Local ketorolac infiltration for postoperative pain in open trigger finger surgery: a randomized controlled trial.

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

[Click phenomenon in acquired Jaensch-Brown syndrome and trigger finger/thumb: the Notta syndrome]. / "Klick"-Phänomen beim erworbenen Jaensch-Brown-Syndrom und schnellenden Finger/Daumen: dem Notta-Syndrom.

CLINICAL FEATURES: The click phenomenon occurs when an acquired mechanical restriction of the elevation in adduction of the eye or of the extension of the finger/thumb, is forcefully overcome. The common cause is a nodule either of the superior oblique tendon posterior to the trochlea in the case of a Jaensch-Brown syndrome or of the digital flexor tendon anterior to the A1 annular pulley in the case of a trigger finger. Both locations share similar anatomical conditions for the development of the nodule and the pathomechanism of the click. RESULTS: From these identical findings in the eye and the hand in small children it can be assumed that the results from the studies of the hand in newborns and infants with a trigger thumb/finger are also applicable to the situation of the eye. 1. This motility disorder is not congenital. This is most likely due to an incomplete development at the time of birth of the sliding factors needed for a free passage of the tendon through the trochlea and the A1 annular pulley. 2. A distinction must be made between stages 0-3: stage 0 = no more restriction of the motility and no click phenomenon; stage 1 = forced active extension/elevation possible; stage 2 = only passive extension/elevation, each with a click phenomenon; stage 3 = no extension/elevation possible and no click phenomenon. 3. In most cases in early childhood there is a spontaneous complete recovery (75% after 6-7 years). In the eye this spontaneous course can only limitedly be shortened with motility exercises in combination with segmental occlusion. CONCLUSION: The click phenomenon is a symptom of stages 1 and 2 of an acquired mechanical restriction of the elevation in adduction of the eye or the extension of the finger/thumb. It should not be called a syndrome.

Ultrasound-Guided A1 Pulley Release: A Systematic Review.

The purpose of this review was to summarize the current literature pertaining to ultrasound-guided percutaneous A1 pulley release procedures. We searched PubMed, Cochrane Library, Embase, and Web of Science for clinical studies examining ultrasound-guided percutaneous A1 pulley release. A total of 17 studies involving 749 procedures were included in this review. The overall success rate was 97%. There were 23 minor complications (4 cases of hematomas, 15 cases of persistent pain, and 4 cases of transient numbness) and no major complications reported. Ultrasound-guided A1 pulley release is an effective and safe procedure for the treatment of trigger fingers and thumb.

Occult Amyloid Deposition in Older Patients Presenting With Bilateral Carpal Tunnel Syndrome or Multiple Trigger Digits.

PURPOSE: The diagnosis of amyloidosis is important for early intervention, disease monitoring, and prevention of complications and progression. Carpal tunnel syndrome (CTS) and trigger digit (TD) are two common conditions associated with early disease. The purpose of this study was to define disease prevalence among patients with bilateral CTS and multiple TDs and assess for an increased rate of diagnosis in the presence of both. METHODS: Men older than 50 years and women older than 60 years of age diagnosed with bilateral CTS, multiple TDs, or a combination of the 2 were prospectively enrolled in our study. Tenosynovial biopsy samples taken at the time of surgery were tested for the presence of amyloid using Congo red staining. Demographic and medical covariates were also collected and analyzed for differences between amyloid-positive and -negative patients. RESULTS: Fifty-six patients were enrolled in the study, and nine patients tested positive for amyloid deposition. The demographics and medical comorbidities were similar between amyloid-positive and -negative patients. Thirty patients with bilateral CTS were enrolled, and four tested positive for amyloid. For patients with multiple TDs, a total of 17 patients were enrolled, and 4 tested positive for amyloid. Among patients with multiple TDs, only men tested positive for amyloid and were, on average, younger than those who tested negative (61 and 73 years, respectively). Patients presenting with a combination of CTS and TD did not exhibit increased amyloid discovery. CONCLUSIONS: Hand surgeons should consider tenosynovial biopsy in men older than 50 years and women older than 60 years presenting with either bilateral CTS or multiple TDs. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic IV.

Patient-Perceived Outcomes of Recovery After Trigger Digit Release.

