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Fisher MM, Allen AD, Jeffs AD, Wellborn PK, Hu D, Patterson JMM, Draeger RW. A Comparison of Patient Characteristics and Outcomes Between Patients Receiving Flexor Digitorum Superficialis Slip Excision or Isolated A1 Pulley Release for Trigger Finger. J Hand Surg Am 2024:S0363-5023(24)00057-1. [PMID: 38506783 DOI: 10.1016/j.jhsa.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 01/31/2024] [Accepted: 02/07/2024] [Indexed: 03/21/2024]
Abstract
PURPOSE Resection of the radial or ulnar slip of the flexor digitorum superficialis (FDS) tendon is a known treatment option for persistent trigger finger. Risk factors for undergoing FDS slip excision are unclear. We hypothesized that patients who underwent A1 pulley release with FDS slip excision secondary to persistent triggering would have a higher comorbidity burden compared to those receiving A1 pulley release alone. METHODS We identified all adult patients who underwent A1 pulley release with FDS slip excision because of persistent triggering either intraoperatively or postoperatively from 2018 to 2023. We selected a 3:1 age- and sex-matched control group who underwent isolated A1 pulley release. Charts were retrospectively reviewed for demographics, selected comorbidities, trigger finger history, and postoperative course. We performed multivariable logistic regression to assess the probability of FDS slip excision after adjusting for several variables that were significant in bivariate comparisons. RESULTS We identified 48 patients who underwent A1 pulley release with FDS slip excision and 144 controls. Our multivariable model showed that patients with additional trigger fingers and a preoperative proximal interphalangeal (PIP) joint contracture were significantly more likely to undergo FDS slip excision. CONCLUSIONS Patients who underwent A1 pulley release with FDS slip excision were significantly more likely to have multiple trigger fingers or a preoperative PIP joint contracture. Clinicians should counsel patients with these risk factors regarding the potential for FDS slip excision in addition to A1 pulley release to alleviate triggering of the affected digit. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic III.
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Affiliation(s)
- Margaret M Fisher
- Department of Orthopaedics, University of North Carolina, Chapel Hill, NC
| | - Andrew D Allen
- Department of Orthopaedics, University of North Carolina, Chapel Hill, NC
| | - Alexander D Jeffs
- Department of Orthopaedics, University of North Carolina, Chapel Hill, NC
| | | | - Di Hu
- Department of Orthopaedics, University of North Carolina, Chapel Hill, NC
| | | | - Reid W Draeger
- Department of Orthopaedics, University of North Carolina, Chapel Hill, NC.
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Chang YC, Lay IS, Tu CH, Lee YC. Increased Risk of Coronary Artery Disease in People with Diagnosis of Neuromuscular Disorders: A Nationwide Retrospective Population-Based Case-Control Study. Diagnostics (Basel) 2024; 14:199. [PMID: 38248075 PMCID: PMC10814733 DOI: 10.3390/diagnostics14020199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/03/2024] [Accepted: 01/12/2024] [Indexed: 01/23/2024] Open
Abstract
The existing literature has explored carpal tunnel syndrome (CTS) and determined that it could be a risk for coronary artery disease (CAD), but there has been little research comparing the relevance of CAD with other neuromuscular disorders (NMDs) to CTS. This case-control study explored the association between CTS, stenosing tenosynovitis (ST), and ulnar side NMDs and CAD. The study utilized data from Taiwan's National Health Insurance Research Database, focusing on health insurance claims. Between January 2000 and December 2011, we employed the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnostic codes to identify 64,025 CAD patients as the case group. The control group consisted of an equal number of individuals without CAD, matched for age, sex, and index year of CAD. Logistic regression analysis was employed to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) for each variable. Multivariate analysis, after adjusting for sociodemographic factors and comorbidities, revealed a significantly higher likelihood of a previous diagnosis of CTS in the CAD group compared to the comparison control group. However, neither ST nor the ulnar side NMDs had any statistical significance. These results indicated that median nerve injury, rather than other NMDs, may uniquely serve as a predisposing factor of CAD.
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Affiliation(s)
- Yi-Chuan Chang
- Graduate Institute of Acupuncture Science, College of Chinese Medicine, China Medical University, Taichung 404328, Taiwan;
- Department of Chinese Medicine, China Medical University Beigang Hospital, Yunlin 651012, Taiwan;
| | - Ing-Shiow Lay
- Department of Chinese Medicine, China Medical University Beigang Hospital, Yunlin 651012, Taiwan;
- School of Post-Baccalaureate Chinese Medicine, China Medical University, Taichung 404328, Taiwan
| | - Cheng-Hao Tu
- Graduate Institute of Acupuncture Science, College of Chinese Medicine, China Medical University, Taichung 404328, Taiwan;
| | - Yu-Chen Lee
- Graduate Institute of Acupuncture Science, College of Chinese Medicine, China Medical University, Taichung 404328, Taiwan;
- School of Chinese Medicine, China Medical University, Taichung 404328, Taiwan
- Department of Chinese Medicine, China Medical University Hospital, Taichung 404328, Taiwan
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Afshar A, Tabrizi A, Shariyate MJ. Trapezium Tunnel Syndrome. J Hand Surg Am 2024; 49:51-56. [PMID: 37999703 DOI: 10.1016/j.jhsa.2023.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/28/2023] [Accepted: 10/15/2023] [Indexed: 11/25/2023]
Abstract
The trapezium tunnel is situated on the lateral side of the carpal tunnel, lined with synovial tissue, and accommodates the flexor carpi radialis tendon. Trapezium tunnel syndrome is characterized by flexor carpi radialis tendinitis/peritendinitis and may lead to complicated clinical scenarios, such as flexor carpi radialis tendon rupture and the formation of primary or recurrent ganglion cysts on the volar radial side of the wrist and thenar area. Notably, the simultaneous presence of trapezium tunnel syndrome might contribute to unsuccessful outcomes in carpal tunnel surgeries. Trapezium tunnel syndrome may arise from either intrinsic or extrinsic factors. The entity of trapezium tunnel syndrome has attracted a low index of clinical suspicion because the other causes of radial side wrist pain that are more prevalent and frequent. We present a narrative review of this condition in an endeavor to heighten awareness and clinical suspicion of trapezium tunnel syndrome.
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Affiliation(s)
- Ahmadreza Afshar
- Department of Orthopedics, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran.
| | - Ali Tabrizi
- Department of Orthopedics, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran
| | - Mohammad Javad Shariyate
- Department of Orthopedics, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran
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Kazal LA, Themer S. Resolution of Trigger Finger with Electroacupuncture. Med Acupunct 2023; 35:342-345. [PMID: 38162547 PMCID: PMC10753943 DOI: 10.1089/acu.2023.0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Background Trigger finger (TF; a type of stenosing tenosynovitis) is common, affecting the flexor tendons of the hand, often causing significant pain and functional impairment. Treatment can include splinting, corticosteroid injection, or surgical release. There is little published research on the role of electroacupuncture (EA) for treating TF. Case After more than 1 year of pain and triggering, a 58 year-old male had locking of his left, fourth ring finger requiring painful manual reduction. EA was performed with 4-6 needles in a rectangular pattern along the radial and ulnar aspects of the A1 pulley of the fourth digit, with 10 Hz delivered in a daisy-chain formation for 45 minutes. Nodule size, frequency of triggering and locking, and severity of pain were assessed before and after 4 treatments over ∼1.5 months. Results This patient's frequency of locking and severity of pain decreased significantly by 50% after his first treatment. Additional clinically significant reductions of locking, pain, and nodule-size were evident after each treatment along with substantial functional gains between visits. After his fourth treatment, he reported 100% resolution of his symptoms with no further pain or triggering. Throughout this time, he continued his usual activities. Conclusions EA alone directed at the A1 pulley may be an effective treatment modality for patients with TF. The authors hypothesize that EA may reduce pain enabling a return to normal function and compression of the nodule, thus eliminating triggering. Further research evaluating the efficacy of EA for TF may help substantiate these results.
