Screening for transthyretin amyloid cardiomyopathy in patients with musculoskeletal symptoms: Red flags in the rheumatology/orthopedics practice setting.

Extracorporeal shockwave therapy (ESWT) acts as an acoustic wave via momentum transfer and mechanotransduction in aplethora of regenerative ways. Scaphoid non-unions benefit from high-energetic focused ESWT. In lunate necrosis aka Morbus Kienböck focused high-energetic ESWT can reduce pain and improve MRI. In CMC1 osteoarthritis focused ESWT appears to be clinically equal to intraarticular ultrasound-guided hyaluronic acid injection with more pronounced effects 6 months after therapy in the ESWT group. Tendinopathies of the hand can be treated with both, radial and focused ESWT, especially in symptomatic trigger finger and de Quervain tendinopathy. In symptomatic painful Dupuytren disease, focused high-energetic ESWT can reduce pain and slow down progression of the disease.

Incidence, Timing, and Predictors of Staged Contralateral Carpal Tunnel Release at Minimum Ten-Year Follow-Up from Unilateral Surgery.

ObjectivesDiabetes mellitus (DM) has a strong genetic component and is a known risk factor for several hand conditions. We aimed to examine whether DM in first-degree relatives is associated with an increased risk of hand surgical diagnoses.DesignA retrospective cohort study.SettingData were collected from a population-based cohort in southern Sweden (Malmö Diet and Cancer Study (MDCS)). Family relationships were obtained through the Swedish Multi-Generation Register and healthcare diagnoses from the National Patient Register.Participants30 446 individuals (60% female) aged 45–73 years were included from the MDCS.Outcome measuresThe primary outcome was any diagnosis within the ‘diabetic hand’ category; carpal tunnel syndrome, ulnar nerve entrapment, trigger finger, Dupuytren’s disease and thumb base osteoarthritis, identified through International Classification of Diseases, tenth revision codes. Logistic regression models were used.ResultsIn the index study population, 4 150 (14%) had ≥1 hand surgical diagnosis. In unadjusted models, DM in the index individual and first-degree relatives was associated with an increased risk of developing hand surgical diagnoses (OR 1.14, 95% CI 1.06 to 1.22). After adjusting for confounders, only DM in the index individual remained significantly associated with the diabetic hand (OR 1.23, 95% CI 1.13 to 1.33). In diagnosis-specific analyses, an association persisted between having ≥1 sibling with DM and Dupuytren’s disease (OR 1.39, 95% CI 1.09 to 1.76), and between having ≥1 child with DM and carpal tunnel syndrome (OR 1.18, 95% CI 1.00 to 1.39).ConclusionWhile DM in the index individual was consistently associated with a higher risk of multiple hand surgical diagnoses, DM in first-degree relatives did not significantly influence the risk after adjustments. Exceptions included an association between ≥1 sibling with DM and Dupuytren’s disease, and ≥1 child with DM and carpal tunnel syndrome. Future research should further explore potential genetic factors contributing to these conditions.

Does Approach Matter? Pain, Plane, and Efficacy in Dorsal Versus Volar Trigger Finger Injections-A Discussion.

Bibliometric analysis of the 50 most-cited articles on ultrasound-guided minimally invasive procedures of the upper limb.

