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Background: Multimodal analgesia is crucial for effective postoperative pain management in minor hand surgeries, enhancing patient satisfaction. The use of local wound infiltration with Ketorolac as an adjuvant pain management strategy is proposed for open trigger finger release surgery. This study aims to compare pain scores and functional outcomes between local wound infiltration with Ketorolac and oral non-steroidal anti-inflammatory drugs. Methods: This study is a double-blind, parallel design, randomized controlled trials. Sixty-nine patients underwent trigger finger surgery between December 2021 and October 2022 were randomized into one of three groups: oral Ibuprofen alone group, local Ketorolac alone group and local Ketorolac with oral Ibuprofen group. The assessment included postoperative numeric rating scale (NRS) pain score, Disabilities of the Arm, Shoulder, and Hand (DASH) score, grip strength, mobility of proximal interphalangeal (PIP) joint. and complications. Results: NRS pain scores during movement of the operated fingers were significantly lower at 6 h in local Ketorolac alone group and local Ketorolac with oral Ibuprofen group compared to oral Ibuprofen alone group. However, there were no significant differences between the groups in postoperative DASH scores, grip strength, mobility of PIP joints, and complications. Conclusions: Local infiltration of Ketorolac as an adjunct in postoperative pain management has been shown to provide superior analgesia during finger movement within the initial 6 h following trigger finger surgery, in comparison to oral NSAIDs. Clinical trial registration: Thaiclinicaltrials.org identifier: TCTR20210825002. Registered 25/08/2021. https://www.thaiclinicaltrials.org/show/TCTR20210825002 [ABSTRACT FROM AUTHOR]

Abstract Trigger finger (TF) is a disorder characterized by snapping or locking a finger. It has a prevalence of greater than 3% in the general population; however, this estimate could be increased to 5% up to 20% in diabetic patients. Some unreal ambiguity about definition, pathophysiology, site of lesion, and etiology are found among researchers and clinicians, leading to a lack of understanding of all aspects of the disease and improper management as many clinicians proceed to anti-inflammatory medications or steroids injection without in-depth patient evaluation. Original articles cited up to 2022, found through a Google search using the specified keywords, have been used in this review. Close-access articles were accessed through our researcher account with the Egyptian Knowledge Bank. In this review, we will focus on pathophysiology to present all possible findings and etiology to represent all risk factors and associated diseases to assess and confirm a diagnosis and the exact location of pathology hence better treatment modalities and reducing the recurrence of the pathology.

PurposeThe purpose of this study was to determine whether extremities undergoing carpal tunnel release (CTR) have an increased rate of trigger finger (TF) compared with conservatively managed carpal tunnel syndrome.MethodsData were collected from the Humana Insurance Database, and subjects were chosen on the basis of a history of CTR with propensity matching performed to develop a nonsurgical cohort. Following propensity matching, 16,768 patients were identified and equally split between surgical and nonsurgical treatments. Demographic information and medical comorbidities were recorded. Univariate and multivariate analyses were performed to identify risk factors for the development of TF within 6 months of carpal tunnel syndrome diagnosis.ResultsPatients in the surgical cohort were more likely to develop TF than those in the nonsurgical cohort whether in the ipsilateral or contralateral extremity. Whether managed surgically or nonsurgically, extremities with carpal tunnel syndrome demonstrated an increased prevalence of TF than their contralateral, unaffected extremity.ConclusionsSurgeons should be aware of the association of TF and CTR both during the presurgical and postsurgical evaluations as they might impact patient management. With knowledge of these data, surgeons may be more attuned to detecting an early TF during the postsurgical period and offer more aggressive treatment of TF pathology during CTR.Type of study/level of evidencePrognostic III.