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Affiliation(s)
- Louis A. Kazal
- Department of Community and Family Medicine, and Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Semran Themer
- 4th year medical student, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
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Maasarani S, Wee CE, Lee CD, Khalid SI, Layon S, Noland SS. Surgical Trigger Finger Release Is Associated With New-Onset Dupuytren Contracture in the Short-Term Postoperative Period: A Matched Analysis. Hand (N Y) 2023; 18:1080-1088. [PMID: 35253506 PMCID: PMC10798206 DOI: 10.1177/15589447221077375] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND This article compares the rates and time-to-development of new-onset Dupuytren disease in patients with trigger finger treated by steroid injection, surgical release, or both. METHODS PearlDiver's Mariner 30 database was queried to identify patients with trigger finger between January 2010 and June 2019. One-to-one exact matching based on baseline patient demographics allowed us to create 4 identical groups defined by the type of trigger finger intervention received. RESULTS The matched population analyzed in this study consisted of 85 944 patients who were equally represented in the steroid injection cohort (n = 21 486, 25.00%), surgical release cohort (n = 21 486, 25.00%), steroids prior to surgery cohort (n = 21 486, 25.00%), and no intervention (control) cohort (n = 21 486, 25.00%). A new Dupuytren diagnosis after trigger finger treatment occurred in 1 in 128 patients overall, 1 in 156 patients treated with steroid injection, and 1 in 126 patients treated with surgical release. Trigger fingers treated by steroid injection only had the lowest rates of Dupuytren disease overall (n = 137, 0.64%, P = .0424) and treatment with fasciectomy (n = 14, 0.07%, P < .0005). In all, 171 patients in the surgery cohort developed Dupuytren disease 1 year after undergoing surgical trigger finger release. Furthermore, this cohort had the highest rates of fasciectomy (n = 55, 0.26%, P < .0005) and the lowest rates of no intervention (n = 103, 0.48%, P = .0471). Trigger fingers managed by surgical release developed Dupuytren disease (mean, 56.11 days; SD, 80.93 days, log-rank P = .02) and underwent fasciectomy (mean, 49.74 days; SD, 62.27 days; log-rank P < .0005) more quickly than all other cohorts. CONCLUSIONS Patients solely undergoing surgical release of their trigger finger had significantly higher odds and expedited rate of developing new-onset Dupuytren disease overall and undergoing subsequent treatment by fasciectomy compared with trigger fingers managed by other interventions.
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Affiliation(s)
| | | | | | | | - Sarah Layon
- University of Minnesota Medical School, Minneapolis, USA
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Abstract
BACKGROUND Open trigger finger release (OTFR) and endoscopic trigger finger release (ETFR) are effective methods in treating stenosing tenosynovitis. However, a paucity of literature exists comparing the techniques. This study describes and compares postoperative complications following OTFR and ETFR at a single institution. METHODS Patients undergoing trigger finger release between 2018 and 2020 within a single institution were identified. Electronic medical records were reviewed for patient demographics, surgical history, surgical characteristics, and clinical outcomes. Major and minor postoperative complications were assessed. Secondary outcome measures included tourniquet time and procedure time. Statistical analysis evaluated associations between postoperative complications, surgical technique, patient demographics, and surgical characteristics. RESULTS In total, 57 patients (80 digits) were included in the study: 42 digits treated with OTFR and 38 digits treated with ETFR. Mean follow-up time was 57.6 ± 69.0 days (range, 7-307 days) for ETFR and 34.2 ± 26.3 days (range, 6-120 days) for OTFR. Overall, major, and minor complication rates for the cohort were 8.8%, 1.8% and 7.0%, respectively. There were no major complications following ETFR and 1 following OTFR (4%), the isolated case being postoperative Chronic regional pain syndrome. Minor complication rates were similar following OTFR (8%) and ETFR (6%). Persistent digit stiffness and swelling were found to be the most prevalent minor complications (n = 2, respectively), followed by wound dehiscence (n = 1). Female patients were significantly more likely to experience postoperative complications. CONCLUSIONS Major complications following trigger finger release are unlikely; however, minor complications are prominent. Patients treated with OTFR and ETFR showed similar postoperative complication rates. Continued investigations into the benefits of ETFR are warranted.
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Affiliation(s)
- Ather Mirza
- North Shore Surgi-Center, Smithtown, NY, USA
- Mirza Orthopedics, Smithtown, NY, USA
| | - Justin Mirza
- North Shore Surgi-Center, Smithtown, NY, USA
- Mirza Orthopedics, Smithtown, NY, USA
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Polatsch DB, Rabinovich RV, Casden MA, Beldner S, Rahman OF. Primary Resection of the Ulnar Slip of Flexor Digitorum Superficialis in the Persistently Triggering Patient After A1 Pulley Release. Hand (N Y) 2023; 18:954-959. [PMID: 35132886 PMCID: PMC10470245 DOI: 10.1177/15589447211073829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
| | | | | | - Steven Beldner
- Lenox Hill Hospital – Northwell Health, New York, NY, USA
| | - Omar F. Rahman
- Lenox Hill Hospital – Northwell Health, New York, NY, USA
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Corvino A, Lonardo V, Corvino F, Tafuri D, Pizzi AD, Cocco G. "Daddy wrist": A high-resolution ultrasound diagnosis of de Quervain tenosynovitis. J Clin Ultrasound 2023; 51:845-847. [PMID: 36753407 DOI: 10.1002/jcu.23440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 01/25/2023] [Accepted: 01/30/2023] [Indexed: 06/02/2023]
Abstract
De Quervain's tenosynovitis involves the first of the six dorsal compartments of the wrist, which contains the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons. It seems to be associated with female sex (F:M = 10:1), middle age (30-50 years) and activities involving repetitive hand and wrist motions such as typing, piano playing or repetitively lifting children head, such as in postpartum females (hence the term "baby wrist" or "mommy wrist"). Aim of this paper was to illustrate high-resolution ultrasound (US) features of the DQD by describing a well-documented case that occurred in a "new dad" taking care of his babe. Hence, firstly in literature we could refer to this condition with the term of "daddy wrist".
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Affiliation(s)
- Antonio Corvino
- Movement Sciences and Wellbeing Department, University of Naples "Parthenope", Naples, Italy
| | - Valeria Lonardo
- Advanced Biomedical Sciences Department, University Federico II of Naples, Naples, Italy
| | - Fabio Corvino
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Naples, Italy
| | - Domenico Tafuri
- Movement Sciences and Wellbeing Department, University of Naples "Parthenope", Naples, Italy
| | - Andrea Delli Pizzi
- Departiment of Innovative Technologies in Medicine and Dentistry, University "G. d'Annunzio", Chieti, Italy
| | - Giulio Cocco
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Aging Sciences, University "G. d'Annunzio", Chieti, Italy
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Fakoya AO, Tarzian M, Sabater EL, Burgos DM, Maldonado Marty GI. De Quervain's Disease: A Discourse on Etiology, Diagnosis, and Treatment. Cureus 2023; 15:e38079. [PMID: 37252462 PMCID: PMC10208847 DOI: 10.7759/cureus.38079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2023] [Indexed: 05/31/2023] Open
Abstract
Since Fritz De Quervain first postulated stenosing tenosynovitis within the radial dorsum of the wrist, much research has been conducted to provide further insights. De Quervain's Disease (DQD) is a condition that affects the tendons that control the movement of the thumb, specifically the abductor pollicis longus and extensor pollicis brevis. Numerous studies have shown that structural divergence from normal anatomy is partly related to contingency for developing DQD. Even though this condition was discovered many years ago, its exact etiology remains a subject of debate. Two schools of thought exist, one that contends an inflammatory-mediated pathway and the other degenerative changes. Substantial evidence exists for both theories, thus necessitating further studies into the etiology of DQD. Classically, Finkelstein's and Eichhoff's tests have been used as the physical examinations of choice for clinically diagnosing this condition. However, these tests have been shown to have low specificity, hence, the emergence of the wrist hyperflexion and abduction of the thumb test. Evidence also suggests that ultrasonography may become a critical diagnostic tool, especially to identify anatomical variations before invasive treatment, reducing the risk of further complications. The management of DQD is typically conservative, with escalation to steroid injections before surgery is indicated. Future research into this disease should focus on establishing a clearer picture of how anatomical variations and other pathological and occupational factors may interplay to bring about this condition. While current research has suggested possible novel approaches for diagnosing and treating DQD, more studies are required to gain greater insights into the effectiveness of these interventions.