BackgroundTrigger finger (TF) is a common hand condition often requiring surgery. Open surgery (OS) is the standard treatment, with high success rates. Percutaneous release (PR) offers potential advantages regarding cost, procedure time, and recovery, although its effectiveness remains debated in different clinical settings. This study compares outcomes, complications, and resource use between PR and OS in a Swedish hospital setting where PR was newly introduced.MethodsWe conducted a retrospective observational study including 110 patients treated for TF between 2018 and 2020 at the Department of Orthopaedics, Falu Regional Hospital, Falun, Sweden. Fifty fingers underwent PR and 94 fingers were treated with OS. PR was performed by two surgeons with procedure-specific expertise corresponding to level 1 and 2, respectively. The primary outcome was elimination of triggering, evaluated through follow-up visits or phone interviews at a median of 39.5 months (interquartile range 13) post-treatment. Secondary outcomes included complications, additional treatments, DASH scores, extension deficits, and estimated treatment costs.ResultsTriggering was resolved in 26/50 (52%) fingers treated with PR and 87/94 (93%) treated with OS (p < 0.001). Secondary interventions were required in 19 (38%) PR cases versus 2 (2%) in the OS group. No major complications (e.g. neurovascular or tendon injury) were reported. Minor transient symptoms (e.g. tenderness, scar pain) were reported by 8% of PR patients and 6% of OS patients. Estimated treatment cost per patient was 53 USD for PR and 138 USD for OS. Despite lower effectiveness, 69% of PR patients indicated willingness to undergo the same procedure again, compared to 97% in the OS group.ConclusionsWhile percutaneous release of the A1 pulley is safe, it was significantly less effective in eliminating triggering compared to open surgery. The procedure might be more technically demanding than previously assumed. Further prospective studies are needed to clarify its cost-effectiveness in different clinical settings, e.g. when performed by less experienced surgeons.Level of evidenceLevel III.Clinical trial registrationEthical Review Board of Region Dalarna, Dnr 2020–07205, dated February 17, 2021.Supplementary InformationThe online version contains supplementary material available at 10.1186/s13018-026-07005-w.

Trigger finger (stenosing tenosynovitis) reflects abnormal tendon-pulley mechanics, primarily at the A1 pulley; however, objective assessment during functional motion remains limited in routine clinical practice. We evaluated electrical contact resistance (ECR) from a wearable tactile sensor during standardized digit motion and examined its association with symptoms. Nine participants with Green grade II-III trigger finger were prospectively enrolled. An origami-inspired pentagon-knot graphene-paper tactile sensor measured ECR over the A1 and A2 pulleys during repeated flexion-extension cycles. A 4-week intervention program (electrical stimulation plus infrared irradiation; three sessions per week) enabled repeated measurements. ECR and patient-reported outcomes were collected at weekly Tuesday assessments, with ECR recorded immediately before and after the session (ECRpre and ECRpost). Outcomes included pain (visual analog scale [VAS]) and triggering severity (ST), frequency (FT), and functional impact (FIT). Within-session change was defined as ΔECRsession = ECRpre - ECRpost. Analyses used linear mixed-effects models, repeated-measures correlation (rmcorr; rrm coefficient) and week-adjusted fixed-effects regression. Sensor placement and recording were feasible, with no adverse events. Across 27 paired weekly sessions (Weeks 1-4), ECR decreased from pre- to post-session at both pulleys (model-estimated mean ΔECRsession: A1 0.0795; A2 0.0990; both P < 0.001). A1 ECRpre declined over Weeks 1-4 (rrm = - 0.672; P = 0.0016). At matched weekly timepoints (N = 6; n = 24), A1 ECRpre correlated with VAS (rrm = 0.781; P < 0.001), FT (rrm = 0.578; P = 0.0095), and ST (rrm = 0.543; P = 0.0164), but not FIT (rrm = 0.165; P = 0.50). Larger A1 ΔECRsession values were associated with greater subsequent week-to-week pain improvement (rrm = 0.625; P = 0.0042). In a fixed-effects model adjusting for week, A1 ECRpre independently predicted VAS (β = 29.19; P = 0.018). Wearable ECR sensing was safe and feasible in this pilot study and demonstrated consistent within-session responsiveness. Clinically, motion-acquired ECR may serve as an objective adjunct for tracking session-level changes and week-to-week status with symptom scales. Retrospectively registered at ChiCTR (ChiCTR2600120811 approved).

