Trigger Finger: An Atraumatic Medical Phenomenon.

Trigger finger is a mechanical problem with many etiological factors as possible causes, such as diabetes mellitus, carpal tunnel syndrome and repetitive finger movements. Although it can afflict anyone, it is much commoner in middle-aged women than men and the most commonly involved digit is reported to be the thumb. The diagnosis is mainly based on clinical symptoms during examination and first-line treatment is conservative with splinting and corticosteroid injections. Surgical open release is the "gold standard" of trigger finger treatment because it allows more careful inspection of the surgical area and is highly effective with low complication rates.

Trigger Finger: Adult and Pediatric Treatment Strategies.

Trigger fingers are common tendinopathies representing a stenosing flexor tenosynovitis of the fingers. Adult trigger finger can be treated nonsurgically using activity modification, splinting, and/or corticosteroid injections. Surgical treatment options include percutaneous A1 pulley release and open A1 pulley release. Excision of a slip of the flexor digitorum superficialis is reserved for patients with persistent triggering despite A1 release or patients with persistent flexion contracture. Pediatric trigger thumb is treated with open A1 pulley release. Pediatric trigger finger is treated with release of the A1 pulley with excision of a slip or all of the flexor digitorum superficialis if triggering persists.

Results of surgical release in pediatric trigger thumb.

OBJECTIVE: To observe and evaluate the treatment outcome of pediatric trigger thumb in patients who had undergone surgical release of the annular ligament with the oblique pulley partially released in patients who did not achieve full IP joint extension. MATERIAL AND METHOD: From 2003 to 2010, 21 surgically operated thumbs in 17 patients were reviewed. Bowstringing, range of motion (ROM) of thumb interphalangeal joint, Notta's node resolution and assessment of patient/parent satisfaction were used as outcome parameters. The pulley pathology system was observed intra-operatively. The annular ligament was completely released, and in patients who were notfully corrected, a further procedure in which 50% of the oblique pulley was released was undertaken. RESULTS: One thumb had recurrent triggering after 60 months of follow-up. No infection, neurovascular injury, excessive scarring, or bowstringing were detected. Notta's node was fully resolved in all operated thumbs. Mean follow-up was 64 months. Improved IP joint motion without flexion contracture was observed in all patients. The procedure was well tolerated by patients and both the patients and parents of patients expressed satisfaction with the results of the procedure. CONCLUSION: Surgical release is recommended for children aged more than one year that are afflicted with trigger thumb. This procedure delivers satisfactory results with minimal complications. To achieve full FPL excursion, some patients need to release 50% of the oblique pulley after the first procedure.

Percutaneous release of trigger fingers.

Open surgery has been indicated as the surgical treatment for trigger finger for many years; however, minimally invasive techniques are replacing conventional methods. Minimally invasive techniques enable early recovery of the patient with minimal damage to soft tissues. The authors' study showed that levels of effectiveness of open surgical and percutaneous methods were superior to those of the conservative method using corticosteroid based on the cure and reappearance rates of the trigger. Percutaneous pulley release for treating trigger finger is a safe, effective, and minimally invasive surgical alternative.

Anatomic outcome of percutaneous release among patients with trigger finger.

PURPOSE: To investigate the adequacy and safety of percutaneous trigger finger release on symptomatic patients. METHODS: Two orthopedic non-hand surgeons performed percutaneous A1 pulley release on the thumb, index, middle, and ring fingers with the use of a 19-gauge needle in 25 fingers of 24 patients. Open inspection was then performed to determine the extent of release and any injury to the surrounding anatomic structures. RESULTS: Triggering was eliminated in all fingers. Of the 25 A1 pulleys, 19 were partially released; only 6 were completely released. Noted injury included only superficial abrasions in 15 tendons. None of the patients had injury to the digital artery or nerve. CONCLUSIONS: In the percutaneous release of trigger fingers, complete anatomic release of the A1 pulley is not always adequately achieved, even though clinically patients experience relief of triggering. It is a safe procedure for the thumb, index, middle, and ring fingers as long as the recommended technique is observed.

Failure of differentiation: Part II (arthrogryposis, camptodactyly, clinodactyly, madelung deformity, trigger finger, and trigger thumb).

The term "failure of differentiation" describes the phenotypes of a large number of otherwise unrelated conditions. The six conditions described here (arthrogryposis, camptodactyly, clinodactyly, Madelung deformity, trigger finger, and trigger thumb) are believed to occur because various structures failed to differentiate normally; however, they have neither common features nor a common cause. We have included information about the history and diagnosis of these conditions, the cause (if known), and the current concepts of treatment and expected outcomes.

ICF components of corresponding outcome measures in flexor tendon rehabilitation - a systematic review.

BACKGROUND: The International Classification of Functioning, Disability and Health (ICF) delivers a holistic approach to health conditions. The objective of the present study is to provide an overview of flexor tendon rehabilitation outcome measures with respect to ICF components. Furthermore, it aims to investigate to which extent current assessments measure aspects of health according to these components primarily focussing on activity and participation. METHODS: A systematic literature review was conducted to identify all studies meeting the inclusion criteria. Studies were only included if they assessed more than body function and body structure and referred to the ICF components activity and participation. The outcome measures were analysed and their linkage to the ICF components were investigated to examine to which degree aspects of health outcome as defined by the ICF were considered. RESULTS: As anticipated, the application of outcome measures after flexor tendon repair is non conform. In many studies the emphasis still lies on physical impairment neglecting activity limitations and participation restrictions.Aspects of health after flexor tendon repair could be assessed more adequately and cover patients' needs more sufficiently by choosing outcome measures which refer to all aspects of functioning. CONCLUSION: The ICF can help to identify aspects of health which are not being considered. The ICF can help promote further development of adequate outcome measures including activity limitation and participation restrictions by targeting patient centred goals and respecting patients' needs.