and determined recurrence rate and injection duration of efficacy. If one injection failed, additional injections or surgical A1 pulley release were offered. Results were analyzed with Student's t test or Fisher's exact test (significance, p < 0.05). RESULTS Women (258, 71.3 %) were affected significantly (p < 0.001) more frequently than men (104, 28.7 %) and at a significantly (p < 0.001) younger age (average, 58.3 versus 62.1 years, respectively). Eighty patients (22.1 %) were diabetic. We observed no correlation between trigger digit and hand dominance. The two most commonly affected digits were the right long finger (17.8 %) and right thumb (17.7 %). For 721 injections, the recurrence rate was 20.3 %; there were no major complications. For recurrences, the injection efficacy averaged 315 days. Surgery was required for 117 patients. CONCLUSIONS Injection therapy is safe and highly effective (79.7 %). Women were affected by trigger digits more often than men and at a younger age. Surgical release provides a definitive therapeutic option if corticosteroid injection fails.
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Jacobs JWG, Michels-van Amelsfort JMR. How to perform local soft-tissue glucocorticoid injections? Best Pract Res Clin Rheumatol 2013; 27:171-94. [PMID: 23731930 DOI: 10.1016/j.berh.2013.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Inflammation of periarticular soft-tissue structures such as tendons, tendon sheaths, entheses, bursae, ligaments and fasciae is the hallmark of many inflammatory rheumatic diseases, but inflammation or rather irritation of these structures also occurs in the absence of an underlying rheumatic disease. In both these primary and secondary soft-tissue lesions, local glucocorticoid injection often is beneficial, although evidence in the literature is limited. This chapter reviews local injection therapy for these lesions and for nerve compression syndromes.
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Affiliation(s)
- J W G Jacobs
- Department of Rheumatology & Clinical Immunology, F02.127, University Medical Center Utrecht, Box 85500, 3508 GA Utrecht, The Netherlands.
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Abstract
Hand or wrist pain is a common complaint in primary care. This pain can be very disabling and can significantly impair a person's quality of life. With the appropriate clinical knowledge and skills, nurse practitioners can effectively evaluate, diagnose, and treat many of the common hand and wrist complaints seen in primary care.
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Catalano LW, Glickel SZ, Barron OA, Harrison R, Marshall A, Purcelli-Lafer M. Effect of local corticosteroid injection of the hand and wrist on blood glucose in patients with diabetes mellitus. Orthopedics 2012; 35:e1754-8. [PMID: 23218632 DOI: 10.3928/01477447-20121120-20] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Locally administered corticosteroids are a common therapy in many hand and wrist disorders. Corticosteroids pose a theoretical risk to patients with diabetes mellitus by potentially raising blood glucose to hyperglycemic levels. Although oral corticosteroids are known to have an effect on blood glucose control, limited data exist on extra-articular administration. The purpose of this study was to examine the systemic impact of extra-articularly administered corticosteroids in the hand and wrist on serum glucose concentration in patients with diabetes mellitus.Twenty-three patients with diabetes mellitus received a 1-mL triamcinolone acetonide injection for de Quervain's tenosynovitis, trigger finger, flexor carpi ulnaris tendonitis, or carpal tunnel syndrome. Patients recorded their daily morning blood glucose levels for 1 week before injection and for 4 weeks after injection. Average blood glucose levels increased slightly from baseline after injection, reaching statistical significance 1, 5, and 6 days after injection, but were not clinically significant (average increase, 14.2, 9.7, and 32.7 mg/dL, respectively). Isolated increases more than 2 times the standard deviation of preinjection values occurred at least once in the majority of patients. The frequency of hyperglycemic episodes increased after injection, but the proportions of patients with at least 1 hyperglycemic episode before and after injection were not significantly different.These results suggest that local corticosteroid injections are a clinically safe treatment option for inflammatory processes of the hand and wrist in patients with diabetes mellitus. On average, patients experienced slight increases in blood glucose after receiving an injection. Most experienced isolated increases substantially beyond baseline and isolated hyperglycemic effects, but these did not pose an apparent clinical risk.
