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Chander DS, Tomezzoli A, Cavatorta MP, Gréau M, Marie S, Pontonnier C. Biomechanical requirements of meat cutting tasks: A pilot study quantifying tasks sustainability and assistance required at the wrist. APPLIED ERGONOMICS 2024; 116:104186. [PMID: 38052153 DOI: 10.1016/j.apergo.2023.104186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 11/14/2023] [Accepted: 11/27/2023] [Indexed: 12/07/2023]
Abstract
The meat processing industry is particularly affected by distal upper limb musculoskeletal disorders. This pilot study aims at proposing a methodology able to quantify biomechanical requirements of meat cutting tasks at butchers' dominant wrist and, when necessary, at estimating the assistance needed to reach sustainability. Six professional butchers repeatedly cut pieces of pork. Joint angles were recorded using a motion capture system, cutting forces using an instrumented knife. Sustainability was computed by the maximal acceptable effort method. Assistance requirements were computed for isolated stressful exertions and for overall work cycle sustainability. Five butchers exceeded the sustainability threshold for wrist flexion. Ulnar or radial deviation torques were excessive for 2 and 3 of them, respectively. Extension torques were sustainable. The peak assistive torque for isolated exertions was at most 1.1Nm, 1.6Nm and 1.1Nm, and the percentage of assistance for overall sustainability was at most 60%, 56% and 56% for wrist flexion, ulnar and radial deviation, respectively.
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Chen PT, Hsu HY, Su YH, Lin CJ, Chieh HF, Kuo LC, Su FC. Force Control Strategy of Five-Digit Precision Grasping With Aligned and Unaligned Configurations. HUMAN FACTORS 2023; 65:1407-1421. [PMID: 34974764 DOI: 10.1177/00187208211040914] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To investigate the digit force control during a five-digit precision grasp in aligned (AG) and unaligned grasping (UG) configurations. BACKGROUND The effects of various cylindrical handles for tools on power grasp performance have been previously investigated. However, there is little information on force control strategy of precision grasp to fit various grasping configurations. METHOD Twenty healthy young adults were recruited to perform a lift-hold-lower task. The AG and UG configurations on a cylindrical simulator with force transducers were adjusted for each individual. The applied force and moment, the force variability during holding, and force correlations between thumb and each finger were measured. RESULT No differences in applied force, force correlation, repeatability, and variability were found between configurations. However, the moments applied in UG were significantly larger than those in AG. CONCLUSION The force control during precision grasp did not change significantly across AG and UG except for the digit moment. The simulator is controlled efficiently with large moment during UG, which is thus the optimal configuration for precision grasping with a cylindrical handle. Further research should consider the effects of task type and handle design on force control, especially for individuals with hand disorders. APPLICATION To design the handle of specific tool, one should consider the appropriate configuration according to the task requirements of precision grasping to reduce the risk of accumulating extra loads on digits with a cylindrical handle.
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Affiliation(s)
- Po-Tsun Chen
- Chang Gung University, Taoyuan
- Chang Gung Memorial Hospital, Taoyuan
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Chen PT, Zhang HW, Tsai ZR, Peng HC, Lin YS, Tsai JJP, Lin CW. Association between hyperlipidemia and trigger finger: A nationwide population-based cohort study. PLoS One 2023; 18:e0288426. [PMID: 37428817 DOI: 10.1371/journal.pone.0288426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 06/27/2023] [Indexed: 07/12/2023] Open
Abstract
The cause of trigger fingers remains uncertain. High lipid levels in the blood may reduce blood supply to the distal fingers and promote inflammation. We aimed to explore the association between hyperlipidemia and trigger finger. A nationwide population-based cohort study using longitudinal data from 2000 to 2013, 41,421 patients were included in the hyperlipidemia cohort and 82,842 age- and sex-matched patients were included in the control cohort. The mean age was 49.90 ± 14.73 years in the hyperlipidemia cohort and 49.79 ± 14.71 years in the control cohort. After adjusting for possible comorbidities, the hazard ratio of trigger finger in the hyperlipidemia cohort was 4.03 (95% confidence interval [CI], 3.57-4.55), with values of 4.59 (95% CI, 3.67-5.73) and 3.77 (95% CI, 3.26-4.36) among male and female patients, respectively. This large-scale population-based study demonstrated that hyperlipidemia is correlated to trigger finger.
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Affiliation(s)
- Pei-Tsen Chen
- Department of Physical Medicine and Rehabilitation, Cardinal Tien Hospital, New Taipei, Taiwan
- Department of Anatomy and Cell Biology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Han-Wei Zhang
- Biomedica Corporation, New Taipei, Taiwan
- Ph.D Program for Aging, China Medical University, Taichung, Taiwan
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
- Department of Electrical and Computer Engineering, Institute of Electrical Control Engineering, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Zhi-Ren Tsai
- Department of Computer Science & Information Engineering, Asia University, Taichung, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
- Center for Precision Medicine Research, Asia University, Taichung, Taiwan
| | | | | | - Jeffrey J P Tsai
- Center for Precision Medicine Research, Asia University, Taichung, Taiwan
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
| | - Chao-Wen Lin
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
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Atthakomol P, Manosroi W, Sathiraleela K, Thaiprasit N, Duangsan T, Tapaman A, Sripheng J. Prognostic factors related to recurrence of trigger finger after open surgical release in adults. J Plast Reconstr Aesthet Surg 2023; 83:352-357. [PMID: 37302240 DOI: 10.1016/j.bjps.2023.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 05/02/2023] [Accepted: 05/14/2023] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Recurrent trigger finger after surgery is one of the major adverse events. However, studies to identify factors associated with recurrence after open surgical release in adult trigger finger patients are still limited. PURPOSE To identify factors associated with recurrent trigger finger after open surgical release. METHODS This 12-year retrospective observational study included 723 patients with 841 trigger fingers who underwent open A1 pulley release. Patients were categorized into 2 groups: those with recurrent trigger finger after surgery and those without. Associations between potential predictors including age, sex, duration of symptoms, occupation status, active smoker status, number of steroid injections before surgery, and types of comorbidities and the outcome of interest, recurrence of trigger finger, were examined using univariable and multivariable analyses. The results are presented as hazard ratios (HR) with a 95% confidence interval (95% CI). RESULTS The recurrence rate after trigger finger release was 2.39% (20 of 841 fingers). After adjusting for confounders, more than 3 steroid injections before surgery and manual labor were the independent predictors of recurrent trigger finger (HR = 4.87, 95%CI = 1.06-22.35 and HR = 3.43, 95%CI = 1.15-10.23, respectively). CONCLUSIONS More than 3 steroid injections before surgery and manual labor increase the risk of recurrent trigger finger after an open A1 pulley release. There may be limited benefit in administering a fourth steroid injection.
