Trigger Finger Research Articles

The Outcomes of 2,154 Endoscopic Trigger Finger Releases

BackgroundTrigger finger is one of the most frequent causes of hand pain and disability. Recently, an endoscopic trigger finger release technique was developed, but outcomes have rarely been reported. Here, we present the outcomes of 2154 endoscopic trigger finger release procedures in a single center. MethodsIn this retrospective study, 2154 endoscopic trigger finger release procedures were performed on 2034 patients. Outcome assessment at 90 days after surgery was classified as excellent, good, fair or poor according to a combination of patient satisfaction with the scar and pain at rest or under load on a numeric rating scale. ResultsThe therapeutic outcomes were: 1027 excellent, 607 good, 400 fair, and none poor. No major surgical complications were observed. Minor complications occurred in 231 fingers (10.7%). ConclusionsAll patients were satisfied with their outcome after endoscopic trigger finger release. Endoscopic release can be an effective and efficient therapeutic method for the treatment of trigger finger.

Prospective evaluation of a novel device for ultrasound-guided percutaneous treatment of carpal tunnel and trigger finger disease. Efficacy and safety of sono-instruments®.

To evaluate the safety and effectiveness of percutaneous release procedures under sonography using Sono-Instruments® in the treatment of carpal tunnel syndrome (CTS) and trigger finger (TF). Prospective study involving 30 patients, divided into two groups (15 CTS, and 15 TF). The primary outcomes were surgical performance-related outcomes (visibility, ease of use, satisfaction, duration) using Sono-Instruments® and patient-related outcomes (pain, activity limitations, time to return to work, functional scores). Secondary outcomes included complications. Patients were followed for two months post-operatively. In the CTS group, the average age of the patients was 58.7years. The percutaneous release of the transverse carpal ligament was effectively completed in all cases, with excellent device performance and no adverse events. At one week, all patients could wash their hands, 80% could perform activities of daily living, and 80% of those working had returned to their activities. At two months, all patients had resumed all activities. Pillar pain was still present in 53.3%. In the TF group, the patients had an average age of 57.9years. The percutaneous release of the A1 annular pulley was successful in all cases, with excellent device performance and no adverse events. At one week, all patients could wash their hands, 93.3% could do all activities of daily living, and 75% of those working were back to their professional activities. At two months, all patients were back to all activities of daily living and work. The DASH score was significantly improved at two months, compared to preoperative, for both groups (p < 0.001). Percutaneous sono-guided release using Sono-Instruments® is safe and efficient, and associated with quick functional recovery. II.

Early Formation of a Tenosynovial Retinacular Cyst Between A1 and A2 Pulleys After Open A1 Pulley Release

Case: A 66-year-old woman presented with a left middle trigger finger and underwent a proximal annular pulley (A1) release. Four weeks later, she presented with a new mass in the same finger without recurrent triggering. She was found to have a tenosynovial retinacular cyst, which was surgically excised. Conclusion: This case demonstrates early ganglion cyst formation between A1 and A2 pulleys after A1 pulley release. Although the etiology is unclear, this case illustrates effective treatment strategies.