Abstract Background An inflammatory disorder known as trigger finger (TF) results in pain in the proximal and distal palm and digit, as well as restricted movement and diminished function. Physiotherapists use a specific treatment called dry needling (DN) to reduce musculoskeletal pain and assist patients with mobility restriction. Objectives This study aimed to examine the effectiveness of DN on quality of life in patients suffering from trigger finger. Methods Forty patients, ranging in age from 45 to 75, were randomized into one of two groups in this Prospective pre and post-test, single-blind parallel group randomized controlled trial. Twenty patients were assigned to the intervention group, which included traditional physiotherapy splinting and ultrasound (ultrasonic dosage was 3MHz, the intensity of 0.5 W/cm2, and the duty cycle 50%. Duration: 5 minutes) as well as to DN upon a nodule at the proximal end of the 1st annular (A1) pulley as well as the discrepancy that existed between the flexor tendon's diameter along with its sheath at the metacarpal head. Twenty patients were assigned to the control group, which consisted of traditional treatment alone, twice weekly, for a total of ten sessions over five weeks. The trial evaluated the quality of life, severity of pain, and hand grip strength using the World Health Organization Quality-of-Life Scale (WHOQOL-BREF), visual analogue scale, and Camry dynamometer respectively two times, beforetreatment and after 10 treatment sessions. Results Within-group analysis using MANOVA demonstrated a significant decline in VAS (p = 0.001) and a significant improvement in quality of life (p = 0.001) and hand grip strength (p = 0.001). Regarding between group comparison using MANOVA there was significant improvement in favor of the DN intervention (p = 0.001) for all measured variables. Conclusions A 5-week dry needling approach with a traditional physiotherapy program was effective in improving in quality of life, pain intensity, and hand grip strength in patients with trigger finger, emphasizing it as the better option. Trial registration: Clinical Trial. Gov, NCT05671523 . Registered 14 December 2022.

Trigger finger surgery is primarily managed with open surgery accompanied by 10–14 days of postoperative recovery, which may interrupt activities of daily living. In the past, we attempted to perform percutaneous surgery by inserting a hockey stick–shaped guide knife through a scalpel incision several millimeters long. Sometimes, we encounter difficult cases wherein triggering does not disappear despite repeated attempts to release the A1 pulley through the small incision, thus forcing us to extend the incision. As a result, the postoperative recovery is sometimes prolonged. We describe our experience using a novel percutaneous procedure in which a guide knife was inserted through one or two 20-gauge needle holes, instead of a scalpel skin incision, to release the A1 pulley. We describe a new method that minimizes skin and soft tissue damage and reliably shortens posttreatment recovery.

Percutaneous first annular pulley (A1 pulley) release, which has been increasingly used to treat trigger fingers, has been widely established as a safe and simple procedure. Multiple studies have reported positive results of percutaneous A1 pulley release. In this study, however, we report cases of patients who developed complications after undergoing percutaneous A1 pulley release at local clinics. A total of six patients visited our hospital for infectious complications after percutaneous A1 pulley release. Various sequelae such as damage to normal structures, insufficient procedure, and tissue necrosis were observed during the exploration. A retrospective study was conducted to identify the cause and trend of the observed complications by instruments (HAKI knife or needle). In the HAKI knife group, there was a tendency for damage to normal structures, while in the needle group, an insufficient release or serious soft tissue necrosis was observed. Based on these cases, our findings confirm the existence and characteristics of infectious complications following the percutaneous A1 pulley release. We further identify that the type of instrument used predicts the nature of complications. Thus, reliable and skilled performance of the procedure by experts is essential for safe treatment.

Background: An inflammatory disorder known as trigger finger (TF) results in pain in the proximal and distal palm and digit, as well as restricted movement and diminished function. Physiotherapists use a specific treatment called dry needling (DN) to reduce musculoskeletal pain and assist patients with mobility restriction. Objectives: This study aimed to examine the effectiveness of DN on quality of life in patients suffering from trigger finger. Methods: Forty patients, ranging in age from 45 to 75, were randomized into one of two groups in this Prospective pre and post-test, single-blind parallel group randomized controlled trial. Twenty patients were assigned to the intervention group, which included traditional physiotherapy splinting and ultrasound (ultrasonic dosage was 3MHz, the intensity of 0.5 W/cm2, and the duty cycle 50%. Duration: 5 minutes) as well as to DN upon a nodule at the proximal end of the 1st annular (A1) pulley as well as the discrepancy that existed between the flexor tendon's diameter along with its sheath at the metacarpal head. Twenty patients were assigned to the control group, which consisted of traditional treatment alone, twice weekly, for a total of ten sessions over five weeks. The trial evaluated the quality of life, severity of pain, and hand grip strength using the World Health Organization Quality-of-Life Scale (WHOQOL-BREF), visual analogue scale, and Camry dynamometer respectively two times, beforetreatment and after 10 treatment sessions. Results: Within-group analysis using MANOVA demonstrated a significant decline in VAS (p = 0.001) and a significant improvement in quality of life (p = 0.001) and hand grip strength (p = 0.001). Regarding between group comparison using MANOVA there was significant improvement in favor of the DN intervention (p = 0.001) for all measured variables. Conclusions: A 5-week dry needling approach with a traditional physiotherapy program was effective in improving in quality of life, pain intensity, and hand grip strength in patients with trigger finger, emphasizing it as the better option. Trial registration: Clinical Trial. Gov, NCT05671523. Registered 14 December 2022. [ABSTRACT FROM AUTHOR]