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Affiliation(s)
- Pichitchai Atthakomol
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Musculoskeletal Science and Translational Research Center, Chiang Mai University, Chiang Mai, Thailand; Clinical Epidemiology and Clinical Statistic Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
| | - Worapaka Manosroi
- Clinical Epidemiology and Clinical Statistic Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
| | - Krittin Sathiraleela
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
| | - Nutthapong Thaiprasit
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
| | - Treephum Duangsan
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
| | - Atithep Tapaman
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
| | - Jiramate Sripheng
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
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Fitch MS, Thiese MS, Wood EM, Kapellusch JM, Hegmann KT. The Coexistence of Carpal Tunnel Syndrome in Workers With Trigger Digit. Hand (N Y) 2021; 16:753-758. [PMID: 31965852 PMCID: PMC8647321 DOI: 10.1177/1558944719893048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The objective of this study was to investigate the prevalence of carpal tunnel syndrome (CTS) in workers with trigger digit. There are few cross-sectional studies that assess this relationship. Methods: A baseline examination of 1216 workers from 17 diverse manufacturing facilities was conducted. Worker demographics, medical history, and symptoms of trigger digit were assessed. Age, sex, and body mass index were obtained. Biomechanical factors were individually measured using the Strain Index (SI). Prevalence was assessed with univariate and multivariate logistic regression. Results: Unadjusted prevalence of trigger digit was 12.0%, and among those workers, there was an unadjusted CTS prevalence of 26.7%. The adjusted multivariate model found an odds ratio (OR) of CTS of 1.56 (95% confidence interval [CI], 1.03-2.36) among the workers with trigger digit. The ORs of CTS for SI (OR = 1.53 [95% CI, 1.04-2.23]), age (OR = 1.03 [95% CI, 1.01-1.04]), and current smoking (OR = 1.76 [95% CI, 1.12-2.75]) were also significant. Sex and diabetes were not statistically significant covariates. Conclusion: The prevalence of CTS is higher among workers with trigger digit.
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Affiliation(s)
| | | | | | | | - Kurt T. Hegmann
- The University of Utah, Salt Lake City, USA,Kurt T. Hegmann, Rocky Mountain Center for Occupational and Environmental Health, The University of Utah, 391 Chipeta Way, Suite C, Salt Lake City, UT 84108, USA.
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Abstract
Trigger finger is a common condition usually curable by a safe, simple
corticosteroid injection. Trigger finger results from a stenotic A1 pulley that
has lost its gliding surface producing friction and nodular change in the
tendon. This results in pain and tenderness to palpation of the A1 pulley,
progressing to catching and then locking. Splinting for 6 to 9 weeks produces
gradual improvement in most patients as does a quick steroid injection with the
latter resulting in resolution of pain in days and resolution of catching or
locking in a few weeks. Percutaneous or open release should be reserved for
injection failures particularly those at high risk for continued injection
failure including diabetics and those with multiple trigger fingers. We present
a step-by-step method for injection with illustrations to encourage primary care
providers to offer this easily performed procedure to their patients.
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Affiliation(s)
- Stephen P. Merry
- Mayo Clinic, Rochester, MN, USA
- Stephen P. Merry, Mayo Clinic, 200 First
Street SW, Rochester, MN 55905, USA.
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Aspinen S, Nordback PH, Anttila T, Stjernberg-Salmela S, Ryhänen J, Kosola J. Platelet-rich plasma versus corticosteroid injection for treatment of trigger finger: study protocol for a prospective randomized triple-blind placebo-controlled trial. Trials 2020; 21:984. [PMID: 33246497 PMCID: PMC7694424 DOI: 10.1186/s13063-020-04907-w] [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] [Received: 04/06/2020] [Accepted: 11/16/2020] [Indexed: 11/22/2022] Open
Abstract
Background Trigger finger is a common hand disorder that limits finger range of motion and causes pain and snapping of the affected finger. Trigger finger is caused by an imbalance of the tendon sheath and the flexor tendon. The initial treatment is generally a local corticosteroid injection around the first annular (A1) pulley. However, it is not unusual that surgical release of the A1 pulley is required. Moreover, adverse events after local corticosteroid injection or operative treatment may occur. Platelet-rich plasma (PRP) has been shown to be safe and to reduce symptoms in different tendon pathologies, such as DeQuervain’s disease. However, the effects of PRP on trigger finger have not been studied. The aim of this single-center triple-blind randomized controlled trial is to study whether PRP is non-inferior to corticosteroid injection in treating trigger finger. The secondary outcome is to assess the safety and efficacy of PRP in comparison to placebo. Methods The trial is designed as a randomized, controlled, patient-, investigator-, and outcome assessor-blinded, single-center, three-armed 1:1:1 non-inferiority trial. The patients with clinical symptoms of trigger finger will be randomly assigned to treatment with PRP, corticosteroid, or normal saline injection. The primary outcome is Patient-Rated Wrist Evaluation and symptom resolution. Secondary outcomes include Quick-Disabilities of the Arm, Shoulder and Hand; pain; grip strength; finger active range of motion; and complications. Appropriate statistical methods will be applied. Discussion We present a novel RCT study design on the use of PRP for the treatment of trigger finger compared to corticosteroid and normal saline injection. The results of the trial will indicate if PRP is appropriate for the treatment of trigger finger. Trial registration ClinicalTrials.gov NCT04167098. Registered on November 18, 2019.