Effect of Orthopedic Resident Surgical Education on Surgical Case Length and Healthcare Costs

Surgical release is an effective treatment for refractory cases of trigger finger; however, the optimal suture material for skin closure remains unclear. This systematic review and meta-analysis compares postoperative outcomes of absorbable versus nonabsorbable sutures following trigger finger (TF) release. This systematic review followed PRISMA guidelines, including a total of 5 studies in the final analysis, comparing absorbable versus nonabsorbable sutures in TF release. Data extraction included suture type, and reported outcomes such as wound complications, functional outcomes, and patient satisfaction. A meta-analysis was performed using RevMan 5.3, with statistical significance set at a P value less than 0.05. Patients who received nonabsorbable sutures had significantly higher odds of wound dehiscence, which was analyzed as a specific wound complication (odds ratio [OR]: 2.83, P = 0.02). Nonabsorbable sutures were also associated with higher odds of surgical site infection (OR: 1.49) and postoperative antibiotic use (OR: 1.17); however, these differences were not statistically significant (P = 0.29 and P = 0.74, respectively). In contrast, overall wound complications, analyzed as a composite outcome, were significantly less frequent with nonabsorbable sutures on sensitivity analysis (OR: 0.42, P = 0.004). Nonabsorbable sutures were associated with a higher risk of wound dehiscence, whereas they demonstrated a lower rate of overall wound complications in sensitivity analysis following TF release surgery. These findings highlight differences between individual wound outcomes; however, the available evidence remains limited. Further high-quality studies are required to confirm these results and guide optimal suture selection.

Ulnar Slip Flexor Digitorum Superficialis Excision in Trigger Finger Surgery: Anatomic Study.

PurposeThe primary objective of this review was to report the results of trigger finger release (TFR) under real-time ultrasound (US) guidance in a real-world population, including patients with concomitant hand issues and other comorbidities.MethodA retrospective review of the corresponding author’s case log for 2023 was conducted to identify all patients who underwent an index, middle, ring, or little finger micro-incision TFR from February through September of that year under real-time US guidance (ultrasound TFR (uTFR)). The preoperative demographics collected included triggering severity, comorbidities, age, and sex. The postoperative course included the number and type of postoperative visits required and notation of intraoperative or postoperative complications.ResultsOverall, 209 TFRs were performed on 116 consecutive patients using uTFR. There were no revision surgeries, nerve injuries, or infections. One digit required an intraoperative conversion to an open TFR (oTFR) with flexor digitorum superficialis (FDS) slip resection for persistent locking. Notably, 114 of the patients (98%) had at least one medical comorbidity or concomitant hand procedure at the time of uTFR. Furthermore, 113 patients (97%) were eligible for a streamlined follow-up process, and 104 (92%) elected to have only a telephone or registered nurse (RN) visit for follow-up after surgery. Seven patients (6%) had a post-procedure steroid injection on the operative digit, and 18 (16%) attended at least one occupational therapy (OT) visit.ConclusionMicroincision uTFR appears to be safe for the index, middle, ring, and little fingers regardless of comorbidities. Multiple digits can be released at the same time, even under local anesthesia. The technique allows for a streamlined process for most patients and for the practice.

IntroductionTrigger wrist is a rare condition often misdiagnosed as trigger finger or carpal tunnel syndrome (CTS). It is characterized by painful clicking, snapping, or locking of the wrist during movement and can result from space‐occupying lesions, such as ganglion cysts. This case highlights an unusual presentation of trigger wrist associated with CTS caused by a ganglion cyst in the flexor tendon sheath.Case PresentationA 44‐year‐old male presented with paresthesia, severe pain, and triggering of the right wrist. Imaging and histopathology confirmed a ganglion cyst between the flexor digitorum profundus tendons of the index and middle fingers, compressing the median nerve and causing CTS. Surgical excision via a carpal tunnel approach resulted in complete symptom resolution.ConclusionThis case emphasizes the diagnostic challenges of trigger wrist and the importance of considering it in patients with CTS‐like symptoms and mechanical wrist dysfunction. Ganglion cysts in flexor tendon sheaths are rare, and surgical excision remains an effective treatment. Increased awareness and reporting of such cases can improve clinical recognition and management.

Resolution of Pediatric Trigger Finger After Combined A1 Pulley Release, A2 Pulley Partial Release, and Flexor Digitorum Superficialis Tendon Split.