Tetik Parmak Hastalığı Hakkında Bilgi Kaynağı Olarak YouTube

Amaç: Tetik parmak hastalığı, literatürde kullanılan diğer adıyla parmağın stenozan tenosinoviti; ilgili parmakta ağrı, şişlik, hareket kısıtlılığı, tam ekstansiyon kaybı gibi klinik bulgulara yol açabilen bir hastalıktır. Çalışmamızın amacı tetik parmak hastalığı ile ilgili en çok izlenen YouTube videolarının kalite ve güvenirliğini değerlendirmektir. Gereç ve Yöntemler: Videoları aramak için “trigger finger” anahtar kelimesi kullanıldı. Arama sonuçlarına göre en çok izlenen 60 video değerlendirildi. Videoların temel video metrik parametreleri izlenme sayısı, günlük izlenme sayısı, beğeni sayısı, yorum sayısı, yüklenme tarihi, YouTube’taki toplam gün sayısı kaydedildi. Videolar yükleyici kaynağa göre doktorlar, diğer sağlık profesyonelleri, sağlık bilgi siteleri, televizyon programları, bağımsız kullanıcılar olarak sınıflandırıldı. Ayrıca global kalite ölçeği (GKÖ) kullanılarak videolar düşük-orta- yüksek kalite olarak gruplandırıldı. Videoların güvenilirliği modifiye DISCERN ölçeği ve Journal of the American Medical Association (JAMA) kriterleri kullanılarak değerlendirildi. Bulgular: Toplam 60 video incelendi ve dâhil edilme kriterlerini karşılayan 41 video çalışmaya alındı. Değerlendirilen 41 videonun 20’si (%48,8) doktorlar, 9’u (%22) diğer sağlık profesyonelleri, 11’i (%26,8) sağlık bilgi siteleri ve 1’i (%2,4) TV programları tarafından yüklenmiştir. Kalite sınıflamasına göre %29,3’ü düşük kalitede, %26,8’i orta kalitede ve %43,9’u ise yüksek kalitededir. Çalışmada yer alan yüksek kaliteli videoların %72 doktorlar tarafından yüklenmiş olup, doktorların yüklediği videoların %65’si yüksek kalitededir. Toplam izlenme sayısı, günlük izlenme, beğeni ve yorum sayısı açısından kalite grupları arasında anlamlı fark yoktu (p&amp;gt;0,05). Kaynağın doktor olduğu videoların GKÖ (p=0,002), JAMA (p=0,041) ve DISCERN (p=0,003) değeri diğer kaynakların değerinden anlamlı şekilde yüksek görülmüştür. Videoların GKÖ skoru ile JAMA, DISCERN ve süre arasında pozitif yönde anlamlı bir korelasyon görülmüştür. Sonuçlar: Tetik parmak hastalığı ilgili doktorlar tarafından yüklenen YouTube videolarının çoğunluğu kalite ve güvenilirliği diğer kaynaklara göre yüksektir. Kullanıcıların videoların görüntülenme sayısı, yorum sayısı, beğeni sayısına göre yönlenmelerinden ziyade video kaynaklarına odaklanmaları faydalarınadır. Doktorlar YouTube gibi çevrimiçi platformları daha çok kullanıp kaliteli ve güvenilir içerikler yüklemelilerdir.

Surgical treatment of trigger finger: a comparative study of A1 pulley opening versus ulnar superficialis slip resection

Trigger finger is a common condition. Surgery most frequently involves opening the A0 and A1 pulleys. However, this shows limited effectiveness in correcting proximal interphalangeal joint fixed flexion deformity. The present study aimed to compare clinical outcomes between two surgical techniques for trigger finger treatment.This retrospective study included 127 patients, 72 of whom underwent resection of the ulnar slip of the flexor superficialis, and 55 underwent opening of the pulleys. Study data comprised patient characteristics, range of motion, proximal interphalangeal fixed flexion deformity measurement, Quick-DASH and PRWE scores, and overall satisfaction.There were no significant differences between the two groups in terms of Quick-DASH or PRWE scores. Fixed flexion deformity correction was slightly but not significantly better with resection of the ulnar slip of the flexor superficialis (100%) compared to opening of the pulleys (88%). Level of evidence: Level IV.

Assessment of Surgical Training Modality Efficacy in Medical Students – A Comparison of Surgical Simulation, Video Demonstration, and Live Instruction

Objectives Surgical simulation is a growing form of education in medical training, but it remains unclear how simulation compares to traditional lecture or apprenticeship models of teaching when translating procedural knowledge to surgical performance. This study aimed to assess the effectiveness of translating procedural knowledge to surgical skill when trained by the surgical simulation app “Touch Surgery (TS),” recorded video lecture, or in-person teaching of the trigger finger release (TFR) surgery. The study also aimed to identify the learners’ preferred teaching modality. Methods Twenty-seven first- and second-year medical students were recruited to participate. They were randomly assigned to one of three cohorts (n=9) as designated by a different TFR surgery learning modality: surgical simulation through TS (cohort “SS”), video demonstration (cohort “VIDEO”), or live teaching by a board-certified orthopaedic hand surgeon (cohort “LIVE”). Each participant completed their modality three times. They then completed an assessment of the procedural steps before performing the TFR surgery on a cadaver. Outcome measures included procedural test scores and cadaveric performance, evaluated using a surgery-specific detailed checklist, a global rating scale (GRS) of soft surgical skills, and a pass/fail assessment. Participants graded their modality’s usefulness using a 5-point Likert scale. Results There was no statistically significant difference in TFR procedural assessment scores (P=0.123) or cadaveric surgical performance between groups when evaluated by the surgery-specific step checklist (P=0.549), GRS (P=0.567), and pass/fail assessment (P=0.874). Students in the LIVE cohort rated their modality as their first-choice training tool (P=0.009); however, those in the SS cohort rated their modality as easiest to use, follow, and understand (P=0.010). Conclusion All educational modalities should be considered in surgical training. This study demonstrates that students can perform cognitively and technically similar learning from virtual or live formats; however, they preferred live teaching. Level of Evidence III