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Affiliation(s)
- Adegbenro O Fakoya
- Cellular Biology and Anatomy, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Martin Tarzian
- Psychiatry, University of Medicine and Health Sciences, Basseterre, KNA
| | - Enrique L Sabater
- Anatomy, University of Medicine and Health Sciences, Basseterre, KNA
| | - Daiana M Burgos
- Anatomy, University of Medicine and Health Sciences, Basseterre, KNA
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Mirza A, Mirza J, Zappia L, Thomas TL, Corabi J, Talay R. Single-Portal Antegrade Endoscopic Trigger Finger Release: Cadaveric and Clinical Outcomes. Hand (N Y) 2023:15589447221150512. [PMID: 36726337 DOI: 10.1177/15589447221150512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND This study aimed to examine the relationship between anatomical surface landmarks in fresh frozen cadavers as related to in vivo endoscopic trigger finger release (ETFR) and present clinical outcomes after a single-portal antegrade ETFR technique. METHODS Endoscopic trigger finger release was performed on 40 cadaveric digits. Each digit was dissected and the following measurements were recorded: distance from palmar digital crease and A1 pulley, length of the A1 pulley, percentage of A1 pulley released, and injury to vulnerable anatomy. A retrospective chart review was performed on 48 patients (62 digits) treated with ETFR. Outcome measures included grip and pinch strength, range of motion, Disability of Arm, Shoulder, and Hand (DASH) questionnaires, and Visual Analog Scale (VAS) pain scores. RESULTS Release of the A1 pulley was achieved in 33 of the 40 cadaveric digits (83%) with an A2 pulley laceration rate of 25%. No flexor tendon or neurovascular injuries occurred. Gross grasp, lateral pinch, 3-jaw chuck, and precision pinch strength had 85%, 90%, 82%, and 90% recovery, respectively. At the final follow-up, average metacarpophalangeal joint, proximal interphalangeal joint, and distal interphalangeal joint range of motion were within the normal limits. Mean VAS scores decreased from 5.7 preoperatively to 1.0 postoperatively and mean DASH score at the final follow-up was 4.8. CONCLUSIONS With the use of anatomical surface landmarks, ETFR may be performed in an efficient and reproducible manner. Patients treated with ETFR had low complication rates, good functional recovery, and improved pain at short-term follow-up. Further study of long-term outcomes and cost-effectiveness of ETFR is warranted.
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Affiliation(s)
- Ather Mirza
- North Shore Surgi-Center, Smithtown, NY, USA
- Mirza Orthopedics, Smithtown, NY, USA
- Stony Brook University, NY, USA
| | - Justin Mirza
- North Shore Surgi-Center, Smithtown, NY, USA
- Mirza Orthopedics, Smithtown, NY, USA
- Stony Brook University, NY, USA
- New York Institute of Technology, Old Westbury, USA
| | - Luke Zappia
- Mirza Orthopedics, Smithtown, NY, USA
- New York Institute of Technology, Old Westbury, USA
| | - Terence L Thomas
- Mirza Orthopedics, Smithtown, NY, USA
- Thomas Jefferson University, Philadelphia, PA, USA
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Patel M, Aiello M. Successful treatment of acute worsening complex regional pain syndrome in affected dominant right-hand from secondary pathology of new onset third and fourth digit trigger finger. Case Reports Plast Surg Hand Surg 2022; 9:123-125. [PMID: 35530752 PMCID: PMC9067952 DOI: 10.1080/23320885.2022.2063871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
65 year old male with preexisting Complex Regional Pain Syndrome (CRPS) in right dominant hand with sudden onset of right third and fourth digit trigger finger successfully treated with flexor tendon sheath corticosteroid and lidocaine injection resulting in long-term resolution of symptoms without causing widely believed aggravation of CRPS.
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Affiliation(s)
- Monika Patel
- Department of Anesthesiology, Division of Pain Management, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Michael Aiello
- Department of Anesthesiology, University of Florida College of Medicine, Jacksonville, FL, USA
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Ge L, Zhang L, Lu L. Stenosing tenosynovitis with rice bodies formation diagnosed by ultrasound: A case report. Medicine (Baltimore) 2022; 101:e28871. [PMID: 35363196 PMCID: PMC9282108 DOI: 10.1097/md.0000000000028871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 02/01/2022] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Rice bodies are usually found in several nonspecific chronic inflammatory diseases that are symptomatically dominated by primary disease and local compression symptoms. Rice bodies are usually detected by magnetic resonance imaging; however, some remote areas and areas with poor economic conditions do not have access to magnetic resonance imaging examination, which leads to delayed diagnosis of the disease. PATIENT CONCERNS We report the case of a 62-year-old man with pain in the metacarpophalangeal joint of his right middle finger and limited flexion activity of his middle finger. DIAGNOSES The mass was 1 cm, well-circumscribed, soft, and painless. Ultrasound showed stenosing tenosynovitis with rice body formation. INTERVENTIONS The patient underwent tenosynovectomy with synovectomy of the right middle finger tendon sheath under plexus block anesthesia. OUTCOMES No postoperative complications were noted. A 6-month follow-up showed no recurrence. The activity of the patient's middle finger improved significantly. LESSONS Stenosing tenosynovitis with rice body formation is a very rare condition, and we use ultrasound for diagnosis. Ultrasound is convenient, rapid, inexpensive, and can obtain blood flow information, facilitate disease follow-up, and even allow ultrasound localization in advance for guided needle biopsy.
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Affiliation(s)
- Lei Ge
- Department of Emergency, People's Hospital of Rizhao, Jining Medical University, Shandong, China
| | - Lei Zhang
- Department of Emergency, People's Hospital of Rizhao, Jining Medical University, Shandong, China
| | - Libin Lu
- Department of Emergency, People's Hospital of Rizhao, Jining Medical University, Shandong, China
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Wei L, Tong Q, Liu Y, Hou X, Zhi F. Different acupotomy for stenosing tenosynovitis: A protocol for systematic review and network meta-analysis. Medicine (Baltimore) 2022; 101:e28050. [PMID: 35029874 PMCID: PMC8735810 DOI: 10.1097/md.0000000000028050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 11/11/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Stenosing tenosynovitis (STS) is a chronic aseptic inflammation caused by mechanical friction. The main clinical manifestations are local pain and limited activity of the affected parts, which reduce people's quality of life. The clinical effect of acupotomy in the treatment of STS is significant, and the operation is simple and the side effect is small. But there are many kinds of acupotomology, and there is a lack of comparative study between different Acupotomology. In this study, the effectiveness of 4 commonly used needle knife therapies (v-knife, oblique knife, crochet knife, flat knife) was ranked by the method of network meta. METHODS CNKI, Wanfang, VIP, Sinomed, PubMed, and Cochrane Library were searched to collect randomized controlled trials of v-knife, oblique knife, crochet knife, and flat knife in the treatment of STS. The search time limit is from the date of establishment to October 15, 2021. Revman5.3, gemtc 0.14.3, and stata14.2 were used for data analysis, and Cochrane bias risk assessment tool was used to screen and evaluate the quality of included literatures. CONCLUSION Objective to provide evidence-based medicine evidence for clinical selection of the best needle knife treatment scheme for STS.