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Affiliation(s)
- Samuli Aspinen
- Department of Hand Surgery, Helsinki University Hospital, Topeliuksenkatu 5, 00260, Helsinki, Finland.
| | - Panu H Nordback
- Department of Hand Surgery, Helsinki University Hospital, Topeliuksenkatu 5, 00260, Helsinki, Finland
| | - Turkka Anttila
- Department of Hand Surgery, Helsinki University Hospital, Topeliuksenkatu 5, 00260, Helsinki, Finland
| | | | - Jorma Ryhänen
- Department of Hand Surgery, Helsinki University Hospital, Topeliuksenkatu 5, 00260, Helsinki, Finland
| | - Jussi Kosola
- Department of Orthopaedics and Traumatology, Kanta-Häme Central Hospital, Ahvenistontie 20, 13530, Hämeenlinna, Finland
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Vasiliadis AV, Charitoudis G, Giotis D, Paschos NK, Malahias MA, Drosos G. Hand disorders demographics in rural areas: A 15-year analysis of demographic characteristics overtime in a stable population. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2020; 54:604-608. [PMID: 33423992 DOI: 10.5152/j.aott.2020.19184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to determine the incidence of hand disorders in a general rural area, record the demographic characteristics for each condition, and evaluate the tendencies overtime in the incidence of these conditions. METHODS Using nationwide census data, we identified a health network system serving a geographic area with stable population. Subsequently, we retrospectively analyzed all the patient records (n=731 patients) with hand disorders documented between 2001 and 2015. We performed a retrospective review and collected demographic data for the patients and disorders treated surgically. We calculated the incidence of these conditions based on the census data and performed qualitative and categorical analysis with different demographic and disease-related variables. RESULTS We reviewed surgically treated 204 male and 527 female patients with hand disorders. The mean annual incidence was 222.5 cases per 100,000 individuals per year. More than 55% of the patients were between 50 and 69 years old. Trigger finger (TF) accounted for approximately 42% of patients, followed by 35% with carpal tunnel syndrome (CTS). TF and CTS were related to hand dominance, and right hand was affected in 53.4% of the patients. CONCLUSION Hand disorders in a rural area seem to correlate with the occupational sector activities, such as farming and agriculture. CTS was the most common disorder in the past; however, the dramatic increase in the incidence rate of TF made it the most common hand disorder in the last decade. Incidence rates in both males and females showed an increasing trend.
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Affiliation(s)
- Angelo V Vasiliadis
- Clinic of Orthopaedic Surgery, General Hospital of Grevena, Grevena, Greece;Clinic of Surgical Oncology, "Theagenio" Cancer Hospital of Thessaloniki, Thessaloniki, Greece
| | | | - Dimitrios Giotis
- Clinic of Orthopaedic Surgery, General Hospital of Grevena, Grevena, Greece
| | - Nikolaos K Paschos
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Georgios Drosos
- Clinic of Orthopaedic Surgery, General Hospital of Grevena, Grevena, Greece
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Dogru M, Erduran M, Narin S. The Effect of Radial Extracorporeal Shock Wave Therapy in the Treatment of Trigger Finger. Cureus 2020; 12:e8385. [PMID: 32637267 PMCID: PMC7331918 DOI: 10.7759/cureus.8385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective The aim of this study was to investigate the effect of radial extracorporeal shock wave therapy (rESWT) on the treatment of trigger finger. Methods Eighteen patients, who were 2nd grade according to Quinnel classification and diagnosed with trigger finger, were included in this prospective cohort clinical study. The study consisted of only the experimental group and no control group. Eighteen patients with trigger fingers were applied to ten sessions, twice a week, for five weeks of rESWT (2000 impulses, 2 bar, 10 Hz). Pain scores (Numeric Pain Rating Scale), general functional capacity (Quick-DASH), range of motion, grip strength, and pinch strength were evaluated before treatment, after treatment, and three months after the treatment. Results Evaluation of ten sessions of rESWT that applied twice a week, for five weeks, was made before treatment, after treatment, and three months after the treatment. Statistical analyses were performed with the Friedman test. As a result of the analyses, there was a decrease in the pain levels (p < 0.001) and increase in general functional capacity, grip strength and pinch strength (p < 0.001), and range of motion (p < 0.001; p < 0.005). After the treatment and after three months, all outcome measures showed statistically significant improvements. Conclusion rESWT is an effective method to decrease pain severity and improve general functional capacity, range of motion, grip strength, and pinch strength in patients with trigger finger. We concluded that the treatment of rESWT might be a non-invasive option to treat the trigger finger. However, randomized controlled trials are needed to provide more evidence of this treatment
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Affiliation(s)
- Mahbube Dogru
- Physiotherapy and Rehabilitation, Institute of Health, Dokuz Eylul University, Izmir, TUR
| | - Mehmet Erduran
- Orthopaedics and Traumatology, Dokuz Eylul University, Izmir, TUR
| | - Selnur Narin
- Physiotherapy and Rehabilitation, Institute of Health, Dokuz Eylul University, Izmir, TUR
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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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Vasiliadis AV, Itsiopoulos I. Trigger Finger: An Atraumatic Medical Phenomenon. J Hand Surg Asian Pac Vol 2017; 22:188-193. [DOI: 10.1142/s021881041750023x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Trigger finger is a mechanical problem with many etiological factors as possible causes, such as diabetes mellitus, carpal tunnel syndrome and repetitive finger movements. Although it can afflict anyone, it is much commoner in middle-aged women than men and the most commonly involved digit is reported to be the thumb. The diagnosis is mainly based on clinical symptoms during examination and first-line treatment is conservative with splinting and corticosteroid injections. Surgical open release is the “gold standard” of trigger finger treatment because it allows more careful inspection of the surgical area and is highly effective with low complication rates.