Accurate assessment of the A1 pulley is essential for the diagnosis and treatment of trigger finger, particularly in ultrasound-guided percutaneous release. Although high-resolution ultrasound is widely used to evaluate pulley morphology, the validity of sonographic measurements of A1 pulley length has not been clearly established against anatomical reference standard. This study evaluated the reliability and validity of ultrasound for measuring A1 pulley length and thickness in human cadavers and assessed the reproducibility of A2 pulley length. Twenty fingers from five fresh-frozen cadaveric hands were examined. Two blinded expert musculoskeletal sonographers independently performed ultrasound acquisition and measurements of A1 and A2 pulley length and A1 pulley thickness, while a third blinded observer obtained anatomical measurements after meticulous dissection using a digital caliper. Ultrasound systematically overestimated A1 pulley length compared with anatomical measurements and showed very poor reliability (ICC = 0.05) with wide limits of agreement. In contrast, A2 pulley length showed high interobserver reliability (ICC = 0.83) and relatively better agreement with anatomical values, whereas A1 pulley thickness showed moderate reproducibility (ICC = 0.61). Overall, A1 length measurements showed substantial variability and limited agreement, while A2 length and A1 thickness appeared more consistent within this experimental setting. These findings should be interpreted within the limitations of a cadaveric model.

This study sought to assess large language models' (LLM) ability to generate correct ICD-10 and CPT codes using clinical documentation, and to determine whether note authorship, prompt design, or diagnosis/procedure type affect LLM performance. We hypothesized that LLMs can code hand surgery clinic and surgical notes with greater than 80% accuracy. Ninety patients evenly distributed across three orthopaedic hand surgeons and procedure types (cubital tunnel, carpal tunnel, and trigger finger release) were identified. Clinic and surgical notes were deidentified, and correct ICD-10 diagnosis and CPT procedure codes were recorded. "Zero-shot," "one-shot," "multishot," and "chain-of-thought" prompts instructed LLMs to assign ICD-10 codes and CPT codes based on note content. Each prompt was posed to Chat GPT 3.5, Chat GPT 4.0, and Gemini. Rates of coding correctness were calculated across attendings, diagnosis/procedure, prompt type, and LLM. Chi-square analysis determined statistical significance for these comparisons (P < 0.05). No differences in LLM coding performance were observed between note authors (P = 0.09 ICD-10, P = 0.48 CPT) or prompt types (P = 0.27 ICD-10, P = 0.62 CPT). Chat GPT 3.5 provided less accurate ICD-10 codes than Chat GPT 4.0 or Gemini (P < 0.0001). All LLMs better predicted CPT codes (91.5% correct) than ICD-10 codes (23.9% correct). The most common error was incorrect or omitted ICD-10 laterality. Prompts updated to emphasize ICD-10 laterality demonstrated improved accuracy (40%). Variation in note content and writing style did not markedly affect LLM performance. Public-facing LLMs require additional optimization to interpret clinical documentation for coding purposes and are not ready for independent use.