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Affiliation(s)
- Lingzhi Wei
- Nanchang Hongdu Hospital of Traditional Chinese Medicine, Jiangxi Province, China
| | - Qi Tong
- Jiangxi Health Vocational College, Jiangxi Province, China
| | - Yue Liu
- Jiangxi Health Vocational College, Jiangxi Province, China
| | - Xinju Hou
- Nanchang Hongdu Hospital of Traditional Chinese Medicine, Jiangxi Province, China
| | - Fang Zhi
- Nanchang Hongdu Hospital of Traditional Chinese Medicine, Jiangxi Province, China
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Leung LTF, Hill M. Comparison of Different Dosages and Volumes of Triamcinolone in the Treatment of Stenosing Tenosynovitis: A Prospective, Blinded, Randomized Trial. Plast Surg (Oakv) 2021; 29:265-271. [PMID: 34760843 DOI: 10.1177/2292550320969643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Stenosing tenosynovitis is a condition due to a size mismatch between the flexor tendons and the first annular pulley. Corticosteroid injection is the mainstay treatment. The purpose of this study is to compare different dosages and volumes of triamcinolone in the treatment of primary stenosing tenosynovitis. Methods Patients with primary Quinnell grades 1 or 2 stenosing tenosynovitis were recruited in this prospective, blinded, randomized trial. Patients were randomized into 1 of 2 groups. Group A received 0.25 mL of triamcinolone 40 mg/mL, mixed with 0.25 mL of 1% lidocaine with epinephrine (10 mg of triamcinolone, 0.5 mL in total volume). Group B received 0.5 mL of triamcinolone 40 mg/mL, mixed with 0.5 mL of 1% lidocaine with epinephrine (20 mg of triamcinolone, 1 mL in total volume). Patients were assessed by a blinded hand therapist at 2 and 4 weeks, and by a blinded hand surgeon at 6 weeks. The primary outcome was complete symptom resolution at 6 weeks. Both per-protocol and intention-to-treat analyses were performed. Results One hundred ninety-one patients were recruited from 2009 to 2018. Eighty-two and 77 patients had complete data in group A and B, respectively. There was no difference in success rates in complete symptom resolution at 6 weeks between group A (59.8%) and group B (62.3%). The mean visual analogue pain scores on injection were 4.31 ± 2.11 for group A and 4.30 ± 2.09 for group B. Conclusions Triamcinolone 10 mg was as effective as 20 mg in the resolution of symptoms of Quinnell grade 1 or 2 stenosing tenosynovitis at 6 weeks.
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Affiliation(s)
- Leslie Tze Fung Leung
- Division of Plastic and Reconstructive Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mark Hill
- Division of Plastic and Reconstructive Surgery, University of British Columbia, Vancouver, British Columbia, Canada
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15
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Patel KR, Fralinger D, MacGillis KJ, Wright-Chisem J, Mejia A. The Anesthetic Effectiveness of J-Tip Needle-Free Injection System Prior to Trigger Finger Injection: A Double-Blind Randomized Clinical Trial. Hand (N Y) 2021; 16:776-780. [PMID: 31795756 PMCID: PMC8647309 DOI: 10.1177/1558944719890035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The aim of this preliminary study was to evaluate the effectiveness of a J-tip needle-free injection system (JNFS) to reduce pain associated with corticosteroid injection of the tendon sheath for treatment of trigger finger. Methods: Thirty-four consecutive trigger fingers occurring in 28 unique patients who met inclusion/exclusion criteria were consented and enrolled into this double-blind randomized controlled study. Patients were randomly assigned to the control (JNFS loaded with sterile normal saline) or treatment group (JNFS loaded with buffered 1% lidocaine). Both the fellowship-trained hand surgeon and patient were blinded to the allocation group. Prior to each trigger finger injection, each patient rated pain associated with stubbing toe and papercut on the visual analog scale (VAS), in addition to a postprocedure VAS pain score. Results: A total of 28 patients and 34 digits were enrolled in this study. There was no difference in patient demographics or preintervention pain perception between the control and treatment groups. The use of JNFS demonstrated lower mean pain VAS score when comparing the control group (n = 17) with the treatment group (n = 17), with VAS pain scores of 49 (SD = 31) and 39 (SD = 36), respectively. However, this difference was not statistically significant (P = .389). Conclusions: The use of JNFS loaded with 1% buffered lidocaine may reduce pain associated with trigger finger injections, although our results did not find a statistically significant difference. We hypothesize that the pain caused by the acidity of lidocaine is the primary driver of pain and discomfort during injection, and the pain from the needle stick is secondary. As a result, any pain reduction from JNFS is masked by the most painful part of injection-the delivery of injectate. Based on the findings and experience obtained from this study, we hypothesize that a follow-up study using buffered lidocaine may be able to better reveal the benefits of JNFS.
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Affiliation(s)
| | - David Fralinger
- The University of Illinois at Chicago, USA,David Fralinger, Department of Orthopaedic Surgery, The University of Illinois at Chicago, M/C 844, 835 S. Wolcott Avenue, Chicago, IL 60612, USA.
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16
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Seigerman D, McEntee RM, Matzon J, Lutsky K, Fletcher D, Rivlin M, Vialonga M, Beredjiklian P. Time to Improvement After Corticosteroid Injection for Trigger Finger. Cureus 2021; 13:e16856. [PMID: 34522494 PMCID: PMC8425109 DOI: 10.7759/cureus.16856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2021] [Indexed: 11/20/2022] Open
Abstract
Purpose Trigger finger is a commonly occurring hand condition that presents with symptoms of pain, clicking, locking, and catching of the finger. A common non-operative management option is corticosteroid injection. The purpose of this study was to evaluate the short-term patient response to corticosteroid injections for trigger finger. Methods The patients of six fellowship-trained orthopedic hand surgeons who underwent a corticosteroid injection for trigger finger between June 2019 and October 2019 were invited to participate in this study. Patients were contacted by phone at one week, two weeks, and three weeks after the injection to complete a questionnaire regarding their pain and triggering symptoms. Medical records were also reviewed to collect basic demographic data. Results A total of 452 patients were included in the study. At the final follow-up, 82.4% of patients reported complete pain relief, 16.3% had partial relief, and 1.2% had no relief from their pain. For their triggering symptoms, 65.9% reported complete triggering relief, 30.4% had partial relief, and 3.5% had no triggering relief. It took an average of 6.6 days following injection for patients to experience complete pain relief, and an average of 8.1 days for patients to experience complete triggering relief. Conclusions This analysis found that most patients experience relief of pain and triggering at three weeks following corticosteroid injection. The majority of patients experienced some pain relief within the first week following corticosteroid injection, while improvement in triggering appeared to lag behind pain relief.