Effect of dry needling on quality of life in patients with trigger finger: a randomized controlled trial

BackgroundAn inflammatory disorder known as trigger finger (TF) results in pain inthe proximal and distal palm and digit, as well as restricted movement and diminished function. Physiotherapists use a specific treatment called dry needling (DN) to reduce musculoskeletal pain and assist patients with mobility restriction.ObjectivesThis study aimed to examine the effectiveness of DN on quality of life in patients suffering from trigger finger.MethodsForty patients, ranging in age from 45 to 75, were randomized into one of two groups in this Prospective pre and post-test, single-blind parallel group randomized controlled trial. Twenty patients were assigned to the intervention group, which included traditional physiotherapy splinting and ultrasound (ultrasonic dosage was 3MHz, the intensity of 0.5 W/cm2, and the duty cycle 50%. Duration: 5 minutes) as well as to DN upon a nodule at the proximal end of the 1st annular (A1) pulley as well as the discrepancy that existed between the flexor tendon's diameter along with its sheath at the metacarpal head. Twenty patients were assigned to the control group, which consisted of traditional treatment alone, twice weekly, for a total of ten sessions over five weeks. The trial evaluated the quality of life, severity of pain, and hand grip strength using the World Health Organization Quality-of-Life Scale (WHOQOL-BREF), visual analogue scale, and Camry dynamometer respectively two times, beforetreatment and after 10 treatment sessions.ResultsWithin-group analysis using MANOVA demonstrated a significant decline in VAS (p = 0.001) and a significant improvement in quality of life (p = 0.001) and hand grip strength (p = 0.001). Regarding between group comparison using MANOVA there was significant improvement in favor of the DN intervention (p = 0.001) for all measured variables.ConclusionsA 5-week dry needling approach with a traditional physiotherapy program was effective in improving in quality of life, pain intensity, and hand grip strength in patients with trigger finger, emphasizing it as the better option.Trial registration:Clinical Trial. Gov, NCT05671523. Registered 14 December 2022.

O24: Triggering Change: Evaluating Minimally Invasive Techniques in the Pandemic-Era Hand Surgery in Malaysia

Abstract Aims This study aimed to compare outcomes of open surgical release versus ultrasound-guided and anatomical landmark-guided percutaneous release techniques for trigger finger treatment during the COVID-19 pandemic (year 2020-2022) at a single centre in Malaysia. Methods A retrospective review was conducted for 44 patients (94 digits) who underwent open surgical release (OS, n=52 digits), ultrasound-guided percutaneous release (UPR, n=30 digits), or anatomical landmark-guided percutaneous release (APR, n=12 digits) for trigger finger from 2020-2022. Outcomes assessed included post-operative pain, triggering recurrence, time to return to work/activities, patient satisfaction, and complications. Results Patients undergoing percutaneous release had expedited return to work/activities (3 days) compared to open surgery (20 days) (p&amp;lt;0.0001). No UPR/APR patients reported persistent pain at 3 months versus 13.5% of OS patients. Recurrence rates were comparable between modalities (1.9% vs 2.4%). Patient satisfaction was similar across OS/UPR/APR groups (4.4 vs 4.3 vs 4.4). Complication risks were lower with percutaneous techniques. Conclusions During the COVID-19 pandemic, percutaneous trigger finger release facilitated swifter rehabilitation and reduced hospital visits versus open surgery. The percutaneous approaches demonstrated clear benefits especially relevant for strained healthcare systems, including neater post-operative recovery, diminished long-term discomfort, and lower complication risks. Percutaneous release has considerable advantages and merits wider embrace.