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Affiliation(s)
- Angelo V. Vasiliadis
- Department of Surgery, Division of Orthopaedic Surgery, General Hospital of Grevena, Grevena
- Department of Physical Education and Sports Science in Serres, Aristotle University of Thessaloniki, Thessaloniki
| | - Iraklis Itsiopoulos
- 1st Propedeutic Surgical Clinic, Aristotle’s University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
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12
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Malliaropoulos N, Jury R, Pyne D, Padhiar N, Turner J, Korakakis V, Meke M, Lohrer H. Radial extracorporeal shockwave therapy for the treatment of finger tenosynovitis (trigger digit). Open Access J Sports Med 2016; 7:143-151. [PMID: 27843364 PMCID: PMC5098764 DOI: 10.2147/oajsm.s108126] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Introduction Stenosing tenosynovitis that is characterized by the inability to flex the digit smoothly, usually leads to prolonged rehabilitation or surgery. Study design This case series is a retrospective cohort study. Purpose The aim of this case series was to evaluate the effectiveness of radial extracorporeal shockwave therapy (rESWT) for the treatment of stenosing tenosynovitis of the digital flexor tendon (trigger digit). Methods A retrospective analysis of 44 patients (49 fingers) treated with an individually adapted rESWT protocol was conducted. Trigger digit pain and function were evaluated at baseline and 1-, 3-, and 12-months posttreatment. Recurrence and pretreatment symptom duration were analyzed. Results Significant reductions in pain scores and functional improvement were found between baseline and all follow-up assessments (P<0.001). Pretreatment symptom duration was significantly correlated with the number of rESWT sessions required (r=0.776, P<0.001) and 1-year posttreatment pain score (r=0.335, P=0.019). Conclusion This study provides initial evidence that rESWT is an effective treatment for trigger digit, but randomised controlled trials are required to provide further evidence of this effect.
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Affiliation(s)
- Nikos Malliaropoulos
- Sports and Exercise Medicine, Thessaloniki Musculoskeletal Clinic; Thessaloniki National Track and Field Centre, Sports Medicine Clinic of S.E.G.A.S., Thessaloniki, Greece; European Sports Care; Department of Rheumatology, Sports Clinic, Barts Health NHS Trust; Centre for Sports & Exercise Medicine, Queen Mary University of London, London, UK
| | - Rosanna Jury
- Sports and Exercise Medicine, Thessaloniki Musculoskeletal Clinic; Thessaloniki National Track and Field Centre, Sports Medicine Clinic of S.E.G.A.S., Thessaloniki, Greece; Centre for Sports & Exercise Medicine, Queen Mary University of London, London, UK
| | - Debasish Pyne
- European Sports Care; Department of Rheumatology, Sports Clinic, Barts Health NHS Trust; Centre for Sports & Exercise Medicine, Queen Mary University of London, London, UK
| | - Nat Padhiar
- European Sports Care; Centre for Sports & Exercise Medicine, Queen Mary University of London, London, UK
| | | | - Vasileios Korakakis
- European Sports Care; Aspetar, Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Maria Meke
- Sports and Exercise Medicine, Thessaloniki Musculoskeletal Clinic
| | - Heinz Lohrer
- European Sports Care; European SportsCare Network (ESN), Zentrum für Sportorthopädie, Wiesbaden-Nordenstadt, Germany
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Karltun J, Vogel K, Bergstrand M, Eklund J. Maintaining knife sharpness in industrial meat cutting: A matter of knife or meat cutter ability. APPLIED ERGONOMICS 2016; 56:92-100. [PMID: 27184316 DOI: 10.1016/j.apergo.2016.03.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 03/18/2016] [Accepted: 03/20/2016] [Indexed: 06/05/2023]
Abstract
Knife sharpness is imperative in meat cutting. The aim of this study was to compare the impact of knife blade steel quality with meat cutters' individual ability to maintain the cutting edge sharp in an industrial production setting. Twelve meat cutters in two different companies using three different knives during normal production were studied in this quasi-experimental study. Methods included were measuring knife cutting force before and after knife use, time knives were used, ratings of sharpness and discomfort and interviews. Results showed that the meat cutters' skill of maintaining sharpness during work had a much larger effect on knife sharpness during work than the knife steel differences. The ability was also related to feelings of discomfort and to physical exertion. It was found that meat cutters using more knives were more likely to suffer from discomfort in the upper limbs, which is a risk for developing MSD.
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Affiliation(s)
- J Karltun
- School of Engineering, Jönköping University, P.O Box 1026, SE-551 11 Jönköping, Sweden.
| | - K Vogel
- KTH Royal Institute of Technology, STH, Unit of Ergonomics, Alfred Nobels allé 10, SE-141 52 Huddinge, Sweden.
| | - M Bergstrand
- Avonova Hälsa, Repslagaregatan 4, SE-591 30 Motala, Sweden.
| | - J Eklund
- KTH Royal Institute of Technology, STH, Unit of Ergonomics, Alfred Nobels allé 10, SE-141 52 Huddinge, Sweden.
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MR imaging findings of trigger thumb. Skeletal Radiol 2015; 44:1201-7. [PMID: 26028473 DOI: 10.1007/s00256-015-2172-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 05/12/2015] [Accepted: 05/13/2015] [Indexed: 02/02/2023]
Abstract
Trigger finger (or trigger thumb), also known as sclerosing tenosynovitis, is a common clinical diagnosis that rarely presents for imaging. Because of this selection bias, many radiologists may not be familiar with the process. Furthermore, patients who do present for imaging frequently have misleading examination indications. To our knowledge, magnetic resonance (MR) imaging findings of trigger thumb have not been previously reported in the literature. In this article, we review the entity of trigger thumb, the anatomy involved, and associated imaging findings, which include flexor pollicis longus tendinosis with a distinct nodule, A1 pulley thickening, and tenosynovitis. In addition, in some cases, an abnormal Av pulley is apparent. In the rare cases of trigger finger that present for MR imaging, accurate diagnosis by the radiologist can allow initiation of treatment and avoid further unnecessary workup.