Finger deformities are a common reason for medical observation in children. Subtle clinical differences can have a significant impact on the diagnosis and treatment of these patients. Identification of the basic diagnostic and treatment principles of trigger thumb, trigger finger, and clasped thumb is of paramount importance to all general practitioners, pediatricians, and orthopedic surgeons who are involved in the care of children. The purpose of this article is to review the most important concepts regarding these important topics, focusing on etiology, epidemiology, clinical presentation, diagnosis, treatment and prognosis. [ABSTRACT FROM AUTHOR]

Background: Although corticosteroid injections are an effective treatment for musculoskeletal pathologies, they may not be suitable for all patients. The purpose of this systematic review was to compare clinical outcomes between patients who received NSAID and corticosteroid injections for various orthopedic conditions. Methods: Medline, Embase, Web of Science, and Cochrane Central Register of Controlled Trials were searched, and meta-analyses were performed using a random-effects model for outcomes presented in three or more studies. Other studies were qualitatively analyzed. Results: A total of 28 articles with 2113 patients were included. A meta-analysis of five studies in patients with shoulder impingement syndrome demonstrated that there was no significant difference in the pain visual analogue scale (VAS) between subacromial NSAID injections and corticosteroid injections at 1 month [weighted mean difference (WMD) −0.244; 95% CI, −1.232 to 0.745; I2, 94.5%]. For patients with knee osteoarthritis, a meta-analysis of three studies demonstrated that there was no significant difference between intraarticular NSAID injections and corticosteroid injections in pain VAS at 1 month (WMD 0.754; 95% CI, −0.413 to 1.921; I2, 90.2%) and 3 months (WMD−0.089; 95% CI, −0.345 to 0.166; I2, 0%). A review of the studies assessing pain outcomes for hip osteoarthritis, adhesive capsulitis, and plantar fasciitis showed no significant differences between the NSAID and corticosteroid groups. Conclusion: NSAID injections may be safe and effective alternatives to steroid injections, especially in shoulder impingement syndrome and knee osteoarthritis. [ABSTRACT FROM AUTHOR]

Percutaneous first annular pulley (A1 pulley) release, which has been increasingly used to treat trigger fingers, has been widely established as a safe and simple procedure. Multiple studies have reported positive results of percutaneous A1 pulley release. In this study, however, we report cases of patients who developed complications after undergoing percutaneous A1 pulley release at local clinics. A total of six patients visited our hospital for infectious complications after percutaneous A1 pulley release. Various sequelae such as damage to normal structures, insufficient procedure, and tissue necrosis were observed during the exploration. A retrospective study was conducted to identify the cause and trend of the observed complications by instruments (HAKI knife or needle). In the HAKI knife group, there was a tendency for damage to normal structures, while in the needle group, an insufficient release or serious soft tissue necrosis was observed. Based on these cases, our findings confirm the existence and characteristics of infectious complications following the percutaneous A1 pulley release. We further identify that the type of instrument used predicts the nature of complications. Thus, reliable and skilled performance of the procedure by experts is essential for safe treatment. [ABSTRACT FROM AUTHOR]

Abstract Background With percutaneous and minimally-invasive pulley release becoming more popular, safety and reliability of such minimally-invasive procedures remain a concern. Visualization of the technical steps by ultrasound suggests increased safety but shows the potential for harm to tendons, nerves and vessels without proper instrumentation. We present the results of implementing a sonographically guided minimally-invasive procedure in 106 trigger digits of 64 patients between 2018–2021. Methods A guide instrument for use with a commercially available hook knife was developed and tested in 16 cadaver hands. Due to complication early in our clinical series this guide was modified in due course. A revised design of the guide has been in use since November 2019 with improved performance and safety. Results One hundred six procedures in 64 patients were performed. After guide revision, we report a success rate of 97.3%. Complications after instrument revision include two cases of incomplete pulley release and one case of inadvertent skin laceration. The majority of patients report returning to all strenuous activities within two weeks at most apart from four individuals with prolonged postoperative discomfort. Conclusion We present the results of the development and implementation of a novel guide instrument for use with a hook knife to treat trigger finger. Despite several limitations of this study, we show that sonographically controlled, minimally-invasive A1 pulley release can be performed safely and effectively with appropriate surgical instruments and practice.