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Affiliation(s)
- Daniel Seigerman
- Orthopedic Surgery, Rothman Orthopedic Institute, New York City, USA
| | - Richard M McEntee
- Orthopedic Surgery, University of Kansas, Kansas City, USA.,Division of Hand Surgery, Rothman Orthopedic Institute, Philadelphia, USA
| | - Jonas Matzon
- Division of Hand Surgery, Rothman Orthopedic Institute, Philadelphia, USA
| | - Kevin Lutsky
- Division of Hand Surgery, Rothman Orthopedic Institute, Philadelphia, USA
| | - Daniel Fletcher
- Division of Hand Surgery, Rothman Orthopedic Institute, Philadelphia, USA
| | - Michael Rivlin
- Division of Hand Surgery, Rothman Orthopedic Institute, Philadelphia, USA
| | - Mason Vialonga
- Orthopedics, Rutgers Robert Wood Johnson University, New Brunswick, USA
| | - Pedro Beredjiklian
- Division of Hand Surgery, Rothman Orthopedic Institute, Philadelphia, USA
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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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18
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Chinzei N, Kanzaki N, Nagai K, Haneda M, Yamamoto T, Kuroda R. Posterior Ankle Arthroscopy for Flexor Hallucis Longus Entrapment: A Case Report. J Orthop Case Rep 2021; 11:70-74. [PMID: 34327170 PMCID: PMC8310630 DOI: 10.13107/jocr.2021.v11.i04.2158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Stenosing tenosynovitis is a chronic disorder frequently observed in finger triggering of a digit. Regarding the toes, although entrapment of the flexor hallucis longus (FHL) has already been reported in a few cases among sports players, the clinical condition is uncommon. Besides, the case without any specific causes is particularly rare. Case Report: We report the case of a 26-year-old male with FHL entrapment. Even though he was unaware of any cause, he felt tenderness on the posteromedial side of his left ankle, and his great toe was locked in the flex position. Magnetic resonance imaging indicated effusion in the tendon sheath of the FHL and the possibility of a partial tear of the FHL. We hypothesized that the scar tissue secondary to the partial tear of the FHL may have been irritated at the retrotalar pulley below the sustentaculum tali, where the FHL glides. Therefore, posterior ankle arthroscopy was performed for the treatment of the FHL entrapment. Conclusion: Orthopedic surgeons should list this pathology as a differential diagnosis of posterior ankle pain, even in non-athletes.
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Affiliation(s)
- Nobuaki Chinzei
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, 650-0017, Japan.,Department of Orthopaedic Surgery, Hyogo Rehabilitation Center, Kobe, 651-2181, Japan
| | - Noriyuki Kanzaki
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, 650-0017, Japan
| | - Kanto Nagai
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, 650-0017, Japan
| | - Masahiko Haneda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, 650-0017, Japan.,Department of Orthopaedic Surgery, Hyogo Rehabilitation Center, Kobe, 651-2181, Japan
| | - Tetsuya Yamamoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, 650-0017, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, 650-0017, Japan
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Silva PHJD, Moraes VYD, Segre NG, Sato ES, Faloppa F, Belloti JC. Diagnosis and Treatment of Trigger Finger in Brazil - A Cross-Sectional Study. Rev Bras Ortop 2021; 56:181-191. [PMID: 33981124 PMCID: PMC8101557 DOI: 10.1055/s-0040-1721363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 09/16/2020] [Indexed: 11/21/2022] Open
Abstract
Objective The present paper aims to evaluate the therapeutic planning for trigger finger by Brazilian orthopedists. Methods This is a cross-sectional study with a population composed of participants from the 2018 Brazilian Congress on Orthopedics and Traumatology (CBOT-2018, in the Portuguese acronym), who answered a questionnaire about the conduct adopted for trigger finger diagnosis and treatment. Results A total of 243 participants were analyzed, with an average age of 37.46 years old; most participants were male (88%), with at least 1 year of experience (55.6%) and from Southeast Brazil (68.3%). Questionnaire analysis revealed a consensus on the following issues: diagnosis based on physical examination alone (73.3%), use of the Quinnell classification modified by Green (58.4%), initial nonsurgical treatment (91.4%), infiltration of steroids combined with an anesthetic agent (61.7%), nonsurgical treatment time ranging from 1 to 3 months (52.3%), surgical treatment using the open approach (84.4%), mainly the transverse open approach (51%), triggering recurrence as the main nonsurgical complication (58%), and open surgery success in > 90% of the cases (63%), with healing intercurrences (54%) as the main complication. There was no consensus on the remaining variables. Orthopedists with different practicing times disagree on treatment duration ( p = 0.013) and on the complication rate of open surgery ( p = 0.010). Conclusions Brazilian orthopedists prefer to diagnose trigger finger with physical examination alone, to classify it according to the Quinnell method modified by Green, to institute an initial nonsurgical treatment, to perform infiltrations with steroids and local anesthetic agents, to sustain the nonsurgical treatment for 1 to 3 months, and to perform the surgical treatment using a transverse open approach; in addition, they state that the main nonsurgical complication was triggering recurrence, and report open surgery success in > 90% of the cases, with healing intercurrences as the main complication.
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Affiliation(s)
| | - Vinícius Ynoe de Moraes
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brasil
| | - Nicolau Granado Segre
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brasil
| | - Edson Sasahara Sato
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brasil
| | - Flávio Faloppa
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brasil
| | - João Carlos Belloti
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brasil
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20
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Zhuang T, Wong S, Aoki R, Zeng E, Ku S, Kamal RN. A Cost-Effectiveness Analysis of Corticosteroid Injections and Open Surgical Release for Trigger Finger. J Hand Surg Am 2020; 45:597-609.e7. [PMID: 32471754 DOI: 10.1016/j.jhsa.2020.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 03/14/2020] [Accepted: 04/14/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the cost-effectiveness of corticosteroid injection(s) versus open surgical release for the treatment of trigger finger. METHODS Using a US health care payer perspective, we created a decision tree model to estimate the costs and outcomes associated with 4 treatment strategies for trigger finger: offering up to 3 steroid injections before to surgery or immediate open surgical release. Costs were obtained from a large administrative claims database. We calculated expected quality-adjusted life-years for each treatment strategy, which were compared using incremental cost-effectiveness ratios. Separate analyses were performed for commercially insured and Medicare Advantage patients. We performed a probabilistic sensitivity analysis using 10,000 second-order Monte Carlo simulations that simultaneously sampled from the uncertainty distributions of all model inputs. RESULTS Offering 3 steroid injections before surgery was the optimal strategy for both commercially insured and Medicare Advantage patients. The probabilistic sensitivity analysis showed that this strategy was cost-effective 67% and 59% of the time for commercially insured and Medicare Advantage patients, respectively. Our results were sensitive to the probability of injection site fat necrosis, success rate of steroid injections, time to symptom relief after a steroid injection, and cost of treatment. Immediate surgical release became cost-effective when the cost of surgery was below $902 or $853 for commercially insured and Medicare Advantage patients, respectively. CONCLUSIONS Multiple treatment strategies exist for treating trigger finger, and our cost-effectiveness analysis helps define the relative value of different approaches. From a health care payer perspective, offering 3 steroid injections before surgery is a cost-effective strategy. TYPE OF STUDY/LEVEL OF EVIDENCE Economic and Decision Analyses II.
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21
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Matzon JL, Lebowitz C, Graham JG, Lucenti L, Lutsky KF, Beredjiklian PK. Risk of Infection in Trigger Finger Release Surgery Following Corticosteroid Injection. J Hand Surg Am 2020; 45:310-316. [PMID: 32113702 DOI: 10.1016/j.jhsa.2020.01.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 11/18/2019] [Accepted: 01/10/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the risk for infection in trigger finger release surgery after preoperative corticosteroid injection. METHODS We retrospectively evaluated all patients undergoing trigger finger release by 16 surgeons over a 2-year period. Data collected included demographic information, medical comorbidities, trigger finger(s) operated on, presence of a prior corticosteroid injection, date of most recent corticosteroid injection, postoperative signs of infection, and need for surgery owing to deep infection. Superficial infection was defined per Centers for Disease Control criteria. Deep infection was defined as the need for surgery related to a surgical site infection. RESULTS In this cohort of 2,480 fingers in 1,857 patients undergoing trigger release surgery, 53 (2.1%) developed an infection (41 superficial [1.7%] and 12 deep [0.5%]). Before surgery, 1,137 fingers had no corticosteroid injection. These patients developed 1 deep (0.1%) and 17 superficial (1.5%) infections. In contrast, 1,343 fingers had been given a corticosteroid injection before surgery. These patients developed 11 deep (0.8%) and 24 superficial (1.8%) infections. Median time from corticosteroid injection to trigger release surgery was shorter for fingers that developed a deep infection (63 days) compared with those that developed no infection (183 days). The risk for developing a deep infection in patients who were operated on within 90 days of an injection (8 infections in 395 fingers) was increased compared with patients who were operated on greater than 90 days after an injection (3 infections in 948 fingers). CONCLUSIONS Preoperative corticosteroid injections are associated with a small but statistically significantly increased rate of deep infection after trigger finger release surgery. The risk for postoperative deep infection seems to be time dependent and greater when injections are performed within 90 days of surgery, especially in the 31- to 90-day postinjection period. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Jonas L Matzon
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA.