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Vogel K, Eklund J. On physiological demands and sustainability in meat cutting. ERGONOMICS 2014; 58:463-479. [PMID: 25383723 DOI: 10.1080/00140139.2014.975287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
UNLABELLED Meat cutters' work has been investigated by several researchers. However, knowledge about the physiological demands of meat cutting is almost lacking. The aim of this explorative study was to assess physiological demands in meat cutting, to compare them with International Labour Organization (ILO) recommendations for acceptable workload and to discuss the findings in relation to individual and work-related factors. In accordance with the ILO recommendations, work was categorised as sustainable or non-sustainable based on critical relative aerobic strain (RAS) levels. Twenty-one beef and pork cutters participated in the study, which included workload measurements, assessment of workplace and individual factors. Thirteen meat cutters were categorised as having non-sustainable and eight as having sustainable work. Results suggest that the workload is higher in beef cutting than in pork cutting, and that longer work experience is related to lower RAS. Other factors contributing to the physical workload are discussed. PRACTITIONER SUMMARY Meat-cutting work may exceed recommended physical workload levels. Beef cutting is physically more demanding than pork cutting. Furthermore, factors such as years in the profession, knife sharpness, work pace, wage system, working technique, maximum oxygen uptake level and muscular strength should be considered when planning actions regarding the workload for meat cutters.
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Affiliation(s)
- Kjerstin Vogel
- a Unit of Ergonomics, KTH Royal Institute of Technology , Huddinge , Sweden
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Kapellusch JM, Garg A, Hegmann KT, Thiese MS, Malloy EJ. The Strain Index and ACGIH TLV for HAL: risk of trigger digit in the WISTAH prospective cohort. HUMAN FACTORS 2014; 56:98-111. [PMID: 24669546 DOI: 10.1177/0018720813493115] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE The objective of this study was to investigate the association between job physical exposure (JPE) and incidence of flexor tendon entrapment of the digits (FTED). BACKGROUND FTED, commonly known as trigger digit, is associated with age, gender, and certain health disorders. Although JPE has been suggested as a risk factor for FTED, there are no prospective cohort studies. METHOD A cohort of 516 workers was enrolled from 10 diverse manufacturing facilities and followed monthly for 6 years. Worker demographics, medical history, and symptoms of FTED were assessed. JPE was individually measured using the Strain Index (SI) and American Conference of Governmental Industrial Hygienists (ACGIH) threshold limit value for hand activity level (TLV for HAL). Changes in JPE (assessed quarterly) and symptoms (assessed monthly) were recorded during follow-up. FTED was defined as demonstrated triggering on examination. RESULTS Point prevalence of FTED at baseline was 3.6%. During follow-up there were 23 incident FTED cases (left and/or right hands). The incident rate for first occurrence of FTED from enrollment was 1.38 per 100 person-years. Risk factors were JPE, age, gender, diabetes mellitus, carpometacarpal osteoarthrosis, and rheumatoid arthritis. In multivariate models, the SI showed strong association with risk of FTED when treated as a continuous variable and marginal association when dichotomized (SI > 6.1). TLV for HAL showed a statistical trend of increasing risk of FTED using the ACGIH limits, but no association as a continuous variable. CONCLUSIONS Both JPE and personal risk factors are associated with FTED development. The SI and TLV for HAL are useful tools for estimating JPE.
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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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Liu KJ, Thomson JG. Experimental model of trigger finger through A1 pulley constriction in a human cadaveric hand: a pilot study. J Hand Surg Am 2013; 38:1933-40. [PMID: 23978786 DOI: 10.1016/j.jhsa.2013.06.033] [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] [Received: 03/16/2012] [Revised: 06/22/2013] [Accepted: 06/26/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE Although it can be reasonably assumed that trigger digits occur as the result of a size mismatch in the pulley-tendon system, it is unclear whether locking, histological changes, and nodule formation occur owing to an intrinsically too small pulley or an enlarged digital flexor tendon. Our purposes in this feasibility study were to (1) create a model of trigger digit by pulley constriction in nonpreserved human tissue, (2) measure the change in work of flexion as the force of pulley constriction increased, (3) compare the work of flexion between nontriggering and triggering conditions, and (4) determine whether triggering can occur at the A2, A3, and A4 pulleys under similar conditions. METHODS Using a tensiometer, we studied the work of flexion in 4 fingers (thumb, index, middle, and ring) in a human cadaveric hand. The load of flexion was measured as the A1 to A4 pulleys were incrementally constricted in order to induce triggering. Work of flexion was analyzed for differences among trial conditions. RESULTS Triggering was successfully induced in all 4 digits through constriction of the A1 pulley. No triggering occurred in any of the A2, A3, or A4 pulley systems in this model. CONCLUSIONS We successfully created a trigger model in a human cadaveric hand. Our results demonstrate that the A1 pulley can cause triggering from manual constriction of the pulley alone. CLINICAL RELEVANCE A trigger model such as this may allow investigations of pathophysiology, and this may result in novel treatment strategies and modalities.