REPORTED PRICES FOR HIGH VOLUME HAND SURGERY IN THE ERA OF PRICE TRANSPARENCY: IMPLICATIONS FOR FUTURE POLICY ITERATIONS.

In 2021, the United States enacted a law requiring hospitals to report prices for healthcare services. Across several healthcare services, poor compliance and wide variation in pricing was found. This study aims to investigate variation in reporting and listed prices by hospital features for high-volume hand surgeries including Carpal Tunnel release, Trigger Finger Release, De Quervain Tenosynovitis Release, and Carpometacarpal Arthroplasty. The Turquoise Health price transparency database was used to obtain listed prices and linked to hospital characteristics from the 2021 Annual American Hospital Association Survey. This study used descriptive statistics and generalized linear regression. The analytic cohort included 2,652 hospitals from across the US. The highest rate of price reporting was in the Midwest (52%, n=836) and lowest in the South (39%, n=925). Compared to commercial insurers, ($3,609, 95% CI: $3,414 to $3,805) public insurance rates were significantly lower (Medicare: $1,588, 95% CI: $1,484 to $1,693, adjusted difference = -$2,021, p<0.001, Medicaid: $1,403, (95% CI: $1,194 to $1,612, adjusted difference = -$2,206, p<0.001). Listed rates for self-pay patients were not statistically different from commercial rates. Although pricing for high volume elective hand surgeries is frequently reported, a high proportion of hospitals do not report prices. These data highlight the need for future transparency policy to include pricing for high-volume hand surgery to give patients the ability to make financially informed choices. These results are a valuable aid for surgeons and patients to promote financially conscious decisions.

A Comparison of Patient Characteristics and Outcomes Between Patients Receiving Flexor Digitorum Superficialis Slip Excision or Isolated A1 Pulley Release for Trigger Finger

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. 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. 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. 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. Therapeutic III.

Trigger Thumb, Trigger Finger and Clasped Thumb.

Finger deformities are a common reason for medical observation in children. Subtle clinical differences can have a significant impact on the diagnosis and treatment of these patients. Identification of the basic diagnostic and treatment principles of trigger thumb, trigger finger, and clasped thumb is of paramount importance to all general practitioners, pediatricians, and orthopedic surgeons who are involved in the care of children. The purpose of this article is to review the most important concepts regarding these important topics, focusing on etiology, epidemiology, clinical presentation, diagnosis, treatment and prognosis.

A pictorial guide for performing dynamic musculoskeletal ultrasound techniques of the Upper Limb

IntroductionDynamic techniques should be used to compliment static imaging in the field of Musculoskeletal ultrasound. Performing limb movements and imaging simultaneously, allows for diagnosing certain musculoskeletal conditions not otherwise confirmed by still images. This article aims to provide guidance on how to perform a selection of these dynamic musculoskeletal ultrasound techniques with a focus on the upper limb. MethodsThis pictorial guide features techniques gathered from literature review and experience gained in the field. ResultsApplication of dynamic ultrasound techniques has been evidenced in the literature to diagnose conditions such as trigger finger, dislocating tendons and causes of peripheral neuropathy. ConclusionMusculoskeletal conditions only elicited during limb movement can be difficult to diagnose. Appropriate use of dynamic techniques increases likelihood of correct diagnosis of the described conditions. Implications for practiceUltrasound provides a unique opportunity to visualise these conditions thus ultrasound users should aim to familiarise themselves with dynamic ultrasound techniques to improve patient outcomes.

Primary Negative Prognostic Factors in Pediatric and Adult Patients Undergoing Trigger Finger Surgery.