| | - Cory Lebowitz
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA
| | - Jack G Graham
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA
| | - Ludovico Lucenti
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA
| | - Kevin F Lutsky
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA
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22
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Abstract
Introduction Trigger finger (TF) is a common cause of hand pain, swelling, and limited motion. It is common in women and in the thumb. Diabetes mellitus (DM) increases the risk of TF. Individuals with DM who develop TF are resistant to both medical and surgical interventions. The aim of this study is to compare the outcomes of percutaneous trigger release in diabetic and nondiabetic patients. Methods Fifty diabetic and 50 non-diabetic patients with a clinical diagnosis of TF were included after informed consent. Percutaneous trigger release was performed in all of them. Follow-ups for pain and/or neurovascular complications were taken after one week, one month, and six months. Data were entered and analyzed using SPSS v. 22 (IBM Corp., Armonk, NY, US). Results In the diabetic group, 86% of patients had TF of grade III or above and in the non-diabetic group, 76% of patients had TF of grade III or above. At the one-week follow-up, 79.2% diabetic patients still had mild to severe pain and 60.4% non-diabetic patients had mild to severe pain. By one month, 40% patients in the diabetic group still reported mild to moderate pain, however, all patients in the non-diabetic group reported no pain. By six months, nine (20%) diabetic patients reported mild pain. There was no incidence of infection or neurovascular damage at any follow-up in the non-diabetic group, and in the diabetic group, 4.2% of patients had an infection on the one-week follow-up. Conclusion Percutaneous trigger finger release is a safe, reliable, time-saving, and cost-effective procedure for the management of trigger finger in both diabetic and non-diabetic patients.
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Affiliation(s)
- Adeel A Siddiqui
- Orthopaedic Surgery, Dow University of Health Sciences, Karachi, PAK
| | | | - Mariyam Adeel
- Orthopaedics, Dow University of Health Sciences, Karachi, PAK
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23
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Abstract
BACKGROUND: Stenosing peroneal tenosynovitis (SPT) is an uncommon entity that is equally difficult to diagnose. We evaluated our outcomes with a local anesthetic diagnostic injection followed by surgical release of the sheath and calcaneal exostectomy. METHODS: Eleven patients diagnosed with SPT underwent surgery between 2006 and 2014. Upon initial presentation, all patients reported a persistent history of pain along the ankle. Ultrasound-guided injections of anesthetics were administered into the peroneal tendon sheath to confirm the diagnosis. In patients with a confirmed diagnosis of SPT, we proceeded with surgical intervention with release of the peroneal tendon sheath and debridement of the calcaneal exostosis. Retrospective chart review was performed, and functional outcomes were assessed using the Foot and Ankle Outcome Score (FAOS). FAOS results were collected pre- and postoperatively and were successfully obtained at 1 year or greater. RESULTS: Of these patients, all showed significant improvements ( P < .05) in 4 of 5 categories of the FAOS (pain, daily activities, sports activities, and quality of life). CONCLUSION: We present a case series in which the peroneal tendon sheath was diagnostically injected with anesthetic to confirm a diagnosis of SPT. In each of these cases, symptomatic improvement was obtained following the injection. With the fact that many of these patients had advanced imaging denoting no significant tears, we believe that this diagnostic injection is paramount for the success of surgical outcome. LEVEL OF EVIDENCE: Level IV, retrospective case series.
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Affiliation(s)
- Geoffrey I Watson
- 1 Department of Orthopedic Surgery, Bone and Joint Institute of Tennessee, Franklin, TN, USA
| | | | - David S Levine
- 3 Department of Orthopedic Surgery, Foot and Ankle, Hospital for Special Surgery, New York, NY, USA
| | - Mark C Drakos
- 3 Department of Orthopedic Surgery, Foot and Ankle, Hospital for Special Surgery, New York, NY, USA
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24
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Abstract
Aim: Trigger finger is a common cause of hand pain and dysfunction. In this study, we aimed to evaluate retrospectively short and long-term outcomes of patients with trigger fingers who underwent percutaneous release operations. Materials and methods: Thirty-nine patients who underwent percutaneous release of the trigger finger were analyzed retrospectively. The patients were evaluated for digital nerve injury (hypoesthesia), recurrence, painful scar, and tendon rupture. Results: The patients' median age was 54 years (minimum 32 years - maximum 63 years). Hypoesthesia was most frequently seen at the first and fourth fingers. At the end of the first year, one patient developed tendon rupture (fourth finger). Recurrences were seen at the end of the first (n=5) and third (n=9) years. Recurrence was mostly seen in the fourth finger, followed by the third finger. Painful scars were observed in two patients. Conclusion: Percutaneous release is a blindly performed intervention and the emergence of unexpected complications should not be forgotten.
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Affiliation(s)
| | - Emin Sir
- Plastic Surgery, Private Hospital, Izmir, TUR
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25
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Halim A, Sobel AD, Eltorai AEM, Mansuripur KP, Weiss APC. Cost-Effective Management of Stenosing Tenosynovitis. J Hand Surg Am 2018; 43:1085-1091. [PMID: 29891265 DOI: 10.1016/j.jhsa.2018.04.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 02/20/2018] [Accepted: 04/09/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE Stenosing tenosynovitis (STS) is a common condition treated by hand surgeons. Limited evidence exists to support the nonsurgical management of STS. The purpose of this study was to prospectively evaluate a cohort of patients with STS, and to determine the strategy for treating patients with this condition that is most cost effective in terms of dollars reimbursed by payers. METHODS Prospective data were collected on patients diagnosed with STS between March 2014 and September 2014. All patients were initially treated with a corticosteroid injection. Patients with persistent symptoms were given the option of injection or surgery. A maximum of 3 injections were offered. All patients were evaluated every 6 months through office appointments or phone calls. A cost analysis was performed in our cohort using actual reimbursement rates for injections, initial and established patient visits, and facility and physician fees for surgery, using the reimbursement rates from the 6 payers covering this patient cohort. Cost savings were calculated based on offering 1, 2, and 3 injections. RESULTS Eighty-eight digits in 82 patients were followed for an average of 21.9 months (range, 18.7-22.7 mo) after an initial corticosteroid injection. Thirty-five digits went on to surgical release, whereas 53 digits were treated nonsurgically. Had all patients initially undergone surgery, the cost would have totaled $169,088.98 ($1,921 per digit). Offering up to 3 injections yielded a potential savings of $72,730 ($826 per digit) or 43% of the total cost. For the 33 patients who underwent more than 1 injection, offering a second injection yielded potential savings of $15,956 ($484 per digit, 22.7%), and for the 7 patients presenting a third time, a third injection saved $1,986 ($283 per digit, 14.5%). CONCLUSIONS Based on the data from our cohort, the efficient way to treat STS in terms of health care dollars spent is to offer up to 3 injections before surgical release. The first injection had the highest component of cost savings, at $826 per digit. TYPE OF STUDY/LEVEL OF EVIDENCE Economic/Decision Analysis III.