PURPOSE: Trigger finger release (TFR) is one of the most commonly performed hand surgeries; nevertheless, the time until patients subjectively feel recovered has not been well documented. The limited literature on patient perceptions of recovery after any type of surgery has described that patients and surgeons may have differing views on the time until full recovery. Our primary study question was to determine how long it takes for patients to subjectively feel fully recovered after TFR. METHODS: In this prospective study, patients who underwent isolated TFR completed questionnaires before surgery and at multiple time points following surgery until they reported full recovery. Patients completed visual analog scale (VAS) pain scores and QuickDASH (Disabilities of the Arm, Shoulder, and Hand) and were asked if they felt fully recovered at 4 weeks, 6 weeks, and 3, 6, 9, and 12 months. RESULTS: The average time to self-reported full recovery was 6.2 months (SD 2.6), and the median time to self-reported full recovery was 6 months (IQR 4 months). At 12 months, four out of 50 patients (8%) did not feel fully recovered. QuickDASH and VAS pain scores improved significantly from preoperative assessment to final follow-up. All patients reported improvement in both VAS pain scores and QuickDASH scores greater than the minimal clinically important difference between 6 weeks and 3 months after surgery. Higher preoperative VAS and QuickDASH scores were associated with failure to fully recover by 12 months after surgery. CONCLUSIONS: The length of time after surgery until patients felt fully recovered after isolated TFR is longer than the senior authors' expectations. This suggests that patients and surgeons may consider distinctly different parameters when discussing recovery. Surgeons should be aware of this discrepancy when discussing recovery after surgery. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.

Day-by-day symptom relief after corticosteroid injection for trigger digit: a randomized controlled study of two techniques.

This prospective randomized controlled study compared two injection techniques for trigger digit: either dorsal to the tendons in the proximal phalanx (PP group) or anterior to the tendons at the A1 pulley level (A1 group) in 106 patients. The primary outcome was the number of days to total relief of pain, stiffness and triggering, as recorded by the patients on visual analogue scales day-by-day for 6 weeks. The median number of days to complete symptom relief was 9 days in the PP group and 11 days in the A1 group for pain, 11 days and 15 days for stiffness and 21 and 20 days for triggering, respectively. Ninety-one per cent of all patients did not require any additional treatment, but 11 patients in both groups reported some remaining symptoms at 6 weeks. This study did not detect any significant difference between the two injection techniques, but provides detailed data of the rate and order of symptomatic relief after corticosteroid injection for this common condition.Level of evidence: I.

Determining the Minimally Important Change of the Michigan Hand outcomes Questionnaire in patients undergoing trigger finger release.

INTRODUCTION: The Michigan Hand outcomes Questionnaire (MHQ) is a widely used instrument to evaluate treatment results for hand conditions. Establishing the Minimally Important Change (MIC) is essential for interpreting change in outcome that is clinically relevant. PURPOSE OF THE STUDY: The purpose of this study was to determine the MIC of the MHQ total and subscale scores in patients undergoing trigger finger release. STUDY DESIGN: This is a prospective cohort study conducted between December 2011 and February 2020. METHODS: Patients completed the MHQ prior to surgery and 3 months postoperatively. The MIC of the MHQ was determined using 5 anchor-based methods (ie, 2 anchor mean change methods and 3 receiver operating characteristic methods). The median MIC value was determined to represent the triangulated MIC. RESULTS: A total of 1814 patients were included. The MIC for the MHQ total score ranged from 7.7 to 10.9, with a triangulated estimate of 9.3. The MIC estimates for 5 of 6 of the MHQ subscales ranged from 7.7 to 20.0. No MICs could be determined for the MHQ subscale "aesthetics" due to low correlations between the anchor questions and MHQ change scores. CONCLUSIONS: These MIC estimates can contribute to the interpretation of clinical outcomes following trigger finger release and for assessment of power in prospective trials.

Ultrasound-Guided A1 Pulley Release Versus Classic Open Surgery for Trigger Digit: A Randomized Clinical Trial.

OBJECTIVES: We compared an ultra-minimally invasive ultrasound-guided percutaneous A1 pulley release and a classic open surgery for trigger digit. METHODS: We designed a single-center randomized control trial. All cases had clinical signs of primary grade III trigger digit. Concealed allocation (1:1) was used for assigning patients to each group and data collectors were blinded. The Quick-Disabilities of the Arm, Shoulder, and Hand (Quick-DASH) questionnaire was our primary variable. Quick-DASH, two-point discrimination, grip strength, time until stopping analgesics, having full digital range of motion and restarting everyday activities were registered on the 1st, 3rd, and 6th weeks, 3rd and 6th months, and 1st year after the procedure. RESULTS: We randomized 84 patients to ultrasound-guided release and classic open surgery. Quick-DASH scores significantly favored the percutaneous technique until the 3rd month: 7.6 ± 1.2 versus 15.3 ± 2.4 (mean ± standard error of the mean). The percutaneous group obtained significantly better results in all the variables studied: time until stopping analgesics, achieving full range of motion and restarting everyday activities. Grip strength was significantly better in the percutaneous group for the 1st week only. Five cases of moderate local pain were observed in the open technique. There was one case of transient nerve numbness per group. CONCLUSIONS: The ultra-minimally invasive ultrasound-guided A1 pulley release was clinically superior to the classic open surgery in functional recovery with a lower complication rate.

