The incidence of trigger digit after carpal tunnel release in diabetic and nondiabetic patients.

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.

The association of hemoglobin A1c with the prevalence of stenosing flexor tenosynovitis.

PURPOSE: Diabetic patients are susceptible to stenosing flexor tenosynovitis (FTS) and may have a diminished response to treatment. The purpose of this study was to determine whether elevated hemoglobin A1c (HbA1c) levels are associated with the development of FTS. METHODS: A review of our diabetic registry identified a cohort of patients with diabetes mellitus. We stratified this cohort to those with and without a diagnosis of FTS during 2008 based on International Classification of Diseases-9 coding (727.00-727.05J). We reviewed charts to confirm the diagnosis. For patients diagnosed with FTS, we used the HbA1c measurement made closest to the date of diagnosis for analysis. We assessed patients without FTS using an average of HbA1c measurements during the same time period and performed subgroup analysis based on specified HbA1c levels (group A, HbA1c level < 7.0%; group B, HbA1c 7.0% to 7.9%; group C, HbA1c 8.0% to 8.9%; group D, HbA1c ≥ 9.0%). Statistical testing consisted of chi-square analysis, odds ratios, and multivariate regression analysis. RESULTS: There were 259,927 patients in 2008 identified with diabetes mellitus, 3,952 of whom were diagnosed with FTS. The period prevalence of FTS in this diabetic population was 1.5%. Multivariate regression analysis revealed that HbA1c greater than 7% was an independent risk factor for FTS (odds ratio/confidence interval: group B, 1.31/1.20-1.42; group C, 1.35/1.21-1.51; group D, 1.23/1.10-1.38). CONCLUSIONS: The prevalence of FTS in this diabetic population was considerably lower than expected and may represent a more accurate assessment given the power of this population-based study. In addition, the development of FTS appears to be associated with higher HbA1c levels. Although further study is necessary, this association may be relevant when evaluating and treating diabetic patients with trigger finger.

Trigger digits in diabetes: their incidence and characteristics.

The purpose of this study was to investigate the incidence and characteristics of trigger digits in patients with diabetes. A questionnaire about trigger digit was completed by 544 patients with diabetes. Ten percent of the patients had a history of trigger digits and 4% had multiple digit involvement. The risk was significantly higher in insulin-dependent patients. The average duration of diabetes was significantly longer in the multiple digit group. Independently, the medical records of 132 trigger digit patients who underwent surgery were reviewed. Twenty-seven patients had diabetes, and 62 patients had multiple digit involvement. Involvement of more than three digits was significantly related to co-existing diabetes. In patients with diabetes, the incidence of trigger digits was about four times higher than in the general population. Screening for diabetes may be warranted in patients with involvement of more than three digits.