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Affiliation(s)
- Kristina J Liu
- Section of Plastic Surgery, Yale University School of Medicine, New Haven, Connecticut
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Alvarez-Nemegyei J, Canoso JJ. Evidence-based soft tissue rheumatology: epicondylitis and hand stenosing tendinopathy. J Clin Rheumatol 2012; 10:33-40. [PMID: 17043459 DOI: 10.1097/01.rhu.0000111312.98454.f8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Lateral and medial epicondylitis represent overuse tendinopathies of wrist extensor and wrist flexor muscles, respectively. In lateral epicondylitis, a short-term therapeutic efficacy of glucocorticoid injection and limited evidence on the efficacy of acupuncture has been shown. De Quervain tendinopathy is caused by tendinous impingement by a thickened retinaculum. There is limited evidence on the efficacy of glucocorticoid injection in this condition.Trigger finger usually results from tendon entrapment beneath a thickened A1 flexor pulley. An association with hand tool use and diabetes has been shown in this condition, and there is evidence on the therapeutic efficacy of glucocorticoid injection. No other therapeutic modality has shown efficacy or has been assessed in a placebo-controlled clinical trial in these conditions.It can be concluded that epicondylitis and stenosing tendinopathy are readily diagnosed, and most patients recover with current therapies. However, still unsolved issues preclude a purely evidence-based approach to these entities.
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Affiliation(s)
- Jose Alvarez-Nemegyei
- From the *Servicio de Reumatología, Hospital de Especialidades, Centro Médico Nacional “Ignacio García Téllez”, Instituto Mexicano del Seguro Social, Mérida, Yucatán, México; and †ABC Medical Center, Mexico City, México, and Tufts University School of Medicine, Boston, Massachusetts
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Garg A, Hegmann KT, Wertsch JJ, Kapellusch J, Thiese MS, Bloswick D, Merryweather A, Sesek R, Deckow-Schaefer G, Foster J, Wood E, Kendall R, Sheng X, Holubkov R. The WISTAH hand study: a prospective cohort study of distal upper extremity musculoskeletal disorders. BMC Musculoskelet Disord 2012; 13:90. [PMID: 22672216 PMCID: PMC3476983 DOI: 10.1186/1471-2474-13-90] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Accepted: 06/06/2012] [Indexed: 11/21/2022] Open
Abstract
Background Few prospective cohort studies of distal upper extremity musculoskeletal disorders have been performed. Past studies have provided somewhat conflicting evidence for occupational risk factors and have largely reported data without adjustments for many personal and psychosocial factors. Methods/design A multi-center prospective cohort study was incepted to quantify risk factors for distal upper extremity musculoskeletal disorders and potentially develop improved methods for analyzing jobs. Disorders to analyze included carpal tunnel syndrome, lateral epicondylalgia, medial epicondylalgia, trigger digit, deQuervain’s stenosing tenosynovitis and other tendinoses. Workers have thus far been enrolled from 17 different employment settings in 3 diverse US states and performed widely varying work. At baseline, workers undergo laptop administered questionnaires, structured interviews, two standardized physical examinations and nerve conduction studies to ascertain demographic, medical history, psychosocial factors and current musculoskeletal disorders. All workers’ jobs are individually measured for physical factors and are videotaped. Workers are followed monthly for the development of musculoskeletal disorders. Repeat nerve conduction studies are performed for those with symptoms of tingling and numbness in the prior six months. Changes in jobs necessitate re-measure and re-videotaping of job physical factors. Case definitions have been established. Point prevalence of carpal tunnel syndrome is a combination of paraesthesias in at least two median nerve-served digits plus an abnormal nerve conduction study at baseline. The lifetime cumulative incidence of carpal tunnel syndrome will also include those with a past history of carpal tunnel syndrome. Incident cases will exclude those with either a past history or prevalent cases at baseline. Statistical methods planned include survival analyses and logistic regression. Discussion A prospective cohort study of distal upper extremity musculoskeletal disorders is underway and has successfully enrolled over 1,000 workers to date.
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Affiliation(s)
- Arun Garg
- Center for Ergonomics, University of Wisconsin-Milwaukee, Milwaukee, WI 53201, USA.
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Cakmak F, Wolf MB, Bruckner T, Hahn P, Unglaub F. Follow-up investigation of open trigger digit release. Arch Orthop Trauma Surg 2012; 132:685-91. [PMID: 22160513 DOI: 10.1007/s00402-011-1440-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this retrospective study was to identify the postoperative complications and disorders associated with open trigger finger release. Factors that were investigated by this study included demographic details, the number of digits affected, BMI, level of manual strain, trauma, received systemic medication, hand dominance, pre-treatment with steroid injection, and concomitant diseases. METHODS One hundred and three patients, who underwent open release surgery for 117 trigger fingers and thumbs, were followed up until complete resolution of all complaints. Patients' age, BMI, hand dominance, occupational manual strain, and previous medical history regarding trigger finger or thumb were obtained. Associated conditions and medical treatment, trauma, and previous hand surgical interventions were included as well. Details regarding duration of complaints, ROM, visual analogue pain scale, swelling, recurrence of the disease following previous surgical release, and persistence of complaints following corticosteroid injection were examined. RESULTS The dominant hand was not significantly more frequently affected than the non-dominant hand. Occupation also did not influence the incidence of trigger digit. Patients with systemic steroid therapy had a significantly shorter duration of postoperative symptoms with a mean duration of 29.3 days (range, 28-31 days ± 1.3). Significantly less postoperative swelling was noticed in patients with a pre-surgical steroid injection. The mean duration of symptoms before and after surgery was significantly shorter for a trigger thumb than for trigger finger. DISCUSSION Open trigger digit release constitutes an adequate low-risk surgical procedure for treatment of trigger digit. In this study, we could show that the incidence of this disease is not significantly correlated with the manual strain, trauma, BMI, hand dominance or concomitant diseases like diabetes mellitus, rheumatoid arthritis, renal insufficiency, and hypothyroidism. Additionally, this study illustrates the importance of a careful postoperative follow-up treatment to avoid potential persistent functional limitations.