Patient preference for trigger finger treatment.

BACKGROUND: Trigger finger is a common disorder of the hand that can cause disabling symptoms. Treatment options range from conservative management with observation and splinting, to surgical release, but there is currently not a consensus on a treatment algorithm. AIM: To determine patient preference for the treatment of trigger finger using an online survey. METHODS: An online crowdsourcing platform, Amazon Mechanical Turk, was used to recruit participants for this study. Participants were led through a scenario in which they were diagnosed with trigger finger. They were then asked to rank their preference of treatment options from the following: Observation, splinting, corticosteroid injection, surgery. The results of the surveys were then analyzed using R software. RESULTS: Of 323 participants completed the survey. 7 participants were excluded because they failed to correctly answer the attention question, leaving 316 participants whose results were included. As a first choice for treatment 117 (37%) of the included participants chose observation, 86 (27%) chose splinting, 61 (19%) chose corticosteroid injection, and 52 (16%) chose surgery. The mean rank for observation was 2.26, for splinting was 2.30, for corticosteroid injection was 2.53, and for surgery was 2.91. The ranking of each treatment option was statistically different (P value < 0.05) from the others except for observation and splinting. CONCLUSION: The practice of shared decision making with patients is imperative to providing the best care possible. The results from this study, especially the preference for less invasive treatment, may help providers better frame discussion around treatment options of trigger fingers. This in turn, may increase patient satisfaction in the treatment of trigger finger.

Factors associated with self-reported pain and hand function following surgical A1 pulley release.

Surgical A1 pulley release can considerably reduce pain and improve hand function, but individual outcomes are highly variable. This study aimed to identify factors contributing to self-reported pain and hand function 3 months postoperatively. We included 2681 patients who had received surgical treatment for a trigger finger or thumb and who completed the Michigan Hand outcomes Questionnaire (MHQ). Hierarchical linear regression models were used to investigate patient and clinical characteristics associated with postoperative pain and hand function. For both pain and hand function, the most influential factors associated with worse outcomes were worse MHQ scores at baseline (ß 0.38 and 0.33, respectively) and ≥3 preoperative steroid injections (ß -0.36 and -0.35). These factors indicated that patients with severe preoperative symptoms represent a group with a more advanced disease that is more difficult to treat. These findings can assist clinicians in patient counselling, expectation management and decision-making about the timing of the intervention.Level of evidence: II.

Risk of Amyloidosis and Heart Failure Among Patients Undergoing Surgery for Trigger Digit or Carpal Tunnel Syndrome: A Nationwide Cohort Study With Implications for Screening.

PURPOSE: Tenosynovial biopsy during carpal tunnel release (CTR) leads to an earlier diagnosis of amyloidosis. Surgery for trigger digit-trigger release (TR)-may provide a similar opportunity. We sought to characterize the risk of amyloidosis diagnosis after TR and/or CTR. METHODS: We conducted a retrospective cohort study of adults without diagnosed amyloidosis undergoing TR and/or CTR in the Veterans Health Administration from 1999 to 2019, including matched controls. We used competing-risks methodology to estimate the cumulative incidence and adjusted subdistribution hazard ratios (sHRs) of amyloidosis, heart failure, and death after TR and/or CTR. RESULTS: Among the 126,788 patients undergoing TR and/or CTR, amyloidosis was diagnosed in 52 of 26,757 patients undergoing TR alone at a median of 4.7 years after surgery (10-year cumulative incidence: 0.26%, 95% CI: 0.18% to 0.34%), 396 of 91,384 patients undergoing CTR alone at a median of 5.1 years after surgery (10-year cumulative incidence: 0.60%, 95% CI: 0.53% to 0.67%), 50 of 8,647 patients undergoing both TR and CTR at a median of 3.1 years after surgery (10-year cumulative incidence: 0.80%, 95% CI: 0.54% to 1.1%), and 54 of 113,452 controls at a median of 5.0 years after the index date (10-year cumulative incidence 0.053%, 95% CI: 0.037% to 0.070%). In the adjusted analysis, patients who underwent TR and/or CTR had a higher risk of amyloidosis (TR: sHRadj 4.80, 95% CI: 3.33-6.92; CTR: sHRadj 10.2, 95% CI: 7.74-13.6; TR and CTR: sHRadj 14.9, 95% CI: 9.87-22.5) and heart failure (TR: sHRadj 1.91, 95% CI: 1.83-1.99; CTR: sHRadj 2.02, 95% CI: 1.97-2.07; TR and CTR: sHRadj 2.18, 95% CI: 2.04-2.33) but not death compared with the controls. Among the patients who underwent TR, age, Black race, prior CTR, heart failure, and the number of digits released were independent risk factors for amyloidosis. CONCLUSIONS: Patients undergoing TR and/or CTR are at increased risk of incident amyloidosis and heart failure compared to controls. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.