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Affiliation(s)
- Andrea Halim
- Department of Orthopaedic Surgery, Brown University, Providence, RI.
| | - Andrew D Sobel
- Department of Orthopaedic Surgery, Brown University, Providence, RI
| | - Adam E M Eltorai
- Warren Alpert School of Medicine, Brown University, Providence, RI
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Wentzell M. Conservative management of a chronic recurrent flexor hallucis longus stenosing tenosynovitis in a pre-professional ballet dancer: a case report. J Can Chiropr Assoc 2018; 62:111-116. [PMID: 30305767 PMCID: PMC6173219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To describe the successful conservative management of a chronic recurrent flexor hallucis longus (FHL) stenosing tenosynovitis. CLINICAL FEATURES A 20-year-old female pre-professional ballet dancer presented with medial ankle and mid-foot pain of 7.5 months duration. Pain was constant but exacerbated with training and assuming the en pointe and demi-pointe dance positions. Plantar flexion of the great toe was pain provoking. Triggering of the great toe and audible and palpable crepitus were noted with active and passive great toe range of motion. A diagnosis of a chronic recurrent FHL stenosing tenosynovitis was made based on the history and physical exam. INTERVENTION AND OUTCOME Soft tissue and joint mobilization and manipulation, laser therapy, kinesiology tape application and rehabilitative exercise was used over 4 months. The patient reported an 8-point decrease in her numeric pain rating scale score and a 15-point improvement in her Lower Extremity Functional Scale score.
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Ali S, Mohamedbahi H. Acute Trigger Finger Presenting as an Extensor Lag. Eplasty 2018; 18:ic1. [PMID: 29375732 PMCID: PMC5765627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Stephen R. Ali
- Department of Plastic, Reconstructive and Burns Surgery, North Bristol NHS Trust, Bristol, United Kingdom,Correspondence:
| | - Hussein Mohamedbahi
- Department of Plastic, Reconstructive and Burns Surgery, North Bristol NHS Trust, Bristol, United Kingdom
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28
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Dardas AZ, VandenBerg J, Shen T, Gelberman RH, Calfee RP. Long-Term Effectiveness of Repeat Corticosteroid Injections for Trigger Finger. J Hand Surg Am 2017; 42:227-35. [PMID: 28372638 DOI: 10.1016/j.jhsa.2017.02.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 01/23/2017] [Accepted: 02/02/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To quantify the long-term success of repeat injections for trigger fingers and to identify predictors of treatment outcomes. METHODS This retrospective case series analyzed 292 repeat corticosteroid injections for trigger fingers administered by hand surgeons at a single tertiary center between January 2010 and January 2013. One hundred eighty-seven patients (64%) were female, 139 patients (48%) had multiple trigger fingers, and 63 patients (22%) were diabetic. The primary outcome, treatment failure, was defined as receiving a subsequent injection or surgical treatment. Patients without either documented failure or a return office visit in 2015 or 2016 were surveyed by telephone to determine if they had required subsequent treatment. Kaplan-Meier analyses with log-rank testing assessed the median time to treatment failure and the effect of demographic and disease-specific characteristics on injection success rate and predictors of injection outcome (success vs failure) were assessed with multivariable logistic regression. RESULTS Second injections provided long-term treatment success in 39% (111 of 285) of trigger fingers with 86 receiving an additional injection and 108 ultimately undergoing surgical release. Thirty-nine percent (24 of 62) of third injections resulted in long-term success, with 22 receiving an additional injection, and 23 ultimately undergoing surgery. Median times-to-failure for second and third injections were 371 and 407 days, respectively. Success curves did not differ significantly according to any patient or disease factor. Logistic regression identified that advancing patient age and injection for trigger thumb were associated with success of second injections. CONCLUSIONS Thirty-nine percent of second and third corticosteroid injections for trigger finger yield long-term relief. Although most patients ultimately require surgical release, 50% of patients receiving repeat trigger injections realize 1 year or more of symptomatic relief. Repeat injections of trigger fingers should be considered in patients who prefer nonsurgical treatment. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Yildirim P, Gultekin A, Yildirim A, Karahan AY, Tok F. Extracorporeal shock wave therapy versus corticosteroid injection in the treatment of trigger finger: a randomized controlled study. J Hand Surg Eur Vol 2016; 41:977-983. [PMID: 26763271 DOI: 10.1177/1753193415622733] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED The purpose of this study was to compare the efficacies of extracorporeal shock wave therapy and corticosteroid injection for the management of trigger finger. In this prospective randomized clinical trial, 40 patients with actively correctable trigger fingers were randomly assigned to extracorporeal shock wave therapy (1000 impulses and 2.1 bar) or injection groups. The effectiveness of the treatment was assessed using cure rates, a visual analogue scale, the frequency of triggering, the severity of triggering, the functional impact of triggering, and the Quick-Disabilities of the Arm, Shoulder, and Hand questionnaire at 1, 3, and 6 months after treatment. An intention-to- treat analysis was used in this study. Both groups demonstrated statistically significant improvements in all outcome measures after treatment. The intention-to-treat analyses showed no between-group differences for cure rates, pain, and functional status at follow-up. We conclude that extracorporeal shock wave therapy could be a non-invasive option for treating trigger finger, especially for those patients who wish to avoid steroid injections. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- P Yildirim
- 1 Department of Physical Medicine and Rehabilitation, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - A Gultekin
- 2 Department of Orthopedics and Traumatology, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - A Yildirim
- 3 Department of Plastic Reconstructive and Aesthetic Surgery, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - A Y Karahan
- 4 Department of Physical Medicine and Rehabilitation, Konya Beyhekim State Hospital, Kocaeli, Turkey
| | - F Tok
- 5 Department of Physical Medicine and Rehabilitation, Gulhane Military Medical Academy, Kocaeli, Turkey
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Abstract
We present a case report of stenosing tenosynovitis of the flexor pollicis longus tendon in an adolescent girl who required surgical release after failing conservative measures. The patient had no other risk factors, aside from her excessive texting, which we postulate led to her condition. Although there have been a few reports of tendinitis and tenosynovitis secondary to texting, we believe this is the first in the literature to report trigger thumb requiring surgical release in an adolescent.
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Affiliation(s)
- Jason D Johnson
- Department of Plastic and Reconstructive Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, United States
| | - Michael P Gaspar
- Department of Orthopaedic Surgery, The Philadelphia Hand Center, P.C., Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - Eon K Shin
- Department of Orthopaedic Surgery, The Philadelphia Hand Center, P.C., Thomas Jefferson University, Philadelphia, Pennsylvania, United States
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Rowland P, Phelan N, Gardiner S, Linton KN, Galvin R. The Effectiveness of Corticosteroid Injection for De Quervain's Stenosing Tenosynovitis (DQST): A Systematic Review and Meta-Analysis. Open Orthop J 2015; 9:456-9. [PMID: 27468839 PMCID: PMC4645863 DOI: 10.2174/1874325001509010456] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 05/12/2015] [Accepted: 08/05/2015] [Indexed: 12/28/2022] Open
Abstract
De Quervain's stenosing tenosynovitis (DQST) treatments include corticosteroid injection around the tendon sheath; however there is some ambiguity concerning the efficacy of this treatment. The aim of this systematic review and meta-analysis is to examine the totality of evidence relating to the use of corticosteroid injection in DQST when compared to placebo or other active treatments. A systematic literature search was conducted in July 2014. Only randomized control trials (RCTs) were included. Outcome measures included impairment, activity limitation and participation restriction. Five RCTs were identified with 165 patients, 88 in the treatment group and 77 in the control group.Patients who received corticosteroid injection (n=142) had a higher rate of resolution of symptoms [RR 2.59, 95% CI: 1.25 to 5.37, p=0.05, I2=62%]. This group reported greater pain relief as assessed by Visual Analogue Scale (VAS) at first assessment [mean difference -2.51, 95% CI: -3.11 to -1.90, p=0.0003, I2=65%] and demonstrated a statistically significant improvement in function (n=78) as measured by the DASH score and Dutch AIMS-HFF score [SMD -0.83, 95% CI: -1.54 to -0.12, p=0.02, I2=48]. This review confirms that corticosteroid injection results in a statistically significant increase in resolution of symptoms, pain relief and increased function in the treatment of DQST.