Abstract Objective To evaluate the open surgical treatment for carpal tunnel syndrome as a risk factor for the development of stenosing tenosynovitis that results in trigger finger and De Quervain disease. Materials and Methods A retrospective study analyzing the medical records of patients submitted to open surgical release of carpal tunnel syndrome between 2010 and 2021 in a secondary- and tertiary-level hospital. The following data were collected: pathological history, duration of the follow-up after the surgical treatment for carpal tunnel syndrome, development of trigger finger or De Quervain tenosynovitis, affected fingers, and the interval between the end of surgery and symptom onset. Results We evaluated 802 patients of both genders and with a mean age of 50.1 (±12.6) years. The mean follow-up was of 13 (±16.4) months. The mean time until the development of trigger finger was of 61.4 months, and of 73.7 months for De Quervain disease. The incidence of development of De Quervain disease was of 4.12%, and for trigger finger it was of 10.2%. The most affected digits were the thumb (47.6%), the middle (24.4%), and the ring finger (8.54%). Age was the only factor that showed an association with the risk of developing trigger finger, with an increase of 2% for each increase in age of 1 year. Conclusion The incidence rates for the development of De Quervain disease (4.12%) and trigger finger (10.2%) after the surgical treatment for carpal tunnel syndrome were like those described in the literature. Only age was a factor that influenced the development of trigger finger.

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. [ABSTRACT FROM AUTHOR]

Background: With percutaneous and minimally-invasive pulley release becoming more popular, safety and reliability of such minimally-invasive procedures remain a concern. Visualization of the technical steps by ultrasound suggests increased safety but shows the potential for harm to tendons, nerves and vessels without proper instrumentation. We present the results of implementing a sonographically guided minimally-invasive procedure in 106 trigger digits of 64 patients between 2018–2021. Methods: A guide instrument for use with a commercially available hook knife was developed and tested in 16 cadaver hands. Due to complication early in our clinical series this guide was modified in due course. A revised design of the guide has been in use since November 2019 with improved performance and safety. Results: One hundred six procedures in 64 patients were performed. After guide revision, we report a success rate of 97.3%. Complications after instrument revision include two cases of incomplete pulley release and one case of inadvertent skin laceration. The majority of patients report returning to all strenuous activities within two weeks at most apart from four individuals with prolonged postoperative discomfort. Conclusion: We present the results of the development and implementation of a novel guide instrument for use with a hook knife to treat trigger finger. Despite several limitations of this study, we show that sonographically controlled, minimally-invasive A1 pulley release can be performed safely and effectively with appropriate surgical instruments and practice. [ABSTRACT FROM AUTHOR]

Abstract Background Trigger finger is a common condition in the hand, and ultrasound-guided acupotomy for trigger finger has been widely used in recent years. Purpose This study aims to investigate the efficacy and safety of ultrasound-guided acupotomy for trigger finger. Methods We searched for relevant studies in the Cochrane Library, China National Knowledge Infrastructure (CNKI), Embase, PubMed, Chinese Biomedical Literature Database (CBM), Wanfang Data, and other resources from their inception to January 2023. Randomized controlled trials of ultrasound-guided acupotomy for trigger finger were included. The meta-analysis was carried out using Review Manager 5.4 and Stata 15.1. Results Overall, 15 studies with 988 patients were included. The experimental group was treated with ultrasound-guided acupotomy, and the Control group received traditional acupotomy, traditional operation or injection of medication. Meta-analysis showed that the overall clinical effectiveness (OR = 4.83; 95% CI 2.49–9.37; I 2 = 73.1%; P

Even in the first application of patients with early complaints of trigger finger, pinch strength of the hand may be affected. Therefore, it is difficult to assess the change of strength as a result of treatment in this problem. In this study, we aimed to evaluate the change of strength taking into account both measured and expected pinch strengths before and after A1 pulley release surgery. Thirty fingers (9 thumbs, 12 middle, 8 ring and 1 index fingers) of 26 patients (17 women, 9 men) who underwent A1 pulley release were included into this study. The mean age of the patients was 53 (16–71). Tip-to-tip finger pinch strengths were measured pre-operatively and at 3 months postoperatively. The expected strengths were calculated using the values obtained from the healthy side and taking into account the dominance effect. In the analysis, pre-operative and postoperative measured strength/expected strength ratios were compared. The mean of measured pinch strength/expected pinch strength ratio was 0.91 ± 0.3 pre-operatively and 1.14 ± 0.3 postoperatively (p < 0.05). With the calculation method used in this study, it was found that there was a significant increase in the tip-to-tip pinch strength after surgical A1 pulley release for the trigger finger. III (Retrospective cohort study). [ABSTRACT FROM AUTHOR]

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). 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.