The Prevalence and Risk Factors for Trigger Digits in a Random Sampling of a Japanese Population Registry between 50 and 89 Years of Age.

Background: Trigger digit(s) (TD) is one of the most common disorders of the hand in the elderly population. The aim of this study is to determine the prevalence and identify the risk factors for TD in an elderly Japanese population. Methods: We randomly sampled 1,297 subjects between the ages of 50 and 89 years from the population registry of a town in Japan. About 413 subjects agreed to participate in the study, and all were examined for the presence of TD. Subjects were divided into three groups namely history of treatment for TD in the past (PTD), current evidence of TD (CTD) or both (BTD). The prevalence of TD was weighted by age according to the composition of the Japanese population. Age, female gender, obesity, hard manual work, exposure to vibration tools, sports activity, smoking, alcohol, wrist fracture, hypertension, hypothyroidism, diabetes mellitus, rheumatoid arthritis and carpal tunnel syndrome were assessed as risk factors for TD using univariate and multivariate logistic regression analysis. Results: Forty subjects had TD. This included 18, 19 and 3 subjects with PTD, CTD and BTD, respectively. The weighted prevalence of TD was 9.7% (female, 14.3%; male, 4.4%) in the Japanese population aged 50-89 years. Age 70-79 and female gender were identified as risk factors for TD. Conclusions: The random sampling of a Japanese population registry between the ages of 50 and 89 years revealed the prevalence of TD as 9.7% and identified age between 70 and 79 and female gender as risk factors for developing TD. Level of Evidence: Level II (Therapeutic).

Multi-site evaluation of advanced practice hand therapy clinics for the management of patients with trigger digit.

STUDY DESIGN: Prospective cohort design. BACKGROUND: Patient time on Australian public hospital surgical outpatient department (SOPD) waitlists often exceeds clinical recommendations for chronic hand conditions. Diversion to allied health is an alternative option, however evidence regarding patient and organizational outcomes in hand therapy is lacking. PURPOSE OF THE STUDY: To evaluate clinical and organizational efficacy, patient outcomes and satisfaction of diversion of referrals for patients with trigger digit (TD) from SOPD waitlists to Advanced Practice Hand Therapy (APHT) at 3 Australian hospitals. METHODS: Data was collected from eligible patients with TD through chart reviews and telephone satisfaction surveys. Data included number of patients requiring SOPD review, repeat referral to SOPD in the 12 months following APHT discharge, patient-rated outcomes, satisfaction scores, wait times to SOPD review and conversion to surgery-rates. Mann Whitney-U, t-test, Pearson's chi-squared test and a Binary Logistic Regression analysis were performed. RESULTS: 104 patients completed APHT treatment. Seventy patients (67%) did not require return to the SOPD waitlist. Repeat referral to SOPD within 12 months of APHT discharge occurred for only 1 patient. Patients requiring SOPD review after APHT treatment were seen within target time frames and demonstrated 88% conversion to surgery-rates. Michigan Hand Outcome Questionnaire scores showed greater improvement in those not requiring SOPD review (P< .001~25.9 vs 4.2). Regression analysis identified a negative association between initial total Michigan Hand Outcome Questionnaire scores and unfavorable discharge outcomes (OR 0.96, P= .007). Most (81%-93%) patients indicated satisfaction with the APHT service. CONCLUSION: Diversion of referrals for TD from SOPD to APHT is an effective waitlist management strategy, with the propensity to reduce waiting times, improve patient flow, whilst resulting in favorable clinical and patient-rated outcomes and satisfaction.