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Affiliation(s)
- Patrick Rowland
- Department of Trauma and Orthopaedic Surgery, Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin 2, Ireland
| | - Nigel Phelan
- Department of Trauma and Orthopaedic Surgery, Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin 2, Ireland
| | - Sean Gardiner
- Department of Trauma and Orthopaedic Surgery, Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin 2, Ireland
| | - Kenneth N Linton
- Department of Trauma and Orthopaedic Surgery, Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin 2, Ireland; Department of Trauma and Orthopaedic Surgery, Our Lady of Lourdes Hospital, Drogheda, Co. Louth, Ireland
| | - Rose Galvin
- HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, 123 St. Stephen’s Green, Dublin 2, Ireland
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Rowland P, Phelan N, Gardiner S, Linton KN, Galvin R. The Effectiveness of Corticosteroid Injection for De Quervain's Stenosing Tenosynovitis (DQST): A Systematic Review and Meta-Analysis. Open Orthop J 2015; 9:437-44. [PMID: 26587059 PMCID: PMC4655850 DOI: 10.2174/1874325001509010437] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Revised: 04/19/2015] [Accepted: 05/18/2015] [Indexed: 11/22/2022] Open
Abstract
De Quervain’s stenosing tenosynovitis (DQST) treatments include corticosteroid injection around the tendon sheath; however there is some ambiguity concerning the efficacy of this treatment. The aim of this systematic review and meta-analysis is to examine the totality of evidence relating to the use of corticosteroid injection in DQST when compared to placebo or other active treatments. A systematic literature search was conducted in July 2014. Only randomized control trials (RCTs) were included. Outcome measures included impairment, activity limitation and participation restriction. Five RCTs were identified with 165 patients, 88 in the treatment group and 77 in the control group. Patients who received corticosteroid injection (n=142) had a higher rate of resolution of symptoms [RR 2.59, 95% CI: 1.25 to 5.37, p=0.05, I2=62%]. This group reported greater pain relief as assessed by Visual Analogue Scale (VAS) at first assessment [mean difference -2.51, 95% CI: -3.11 to -1.90, p=0.0003, I2=65%] and demonstrated a statistically significant improvement in function (n=78) as measured by the DASH score and Dutch AIMS-HFF score [SMD -0.83, 95% CI: -1.54 to -0.12, p=0.02, I2=48]. This review confirms that corticosteroid injection results in a statistically significant increase in resolution of symptoms, pain relief and increased function in the treatment of DQST.
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Affiliation(s)
- Patrick Rowland
- Department of Trauma and Orthopaedic Surgery, Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin 2, Ireland
| | - Nigel Phelan
- Department of Trauma and Orthopaedic Surgery, Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin 2, Ireland
| | - Sean Gardiner
- Department of Trauma and Orthopaedic Surgery, Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin 2, Ireland
| | - Kenneth N Linton
- Department of Trauma and Orthopaedic Surgery, Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin 2, Ireland; Department of Trauma and Orthopaedic Surgery, Our Lady of Lourdes Hospital, Drogheda, Co. Louth, Ireland
| | - Rose Galvin
- HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, 123 St. Stephen’s Green, Dublin 2, Ireland
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Chopra K, Walker GN, Tadisina KK, Lifchez SD. Surgical decompression of trigger finger. Eplasty 2014; 14:ic31. [PMID: 25328576 PMCID: PMC4155838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Karan Chopra
- aDepartment of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, Md,bDivision of Plastic Surgery, University of Maryland School of Medicine, Baltimore, Md
| | | | | | - Scott D. Lifchez
- aDepartment of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, Md,Correspondence:
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Grandizio LC, Beck JD, Rutter MR, Graham J, Klena JC. The incidence of trigger digit after carpal tunnel release in diabetic and nondiabetic patients. J Hand Surg Am 2014; 39:280-5. [PMID: 24360881 DOI: 10.1016/j.jhsa.2013.10.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 10/25/2013] [Accepted: 10/25/2013] [Indexed: 02/07/2023]
Abstract
PURPOSE To determine whether patients with diabetes mellitus (DM) are at greater risk for developing postoperative trigger digits (TD) after carpal tunnel release (CTR) compared with patients without diabetes. METHODS A retrospective review of our electronic medical records identified all patients who had undergone CTR by a single hand fellowship-trained surgeon from September 2007 through May 2012. For patients with DM, additional information regarding method of disease control and hemoglobin A1c (HbA1c) level was recorded. We recorded HbA1c levels 3 months before and 3 months after CTR. The location and time to development of postoperative, new-onset TD were recorded for each case. Statistical testing included chi-square or Student t test and multivariate logistic regression analysis. RESULTS Of the 1,217 CTRs, 214 had DM. Of the 1,003 CTRs in cases without DM, 3% developed TD within 6 months of CTR and 4% within 1 year of CTR, compared with 8% and 10%, respectively, for diabetic cases. A multivariate regression analysis revealed DM as a significant risk factor for developing TD after CTR at 6 and 12 months. We found no significant association between HbA1c level at the time of CTR and the likelihood of developing TD. CONCLUSIONS The incidence of TD after CTR was higher in the diabetic population compared with a nondiabetic cohort. The presence of DM rather than its severity was the most important factor for developing TD. Preoperative counseling for patients with DM undergoing CTR may alert them to the possibility of developing TD. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.
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Affiliation(s)
- Louis C Grandizio
- Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, PA.
| | - John D Beck
- Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, PA
| | - Michael R Rutter
- Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, PA
| | - Jove Graham
- Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, PA
| | - Joel C Klena
- Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, PA
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Papa JA. Conservative management of De Quervain's stenosing tenosynovitis: a case report. J Can Chiropr Assoc 2012; 56:112-20. [PMID: 22675224 PMCID: PMC3364060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To chronicle the conservative treatment and management of a 32-year old female patient presenting with radial wrist pain of 4 months duration, diagnosed as De Quervain's stenosing tenosynovitis. CLINICAL FEATURES The primary clinical feature is wrist pain at the radial styloid with resultant impairment of wrist, hand, and thumb function. INTERVENTION AND OUTCOME The conservative treatment approach consisted of activity modification, Graston Technique(®), and eccentric training. Outcome measures included verbal pain rating scale, QuickDASH Disability/Symptom Score, and a return to activities of daily living (ADLs). The patient attained symptom resolution and at 6 month follow-up reported no recurrence of wrist pain. CONCLUSION A combination of conservative rehabilitation strategies may be used by chiropractors to treat De Quervain's stenosing tenosynovitis and allow for an individual to return to pain free ADLs in a timely manner.
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Affiliation(s)
- John A Papa
- Private Practice, 338 Waterloo Street Unit 9, New Hamburg, Ontario, N3A 0C5. E-mail:
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Chahal J, Dhotar HS, Anastakis DJ. Phaeohyphomycosis infection leading to flexor tendon rupture: a case report. Hand (N Y) 2009; 4:335-8. [PMID: 19259746 DOI: 10.1007/s11552-009-9178-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Accepted: 02/09/2009] [Indexed: 10/21/2022]
Abstract
A rare previously unreported cause of flexor tendon rupture is described. A 66-year-old man presented with a fully extended left middle finger, accompanied by swelling and purulent drainage. Prior to presentation, he had received a steroid injection for left middle finger stenosing tenosynovitis and subsequently developed culture-proven phaeohyphomycosis fungal infection and secondary enterococcal bacterial infection, requiring pharmacotherapy and incision, drainage, and debridement for abscess formation. Clinical and magnetic resonance imaging findings were consistent with the diagnosis of closed flexor tendon rupture of the left middle finger. Antifungal and antibiotic therapy followed by two-stage flexor tendon reconstruction was performed. Six months postoperatively, full passive range of motion was achieved and the proximal interphalangeal and distal interphalangeal joints of the left middle finger actively flexed to 125 degrees and 90 degrees, respectively.
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