Background: Trigger finger is a common condition in the hand, and ultrasound-guided acupotomy for trigger finger has been widely used in recent years. Purpose: This study aims to investigate the efficacy and safety of ultrasound-guided acupotomy for trigger finger. Methods: We searched for relevant studies in the Cochrane Library, China National Knowledge Infrastructure (CNKI), Embase, PubMed, Chinese Biomedical Literature Database (CBM), Wanfang Data, and other resources from their inception to January 2023. Randomized controlled trials of ultrasound-guided acupotomy for trigger finger were included. The meta-analysis was carried out using Review Manager 5.4 and Stata 15.1. Results: Overall, 15 studies with 988 patients were included. The experimental group was treated with ultrasound-guided acupotomy, and the Control group received traditional acupotomy, traditional operation or injection of medication. Meta-analysis showed that the overall clinical effectiveness (OR = 4.83; 95% CI 2.49–9.37; I2 = 73.1%; P < 0.001) in the experimental group was significantly better than that of the control group. And the Visual Analogue Scale (VAS) score (WMD = − 1; 95% CI − 1.24, − 0.76; I2 = 99%; P < 0.001), the QuinneII classification (WMD = − 0.84; 95% CI − 1.28, − 0.39; I2 = 99.1%, P < 0.001), the incidence of complications (RR = 0.26; 95% CI 0.11, 0.63; I2 = 0%, P = 0.003), and the recurrence rate (RR = 0.14; 95% CI 0.03, 0.74; I2 = 0%; P = 0.021) were significantly lower in the experimental group. Conclusion: Our systematic review and meta-analysis can prove the effectiveness and safety of ultrasound-guided acupotomy in the treatment of trigger finger, but this still needs to be verified by a clinical standard large sample test. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to determine the occurrence of patients undergoing primary trigger finger release (TFR) that underwent ulnar superficialis slip resection (USSR) for decompression and to determine which digit was most commonly affected. Methods: A retrospective chart review was conducted of all cases of open TFR performed by a single surgeon. The following data were obtained: age, sex, laterality, affected digit, and consideration for USSR. All patients failed nonoperative treatment of at least 1 steroid injection. The occurrence of patients who underwent TFR and USSR and which digit(s) most commonly underwent USSR were determined. The average patient age that underwent USSR, frequency by sex, and relative occurrence of USSR in each digit were computed. Statistical calculations were conducted using χ2 analysis (P <.05). Results: A total of 911 primary open TFRs were performed in 631 patients over a 16-year period. A total of 20 TFRs in 20 patients underwent USSR (2.2%). The long finger was the most commonly affected digit (40%) that required simple decompression. Within all USSR cases, the long finger was the most commonly affected digit. The index finger was the second most affected (30%), and there were no cases in the small finger. Conclusions: This study determined the occurrence of primary TFR cases that underwent USSR, with the long finger being the most commonly affected digit. Surgeons may consider this additional procedure to perform a larger decompression than simple A1 pulley release alone. [ABSTRACT FROM AUTHOR]

Introduction. Orthopedic video contents published on YouTube are not scanned and do not go through an editorial evaluation process. It is important to determine the quality and content accuracy of health-related videos. Trigger finger is a common disease and the deterioration in quality of life. However, the quality, content and adequacy of YouTube videos as a source of information about this disease have not been evaluated. The aim of this study is to investigate the quality and adequacy of the medical content of the videos on YouTube about trigger finger disease. Methods. In September 2022, the phrase "trigger finger" was entered in the YouTube search bar and the 50 most watched videos were included in the study, provided that the language of the video was English. Who uploaded the videos, real or animated content, number of views, upload date, number of comments, number of like-dislikes and video length were recorded. 3 orthopedic surgeons and 1 hand surgeon watched the videos simultaneously and separately. JAMA, DISCERN and GQS scores were calculated. Results. Average length of 50 videos is 321 seconds, number of views is 244,150, number of days from upload date to evaluation date is 1,789 days, VPI was 94, view ratio was 300. The average scores of 4 different surgeons from the parameters used for the quality and relevance analysis of the videos: JAMA 2, DISCERN 36, and GQS 2. The scores of 4 different surgeons were statistically compatible with each other (p = 0.000). The interclass correlation coefficient (ICC) was 0.906 for the JAMA score, 0.889 for the DISCERN score, and 0.831 for the GQS score. Conclusions. YouTube videos about trigger finger were low quality and unreliable. In the light of our study and other studies, the possibility of high-quality and reliable videos for patients can be increased by the evaluation and inspection of videos presented by YouTube. [ABSTRACT FROM AUTHOR]