Trigger Finger Associated with Fencing in an Adolescent: A Case Report.

Trigger digits in children are rare and the vast majority of cases are primary and involve the thumb. Although there are isolated reports of trigger digits in children after trauma, we were unable to find any report of a trigger digit in a child caused by repetitive forceful gripping. We report a 14-year-old fencer who developed a trigger of his middle finger to highlight this unusual association. This was initially managed with a splint and analgesics and eventually required two intrathecal steroid injections for resolution of symptoms.

Comparison of Complication Risk Following Trigger Digit Release Performed in the Office Versus the Operating Room: A Population-Based Assessment.

PURPOSE: Trigger digit release (TDR) performed in an office-based procedure room (PR) setting minimizes surgical costs compared with that performed in an operating room (OR); yet, it remains unclear whether the rates of major complications differ by setting. We hypothesized that surgical setting does not have an impact on the rate of major complications after TDR. METHODS: Adult patients who underwent isolated TDR from 2006 to 2015 were identified from the MarketScan commercial database (IBM) using the provider current procedural terminology code 26055 with a concordant diagnosis on the same claim line (International Classification of Diseases, ninth revision, clinical modification 727.03). The PR cohort was defined by presence of a place-of-service code for an in-office procedure without OR or ambulatory center revenue codes, or anesthesiologist claims, on the day of the surgery. The OR cohort was defined by presence of an OR revenue code. We identified major medical complications, surgical site complications, as well as iatrogenic neurovascular and tendon complications within 90 days of the surgery using International Classification of Diseases, ninth revision, clinical modification diagnosis and/or current procedural terminology codes. Multivariable logistic regression was used to compare the risk of complications between the PR and OR groups while controlling for Elixhauser comorbidities, smoking, and demographics. RESULTS: For 7,640 PR and 29,962 OR cases, the pooled rate of major medical complications was 0.99% (76/7,640) and 1.47% (440/29,962), respectively. The PR setting was associated with a significantly lower risk of major medical complications in the multivariable analysis (adjusted odds ratio 0.76; 95% confidence interval 0.60-0.98). The pooled rate of surgical site complications was 0.67% (51/7,640) and 0.88% (265/29,962) for the PR and OR cases, respectively, with no difference between the surgical settings in the multivariable analysis (adjusted odds ratio 0.81; 95% confidence interval 0.60-1.10). Iatrogenic complications were infrequently observed (PR 5/7,640 [0.07%]; OR 26/29,962 [0.09%]). CONCLUSIONS: Compared with performing TDR in the OR using a spectrum of commonly used anesthesia types, performing TDR in the PR using local-only anesthesia was associated with a comparably low risk of major medical complications, surgical complications, and iatrogenic complications. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.

Trigger Digit Incidence After Carpal Tunnel Release: Reconstruction in Elongated Position Versus Traditional Carpal Tunnel Release.

Background: The development of trigger digit after carpal tunnel syndrome release surgery has been widely reported. Lluch described reconstruction of the flexor retinaculum in elongated position to prevent such complication. Methods: We conducted a retrospective review to determine whether patients who undergo reconstruction in elongated position of the flexor retinaculum have a lower incidence of trigger digit postoperatively. In total, 1050 patients were included, 865 of whom had undergone traditional carpal tunnel release and 185 flexor retinaculum reconstruction. Results: No differences were found in the incidence of trigger digit after surgery (8.7% of the patients who underwent traditional release vs 11.9% in the reconstruction group). Neither difference was found when comparing mean time with the development of trigger digit. Conclusions: In the absence of randomized long-term studies comparing traditional release and reconstruction in elongated position after carpal tunnel release, given our results, we see no reason to favor reconstruction over standard carpal tunnel release as a means to prevent postoperative triggering of digits.

Topical anaesthesia as an adjuvant to local anaesthetic injection in open trigger digit release: a randomized controlled trial.

We conducted a randomized controlled trial to compare pain scores and patient satisfaction between topical anaesthetic cream (5% lidocaine-prilocaine cream) versus placebo cream, applied approximately 90 minutes before local anaesthetic injection for open trigger digit release. One hundred participants were enrolled and randomly allocated into the two groups between May 2019 and February 2020. The visual analogue pain scores and satisfaction scores were measured. Most participants were female with Quinnell Grade 2-3 trigger digits. The pain scores during needle injection, local anaesthetic infiltration, the overall pain and satisfaction scores had no statistically significant differences between groups. There was no correlation between duration of topical anaesthetic drug application and pain scores. Subgroup analysis did not show significant differences in pain scores between genders. No complications were found during the study period. The topical anaesthetic drug was ineffective to use on the palmar skin during open trigger digit release surgery.Level of evidence: II.