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Affiliation(s)
- Fedaye Cakmak
- Department of Hand Surgery, Vulpiusklinik, Bad Rappenau, Germany
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Abstract
Trigger finger is a common finger aliment, thought to be caused by inflammation and subsequent narrowing of the A1 pulley, which causes pain, clicking, catching, and loss of motion of the affected finger. Although it can occur in anyone, it is seen more frequently in the diabetic population and in women, typically in the fifth to sixth decade of life. The diagnosis is usually fairly straightforward, as most patients complain of clicking or locking of the finger, but other pathological processes such as fracture, tumor, or other traumatic soft tissue injuries must be excluded. Treatment modalities, including splinting, corticosteroid injection, or surgical release, are very effective and are tailored to the severity and duration of symptoms.
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Psychosocial factors at work and perceived health among agricultural meat industry workers in France. Int Arch Occup Environ Health 2009; 82:807-18. [PMID: 19466444 DOI: 10.1007/s00420-009-0430-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2007] [Accepted: 05/08/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The objective of this study was to describe the perceived health status of the meat industry employees--i.e., working in the slaughtering, cutting, and boning of large animals and poultry--and its relation to their organisational and psychosocial constraints at work. METHODS This postal survey included all 3,000 employees of the meat industry (beef, pork and poultry) in four districts in Brittany, France, whose companies were affiliated with the agricultural branch of the national health insurance fund. The questionnaire asked for social and demographic data and information describing their job and the organisation of their work. The psychosocial factors at work were described according to Karasek's questionnaire (demand, latitude and social support at work). Perceived health was measured with the Nottingham Health Profile perceived health indicator. RESULTS This study shows the high prevalence of poor health reported by the workers in this industry. This poor perceived health was worse in women and increased regularly with age. Among the psychosocial factors studied, high quantitative and qualitative demand at work, inadequate resources for good work and to a lesser extent, inadequate prospects for promotion appear especially associated with poor perceived health. Other factors often associated with poor perceived health included young age at the first job and work hours that disrupt sleep rhythms (especially for women). CONCLUSION Our results show that this population of workers is especially vulnerable from the point of view of perceived physical and psychological health and is exposed to strong physical, organisational and psychosocial constraints at work. They also demonstrate that poor perceived health is associated with some psychosocial (such as high psychological demand and insufficient resources) and organisational factors at work. These results, in conjunction with those from other disciplines involved in studying this industry, may help the companies to develop preventive activities.
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Peters-Veluthamaningal C, van der Windt DAWM, Winters JC, Meyboom-de Jong B. Corticosteroid injection for trigger finger in adults. Cochrane Database Syst Rev 2009:CD005617. [PMID: 19160256 DOI: 10.1002/14651858.cd005617.pub2] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Trigger finger is a disease of the tendons of the hand leading to triggering (locking) of affected fingers, dysfunction and pain. Available treatments include local injection with corticosteroids, surgery, or splinting. OBJECTIVES To summarize the evidence on the efficacy and safety of corticosteroid injections for trigger finger in adults using the following endpoints: treatment success, frequency of triggering or locking, functional status of the affected fingers, and severity of pain of the fingers. SEARCH STRATEGY The databases CENTRAL, DARE, MEDLINE (1966 to November 2007), EMBASE (1956 to November 2007), CINAHL (1982 to November 2007), AMED (1985 to November 2007) and PEDro (a physiotherapy evidence database) were searched. SELECTION CRITERIA We selected randomized and controlled clinical trials evaluating efficacy and safety of corticosteroid injections for trigger finger in adults. DATA COLLECTION AND ANALYSIS The databases were searched for titles of eligible studies. After screening abstracts of these studies, full text articles of studies which fulfilled the selection criteria were obtained. Data were extracted using a predefined electronic form. The methodological quality of included trials was assessed by using items from the checklist developed by Jadad and the Delphi list. We planned to extract data regarding information on the primary outcome measures: treatment success, frequency of triggering or locking, and functional impairment of fingers, severity of the trigger finger; and the secondary outcome measures: proportion of patients with side effects, types of side effects, and patient satisfaction with injection. MAIN RESULTS Two randomized controlled studies were found that involved 63 participants: 34 were allocated to corticosteroids and lidocaine, and 29 were allocated to lidocaine alone. Corticosteroid injection with lidocaine was more effective than lidocaine alone on treatment success at four weeks (relative risk 3.15, 95% CI 1.34 to 7.40). The number needed to treat to benefit was 3. No adverse events or side effects were reported. AUTHORS' CONCLUSIONS The effectiveness of local corticosteroid injections was studied in only two small randomized controlled trials of poor methodological quality. Both studies showed better short-term effects of corticosteroid injection combined with lidocaine compared to lidocaine alone on the treatment success outcome. In one study the effects of corticosteroid injections lasted up to four months. No adverse effects were observed. The available evidence for the effectiveness of intra-tendon sheath corticosteroid injection for trigger finger can be graded as a silver level evidence for superiority of corticosteroid injections combined with lidocaine over injections with lidocaine alone.
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Affiliation(s)
- Cyriac Peters-Veluthamaningal
- Department of General Practice, University Medical Center Groningen, Antonius Deusinglaan 1, Groningen, Netherlands, 9713 AV.
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Mehrotra S. Trigger finger: functional pulley release by 'N'-plasty. J Plast Reconstr Aesthet Surg 2008; 63:e114-5. [PMID: 19083278 DOI: 10.1016/j.bjps.2008.08.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2008] [Accepted: 08/12/2008] [Indexed: 10/21/2022]
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Abstract
Trigger finger is a common disease particularly in the middle aged women. A very rare case in which an adult man had 10 trigger fingers was experienced. He was treated with local steroid injections in both thumbs, but trigger finger disease has been aggravated in every digit of both hands. We performed an early operative treatment. Three months after the operation, the patient could perform his work without discomfort in his hands and showed normal range of motion in all fingers.
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Affiliation(s)
- Young-Keun Lee
- Dr. Park's Orthopedic Clinic, 962-3 Seosin-dong, Wansan-gu, Chonju, Korea.