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Wiwanitkit S, Wiwanitkit V. Trigger digits and diabetes mellitus. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2012; 4:117-9. [PMID: 22454822 PMCID: PMC3309616 DOI: 10.4103/1947-2714.93879] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The problem of finger in the patient with diabetes mellitus is important consideration in diabetology. Generally, peripheral neuropathy that manifests with finger paresthesia is common. However, some recent reports mention the concern on trigger digits in diabetic patients. In this brief article, the authors focus review and discussion on this specific topic. The searching of standard database, PubMed, on available publication on this area selecting by keywords trigger digits and diabetes mellitus was done and all derived papers were extracted and further synthesized in this review article. Epidemiology and management of the condition are the mainly focused reviewed areas and presented in this article.
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Bruijnzeel H, Neuhaus V, Fostvedt S, Jupiter JB, Mudgal CS, Ring DC. Adverse events of open A1 pulley release for idiopathic trigger finger. J Hand Surg Am 2012; 37:1650-6. [PMID: 22763058 DOI: 10.1016/j.jhsa.2012.05.014] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Revised: 05/05/2012] [Accepted: 05/08/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE To classify and report adverse events of trigger finger release in a large cohort of patients. METHODS We retrospectively reviewed 1,598 trigger finger releases performed by 12 surgeons in 984 patients between 2001 and 2011. Adverse events were classified based on a system derived from the Centers for Disease Control and Prevention criteria and clinical experience. Risk factors for various adverse events were sought in bivariate and multivariable statistical analysis. RESULTS At the latest follow-up, 66 patients (7%), or 84 operated trigger digits (5%), experienced a documented adverse event. The most common adverse events were recovery issues in 46 patients (3%) (such as postoperative symptoms treated with steroid injection or slow recovery of motion treated with hand therapy), wound problems in 30 patients (2%) (consisting of suture abscess, superficial infection, or wound separation), persistent postoperative triggering in 10 patients (0.6%), and recurrent triggering in 4 patients (0.3%). Diabetes mellitus was associated with wound problems, slow recovery of motion, and recurrence. Concomitant carpal tunnel release on the same side was associated with slow recovery. CONCLUSIONS Fourteen patients, less than 1%, in this cohort experienced an adverse event, such as persistent or recurrent triggering, requiring secondary surgery. No nerve injury or deep infection occurred in our cohort. One in 15 patients experienced a minor transient or treatable adverse event, and patients with diabetes were at greater risk. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Hanneke Bruijnzeel
- Orthopaedic Hand Service, Massachusetts General Hospital, Boston, MA, USA
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Shakeel H, Ahmad TS. Steroid injection versus NSAID injection for trigger finger: a comparative study of early outcomes. J Hand Surg Am 2012; 37:1319-23. [PMID: 22721455 DOI: 10.1016/j.jhsa.2012.03.040] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2010] [Revised: 03/23/2012] [Accepted: 03/23/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE Stenosing tenosynovitis of the flexor tendon sheath of the digits of the hand results from a discrepancy between the diameter of the flexor tendon and its sheath at the A1 pulley. The treatment options for trigger digits include oral nonsteroidal anti-inflammatory drugs (NSAIDs) and local NSAID applications, splintage, steroid injection, and percutaneous and open release of the A1 pulley. Injectable NSAID is used intramuscularly and locally in other sites. The hypothesis is that an injectable NSAID is as effective as the traditionally used steroid injection in the treatment of trigger digit, based on Quinnell grading, and that the treatment works as well in patients with diabetes as in those without diabetes. METHODS In this prospective, randomized, double-blinded controlled study for trigger digits, we injected diclofenac sodium locally in one group (NSAID group) and triamcinolone acetonide in another (corticosteroid group). A total of 100 patients (50 patients in each group) were followed up and assessed 3 weeks and 3 months after the injection. RESULTS At the end of the follow-up, 35 patients (70%) in the corticosteroid group and 28 patients (53%) in the NSAID group had complete symptomatic resolution. There was no difference between the response of patients with and without diabetes. There was no significant difference found in Quinnell score between treatments at 3 months, although at 3 weeks, the patients who received steroid had significantly better Quinnell scores. CONCLUSIONS We concluded that, although steroids gave quicker relief, NSAID injections are equally effective at 3 months in the treatment of trigger digits. We were unable to detect a statistically significant difference in the response of patients with and without diabetes to either treatment.