BackgroundCarpal tunnel syndrome (CTS) is a common painful musculoskeletal disorder caused by inflammation and hypertrophy of the flexor retinaculum. Significant relationships exist between CTS, metabolic syndrome, smoking, and health-related factors, but the molecular mechanisms remain poorly understood.MethodsThis cross-sectional preliminary investigation was conducted at Al-Razi Hospital (Department of Orthopaedics), Kuwait, between October 2022 and September 2023. Tissue samples from the flexor retinaculum were collected following carpal tunnel release surgery from patients with symptomatic CTS. Seven groups were included: healthy control (n = 10), trigger finger (control for gene expression analysis; n = 10), CTS (n = 10), diabetic CTS (n = 9), hypertensive CTS (n = 7), dyslipidemic CTS (n = 7), and smoker CTS (n = 9). Expression levels of CTS-related genes (COL-I, COL-II) and inflammatory genes (TNF-α) were evaluated by reverse transcription-polymerase chain reaction (RT-PCR). Participants completed the Perceived Stress Scale (PSS), Pittsburgh Sleep Quality Index (PSQI), Disability of the Arm, Shoulder and Hand (DASH), Numeric Pain Rating Scale (NRS), and Satisfaction with Life Scale (SWLS) questionnaires. One-way ANOVA with Bonferroni post-hoc correction and Pearson correlation analyses were used, with adjustment for confounders using directed acyclic graphs (DAGs).ResultsA total of 62 participants (33 males, 29 females; mean age 54 ± 6.9 years; mean BMI 28.2 ± 3.4 kg/m2) were enrolled. Hand dysfunction was significantly greater in metabolic CTS and smoker groups versus CTS group (p < 0.0001; 95% CI for DASH score: 15.224.6). Stress levels were significantly higher in smoker CTS (p = 0.024; 95% CI: 2.3–8.7) and hypertensive CTS groups (p = 0.013; 95% CI: 1.9–7.4) compared to CTS alone. The diabetic CTS group showed significant sleep disturbance (p < 0.0001; 95% CI: 3.5–9.2) and increased pain (p < 0.0001; 95% CI: 2.1–5.8) compared to CTS alone. Life satisfaction was significantly lower in diabetic and hypertensive CTS groups (p < 0.0001; 95% CI for SWLS score reduction: -12.4 to -5.8). COL-I, COL-II, and TNF-α gene expression significantly increased in metabolic CTS and smoker groups (p < 0.0001; 95% CI for fold-change: 1.8–3.4). Strong correlations were observed between gene expression and all health-related factors (r = 0.34–0.93, p < 0.01).ConclusionsThis preliminary investigation demonstrates that hand dysfunction, stress levels, pain severity, and reduced life satisfaction in CTS patients are strongly associated with increased inflammation (tumor necrosis factor-alpha) and collagen gene expression (collagen type I and collagen type II) in patients with diabetes, hypertension, or dyslipidemia and smokers with CTS. These findings provide mechanistic insights into CTS pathophysiology. Further rigorous research with larger samples is needed to validate these preliminary findings.

Effectiveness of Proximal Interphalangeal Joint Orthosis and Therapeutic Exercise in the Management of Trigger Finger: A Prospective Case Series

Trigger finger (TF) release is one of the most common procedures in hand surgery. It is not clear whether outcomes differ when multiple digits are released in the same operating session. The present study aimed to compare outcomes between patients undergoing single digit and multiple digit TF release. We conducted a retrospective cohort study using the TriNetX database (https://trinetx.com/) to identify patients undergoing trigger finger release between 2010 and 2025. Patients were categorized into single digit and multiple digit release groups. Postoperative complications within 90 days, as defined by International Classification of Diseases, 10th revision codes, including hand pain, stiffness, haematoma, delayed wound healing and need for flexor tenolysis, were assessed. To minimize confounding, cohorts were balanced using 1:1 propensity score matching for demographics and comorbidities. A total of 119,306 patients undergoing trigger finger release were identified. After 1:1 propensity score matching, 48,840 patients were included in each cohort with well-balanced baseline demographics and comorbidities. Compared with single-digit release, multiple-digit release was associated with significantly higher rates of postoperative pain (1.92% vs. 1.00%; RR 1.92; 95% CI: 1.72 to 2.14; p < 0.001), joint stiffness or contracture (6.82% vs. 3.03%; RR 2.25; 95% CI: 2.12 to 2.39; p < 0.001), and subsequent flexor tenolysis (1.06% vs. 0.80%; RR 1.32; 95% CI: 1.16 to 1.51; p < 0.001). Complex regional pain syndrome was rare and observed only in the multiple-digit cohort (0.04%). Multiple-digit trigger finger release in a single operative session is associated with higher rates of postoperative pain, joint stiffness and need for flexor tenolysis compared with single-digit release, even after adjustment for demographics and comorbidities. III.

Wide-Awake Local Anesthesia No Tourniquet (WALANT) Versus General Anesthesia for Pediatric Trigger Thumb Release: Clinical Outcomes, Efficiency, and Costs.