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Walker-Bone KE, Palmer KT, Reading I, Cooper C. Soft-tissue rheumatic disorders of the neck and upper limb: prevalence and risk factors. Semin Arthritis Rheum 2004; 33:185-203. [PMID: 14671728 DOI: 10.1016/s0049-0172(03)00128-8] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To review the epidemiologic literature concerning the occurrence of and the risk factors for pain and specific soft-tissue rheumatic conditions that affect the neck and upper limbs. METHODS An extensive search of the literature, including a search of Medline and EMBASE, authoritative recent reviews, and relevant textbooks, was performed. Studies that furnished data about the occurrence of or risk factors for regional pain or specific soft-tissue entities were extracted. RESULTS Numerous epidemiologic studies among different populations suggest a high prevalence of pain in the neck (10% to 19%), shoulder (18% to 26%), elbow (8% to 12%), and wrist/hand (9% to 17%) at any point in time. Less clear is the proportion of pain caused by specific upper-limb disorders as compared with nonspecific pain; however, as many as 6% of adults may have carpal tunnel syndrome. Significant risk factors for these disorders include age, female gender, obesity, and association with mechanical exposures (eg, posture, force, repetition, vibration) in the workplace. Also implicated are psychologic well-being and psychosocial workplace factors such as high levels of demand, poor control, and poor support. CONCLUSION Pain and soft-tissue rheumatic disorders of the neck and upper limb are common. It appears that individual, mechanical, and psychosocial factors all contribute to upper-limb disorders, suggesting that future strategies for prevention will need to address each of these factors if they are to be successful.
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Affiliation(s)
- Karen E Walker-Bone
- Medical Research Council Environmental Epidemiology Unit, University of Southampton, England
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Casarotto RA, Mendes LF. Queixas, doenças ocupacionais e acidentes de trabalho em trabalhadores de cozinhas industriais. REVISTA BRASILEIRA DE SAÚDE OCUPACIONAL 2003. [DOI: 10.1590/s0303-76572003000200011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
As atividades desenvolvidas em cozinhas industriais apresentam um conjunto de características que podem desencadear doenças ocupacionais e acidentes de trabalho típicos. O objetivo deste estudo é comparar a prevalência de doenças ocupacionais, acidentes de trabalho e dores músculo-esqueléticas em trabalhadores de cinco cozinhas industriais. Para alcançar estes objetivos, foram avaliados 257 trabalhadores de cinco cozinhas industriais, com os seguintes procedimentos: entrevistas, questionários, análise da atividade real e aplicação do método NIOSH. Utilizou-se o teste qui-quadrado (x) para comparar a homogeneidade dos dados entre os trabalhadores. Excetuando-se a prevalência de dor na região dorsal da coluna (p=0,01) e alergia (p=0,00461), todas as variáveis estudadas apresentaram p>0,05, mostrando a homogeneidade entre os trabalhadores. A análise ergonômica identificou os seguintes problemas: ambiente físico (dimensões, configurações, ambiências), instrumentos e equipamentos inadequados, má postura, organização do trabalho inadequada e levantamento de pesos acima dos limites recomendados.
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Tanaka S, Petersen M, Cameron L. Prevalence and risk factors of tendinitis and related disorders of the distal upper extremity among U.S. workers: comparison to carpal tunnel syndrome. Am J Ind Med 2001; 39:328-35. [PMID: 11241566 DOI: 10.1002/1097-0274(200103)39:3<328::aid-ajim1021>3.0.co;2-i] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND National estimates of tendinitis and related disorders of the distal upper extremity among U.S. workers have not been available with the exception of carpal tunnel syndrome. METHODS The Occupational Health Supplement Data of the 1988 National Health Interview Survey were analyzed for tendinitis and related disorders of the hand/wrist and elbow (distal upper extremity) using the Survey Data Analysis (SUDAAN) software. RESULTS Among the 30,074 respondents (statistically weighted population of 127 million) who had worked anytime during the previous 12 months, 0.46% (95% CI: 0.36, 0.56) reported that they experienced a "prolonged" hand discomfort which was called tendinitis, synovitis, tenosynovitis, deQuervain's disease, epicondylitis, ganglion cyst, or trigger finger, by a medical person. This corresponds to 588,000 persons (95% CI: 457,000; 712,000) reporting one of these disorders, 28% (or 164,000) of which were thought to be work-related by the medical person. Among various risk factors examined by multiple logistic regression analysis, bending/twisting of the hands/wrists at work and female gender were significantly associated with reporting of these disorders. CONCLUSIONS By combining these cases with the previously reported cases of work-related carpal tunnel syndrome, we estimate that there were approximately 520,000 cases of work-related musculoskeletal disorders of the distal upper extremity among US workers in 1988.
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Affiliation(s)
- S Tanaka
- Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, U.S. Public Health Service, Cincinnati, Ohio 45226, USA.
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Abstract
Flexor tendon entrapment of the digits is a disorder characterized by snapping or locking of the thumb or fingers (with or without pain). Most cases are secondary to thickening of the digit's A1 pulley, but other pathogeneses include tendon abnormalities at the level of the carpal tunnel, thickening of other pulleys, and abnormalities of the metacarpal-phalangeal joint. Its historical name, stenosing tenosynovitis of the digits, is inappropriate because histological studies document a lack of inflammation. Flexor tendon entrapment of the digits is a relatively common, uncomplicated, and non-controversial musculotendinous disorder of the distal upper extremity. The purpose of this invited review is to summarize information from the medical literature on aspects of this condition likely to be of interest and relevant to occupational medicine practitioners. Topics covered include normal anatomy and kinesiology, history, clinical observations related to diagnosis, pathology, pathophysiology, clinical observations on etiology, descriptive epidemiology, epidemiological studies, and case management. Models for the pathogenesis of flexor tendon entrapment of the digits are proposed, and opportunities for future research are presented.
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Affiliation(s)
- J S Moore
- NSF Industry/University Cooperative Research Center in Ergonomics, Texas A&M University, College Station 78443-3133, USA.
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