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Affiliation(s)
- Hussain Shakeel
- Department of Orthopaedic Surgery, University of Malaya, Kuala Lumpur, Malaysia.
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Callegari L, Spanò E, Bini A, Valli F, Genovese E, Fugazzola C. Ultrasound-guided injection of a corticosteroid and hyaluronic acid: a potential new approach to the treatment of trigger finger. Drugs R D 2012; 11:137-45. [PMID: 21545190 PMCID: PMC3585899 DOI: 10.2165/11591220-000000000-00000] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives: Stenosing tenosynovitis (trigger finger) is one of the most common causes of pain and disability in the hand, which may often require treatment with anti-inflammatory drugs, corticosteroid injection, or open surgery. However, there is still large room for improvement in the treatment of this condition by corticosteroid injection. The mechanical, viscoelastic, and antinociceptive properties of hyaluronic acid may potentially support the use of this molecule in association with corticosteroids for the treatment of trigger finger. This study examines the feasibility and safety of ultrasound-guided injection of a corticosteroid and hyaluronic acid compared, for the first time, with open surgery for the treatment of trigger finger. Methods: This was a monocentric, open-label, randomized study. Consecutive patients aged between 35 and 70 years with ultrasound-confirmed diagnosis of trigger finger were included. Patients were randomly assigned to either ultrasound-guided injection of methylprednisolone acetate 40 mg/mL with 0.8mL lidocaine into the flexor sheath plus injection of 1mL hyaluronic acid 0.8% 10 days later (n = 15; group A), or to open surgical release of the first annular pulley (n = 15; group B). Clinical assessment of the digital articular chain was conducted prior to treatment and after 6 weeks, and 3, 6, and 12 months. The duration of abstention from work and/or sports activity, and any treatment complications or additional treatment requirements (e.g. physiotherapy, compression, medication) were also recorded. Results: Fourteen patients (93.3%) in group A had complete symptom resolution at 6 months, which persisted for 12 months in 11 patients (73.3%), while three patients experienced recurrences and one experienced no symptom improvements. No patients in group A reported major or minor complications during or after corticosteroid injection, or required a compression bandage. All 15 patients in group B achieved complete resolution of articular impairment by 3 weeks after surgery, but ten patients were assigned to physiotherapy and local and/or oral analgesics for complete resolution of symptoms, which was approximately 30–40 days postsurgery. The mean duration of abstention from work and/or sport was 2–3 days in group A and 26 days in group B. Conclusions: Although the limited sample size did not allow any statistical comparison between treatment groups, and therefore all the findings should be regarded as preliminary, the results of this explorative study suggest that ultrasound-guided injection of a corticosteroid and hyaluronic acid could be a safe and feasible approach for the treatment of trigger finger. It is also associated with a shorter recovery time than open surgery, which leads to a reduced abstention from sports and, in particular, work activities, and therefore may have some pharmacoeconomic implications, which may be further explored. In light of the promising results obtained in this investigation, further studies comparing ultrasound-guided injection of corticosteroid plus hyaluronic acid with corticosteroid alone are recommended in order to clarify the actual benefits attributable to hyaluronic acid.
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Affiliation(s)
- Leonardo Callegari
- Department of Radiology, University of Insubria, Ospedale di Circolo-Fondazione Macchi, Varese, Italy
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Brown E, Genoway KA. Impact of diabetes on outcomes in hand surgery. J Hand Surg Am 2011; 36:2067-72. [PMID: 22123050 DOI: 10.1016/j.jhsa.2011.10.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2011] [Accepted: 10/04/2011] [Indexed: 02/02/2023]
Abstract
Diabetes mellitus is associated with the development of several pathologic conditions of the hand, including carpal tunnel syndrome, Dupuytren disease, trigger digits, and limited joint mobility or cheiroarthropathy. In recent years, across a variety of surgical disciplines, increased emphasis has been placed on the impact of diabetes on treatment outcomes. This review provides an overview of the current literature regarding the effect of diabetes on outcomes of hand surgery for these common diabetes-related conditions. Taken as a whole, the best current evidence supports the efficacy of surgical interventions for the management of these conditions in diabetic individuals; however, additional research is required to determine whether the treatment outcomes are equivalent to those of nondiabetic patients, and whether diabetes is associated with an increased risk of complications.