Outcome of Percutaneous Release for Trigger Digits in Diabetic and Non-diabetic Patients.

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.

Factors associated with trigger digit following carpal tunnel release.

BACKGROUND: Trigger digit is a common disorder of the hand associated with carpal tunnel syndrome. Carpal tunnel release (CTR) surgery may be a risk factor for trigger digit development; however, the association between surgical approach to CTR and postoperative trigger digit is equivocal. AIM: To investigate patient risk factors for trigger digit development following either open carpal tunnel release (OCTR) or endoscopic carpal tunnel release (ECTR). METHODS: This retrospective chart analysis evaluated 967 CTR procedures from 694 patients for the development of postoperative trigger digit. Patients were stratified according to the technique utilized for their CTR, either open or endoscopic. The development of postoperative trigger digit was evaluated at three time points: within 6 mo following CTR, between 6 mo and 12 mo following CTR, and after 12 mo following CTR. Firth's penalized likelihood logistic regression was conducted to evaluate sociodemographic and patient comorbidities as potential independent risk factors for trigger digit. Secondary regression models were conducted within each surgical group to reveal any potential interaction effects between surgical approach and patient risk factors for the development of postoperative trigger digit. RESULTS: A total of 47 hands developed postoperative trigger digit following 967 CTR procedures (4.9%). In total, 64 digits experienced postoperative triggering. The long finger was most commonly affected. There was no significant difference between the open and endoscopic groups for trigger digit development at all three time points following CTR. Furthermore, there were no significant independent risk factors for postoperative trigger digit; however, within group analysis revealed a significant interaction effect between gender and surgical approach (P = 0.008). Females were more likely to develop postoperative trigger digit than males after OCTR(OR = 3.992), but were less likely to develop postoperative trigger digit than males after ECTR (OR = 0.489). CONCLUSION: Patient comorbidities do not influence the development of trigger digit following CTR. Markedly, gender differences for postoperative trigger digit may depend on surgical approach to CTR.

Effectiveness of proximal interphalangeal joint-blocking orthosis vs metacarpophalangeal joint-blocking orthosis in trigger digit management: A randomized clinical trial.

STUDY DESIGN: Patients with Green's classification grade 2 or 3 A1-pulley trigger digit (TD) were recruited and randomized to receive the proximal interphalangeal joint-blocking orthosis (PIPJ-BO) or metacarpophalangeal joint-blocking orthosis (MCPJ-BO). INTRODUCTION: TD is a common hand condition that can affect one's performance in activities of daily living. Conservative management of TD involves prescription of orthoses to facilitate recovery. No studies have evaluated the effectiveness of PIPJ-BO, optimal orthosis wear regime, and other factors affecting orthotic effectiveness. PURPOSE OF THE STUDY: To compare the effectiveness of PIPJ-BO vs MCPJ-BO in TD management. METHODS: Outcome measures included pain numerical rating scale, Green's classification grading, and Quick Disability of the Arm, Shoulder and Hand. Orthosis wear duration was also collated. Patients were followed up for 2 months, and changes between initial and final assessment score within each group and between both groups were analyzed. RESULTS: Thirty-five patients with 43 TD were included in final analysis. Twenty-three TD were allocated PIPJ-BO while 20 with MCPJ-BO. Pain reduction was observed in both groups, but reduction was greater in PIPJ-BO group (P = .02). About 47.83% in PIPJ-BO group and 40% in MCPJ-BO group improved by at least 1 Green's classification grade. There was only significant improvement in Quick Disability of the Arm, Shoulder and Hand score for PIPJ-BO group (P = .0007), and duration of orthosis wear was significantly longer in the PIPJ-BO group (P = .0010). Advancing age was found to have higher rate of orthosis failure. DISCUSSION: Findings suggest that both orthoses are effective in reducing pain and disability and improve in triggering symptoms, with PIPJ-BO being more superior. Moreover, PIPJ-BO is less restrictive, has better cosmesis and allowed better functional performance than MCPJ-BO. CONCLUSION: PIPJ-BO is more effective than MCPJ-BO in pain reduction and achieved better functional outcome. Orthosis wear of 24 hours for more than 8 weeks is recommended.