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Affiliation(s)
- Erin Brown
- Division of Plastic Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
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Zyluk A, Jagielski G. Percutaneous A1 pulley release vs steroid injection for trigger digit: the results of a prospective, randomized trial. J Hand Surg Eur Vol 2011; 36:53-6. [PMID: 20709708 DOI: 10.1177/1753193410381824] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study compared the results of percutaneous A1 pulley release and steroid injection in 105 trigger digits in 95 patients. The patients were randomly assigned to either surgery (43 patients, 46 digits) or steroid injection (52 patients, 59 digits). The results were assessed at 1 and 6 months and the measurements included rate of recurrence (primary outcome measure), pain on movement, active range of movement of the affected digit and grip strength. No recurrences were seen at 1 month. At the 1 month assessment, patients after steroid injection achieved greater active range of movement of the fingers (270° vs 264°) and stronger grip (99% vs 85%) than those treated by percutaneous release. At the 6 month assessment six recurrences (11%) occurred in the steroid injection group and none in the percutaneous release group (P = 0.005). Patients after percutaneous release had less pain on movement of the involved digit (VAS 0.4 vs 1.3), but still had lower AROM of the fingers (265° vs 270° after steroid injection). We conclude that percutaneous A1 pulley release is more effective medium-term therapy for trigger digit than steroid injection, because of lower risk of recurrence.
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Affiliation(s)
- A Zyluk
- Department of General and Hand Surgery, Pomeranian Medical University in Szczecin, Poland.
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Tung WL, Zhao C, Yoshii Y, Amadio PC, Su FC, An KN. A comparative study of A1 pulley compliance. Clin Biomech (Bristol, Avon) 2010; 25:530-4. [PMID: 20363060 PMCID: PMC5156867 DOI: 10.1016/j.clinbiomech.2010.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Revised: 02/16/2010] [Accepted: 02/17/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND Trigger finger is most common in the ring finger, but the reason for this is not known. We hypothesized that the compliance of the A1 pulley might be one of the factors responsible for this phenomenon. The purpose of this study was therefore to compare the compliance of the normal A1 pulley of the thumb, index, middle, ring and little fingers using human cadavers. METHODS Eight normal thumbs, index, middle, ring and little fingers from eight fresh frozen human hand cadavers were used in this experiment. The compliance of the A1 pulley was measured by the resistance when passing a tapered metal rod through the A1 pulley. The slopes of the linear region of radial force/increasing area ratio curve were calculated and analyzed. FINDINGS The mean slope of the linear region of the radial force/increasing area ratio curve was significantly different among the five digits (p<0.05). Post hoc analysis indicated that the mean slope for the middle finger A1 pulleys was larger than the thumb and little finger A1 pulleys (p<0.05). INTERPRETATION The findings did not support our clinical hypothesis that A1 pulley stiffness would parallel the relative frequency of trigger finger by digit.
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Affiliation(s)
- Wen-Lin Tung
- Biomechanics Laboratory, Department of Orthopedics, Mayo Clinic, Rochester, MN, USA,Institue of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Chunfeng Zhao
- Biomechanics Laboratory, Department of Orthopedics, Mayo Clinic, Rochester, MN, USA
| | - Yuichi Yoshii
- Biomechanics Laboratory, Department of Orthopedics, Mayo Clinic, Rochester, MN, USA
| | - Peter C. Amadio
- Biomechanics Laboratory, Department of Orthopedics, Mayo Clinic, Rochester, MN, USA
| | - Fong-Chin Su
- Institue of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Kai-Nan An
- Biomechanics Laboratory, Department of Orthopedics, Mayo Clinic, Rochester, MN, USA,Corresponding author. Department of Orthopedics, Biomechanics Laboratory, Mayo Clinic 200 First Street SW, Rochester, MN 55905, USA. (K.-N. An)
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