Objectives This study aims to investigate the negative prognostic indicators of pediatric and adult trigger finger surgery patients concerning complications, recurrence, and satisfaction. Methods A retrospective study was conducted on 61 patients with a total of 91 trigger fingers, including 31 in children and 30 in adult patients, all of whom were treated using a standardized surgical technique. The study considered several demographic and clinical factors, including age, gender, dominant hand, body mass index, occupation, history of trauma, single or multiple finger involvement, staging according to Green classification, diabetes mellitus, comorbidities, recurrence, revision surgery, utilization of non-surgical treatment methods, need for rehabilitation after surgery, time to return to work, the time interval from clinic initiation to the surgery, satisfaction and the duration of the follow-up period. In addition, the quick version of the disabilities of the arm, shoulder, and hand (QDASH); and the visual analog scale (VAS) were used to assess patients' data. Results In adult patients, a statistically significant relationship was observed between the increasing grade of the Green stage and complication rate (p<0.001), recurrence (p<0.001), and lower satisfaction (p<0.001). No statistically significant relationship was identified between Green's classification and complications (p=0.129), recurrence (p=0.854), or satisfaction (p=0.143) in pediatric patients. While a statistically significant relationship existed between the time interval from clinic initiation to surgery and complications (p=0.033) in adult patients, no significant relationships were observed for recurrence or satisfaction. Conversely, there was no statistically significant relationship between the time interval from clinic initiation to surgery and complications, recurrence, or satisfaction in pediatric patients. Conclusion This study demonstrates that increasing the grade of the Green stage and duration of symptoms before surgery were the substantial factors contributing to prognosis in adult patients but not in pediatric patients. These findings can assist physicians during patients' treatment management. We suggest that physicians consider these factors for patients' satisfaction.

Percutaneous release of trigger finger and its functional outcome

Background: An overview of percutaneous release for trigger finger and its functional outcomes. Methods: The present prospective controlled analytical study was conducted after taking approval from center human ethical committee. A written and informed consent was obtained. There were 50 patients who reported to outpatient department (OPD) with symptoms suggestive of trigger thumb/ finger, were subjected to the study. Results: Most of the patients belonged to the age group of 41-50 years. Majority of patients were females (56%) and males were (44%). Most of the patients had the right 1st digit involved (32%), followed by left 1st and right 3rd digit (18% each). Before the release of affected digit, 56% were grade 3, 26% were grade 4 and only 18% were grade 1. Complete resolution immediately after the procedure was seen in 82% cases. Pre procedure, mean VAS of 8.4 reduced to mean VAS of 6.2 immediate post procedure. At 48 hours post procedure, mean VAS of 3.06 and mean VAS of 1.12 was seen at 1-month post procedure period. At 3 months post procedure, mean VAS of 0.42. 94% cases had no complications. Conclusions: Percutaneous release of trigger finger is a safe and effective procedure associated with favorable functional outcomes. It provides an alternative treatment option for patients who have failed conservative management or prefer a minimally invasive approach.

Incision techniques for trigger thumb release: a comparison of outcomes of four types of skin incision.

Although trigger thumb release is commonly performed, there is no consensus on the optimal skin incision. This study aimed to compare outcomes of four incision techniques, including V-shaped, oblique, transverse and longitudinal incisions. Outcomes included the Michigan Hand Outcomes Questionnaire, satisfaction with the treatment and postoperative complications. The results of 875 patients who underwent trigger thumb release were assessed. All groups demonstrated improvement in self-reported hand function (range of 10-14 points), pain (25-27 points) and aesthetics (4-7 points) from baseline to 3 months postoperatively with no differences between incision techniques. Of the patients, 76% reported good or excellent satisfaction with the outcome of treatment. Satisfaction and complication rates of the different incision techniques were similar. These findings imply that there is no clear benefit of one type of incision over another for trigger thumb release, suggesting that surgeons may use the technique of their preference.Level of evidence: III.

Serious Complications of the Percutaneous A1 Pulley Release: Case Reports and Literature Review.

Percutaneous first annular pulley (A1 pulley) release, which has been increasingly used to treat trigger fingers, has been widely established as a safe and simple procedure. Multiple studies have reported positive results of percutaneous A1 pulley release. In this study, however, we report cases of patients who developed complications after undergoing percutaneous A1 pulley release at local clinics. A total of six patients visited our hospital for infectious complications after percutaneous A1 pulley release. Various sequelae such as damage to normal structures, insufficient procedure, and tissue necrosis were observed during the exploration. A retrospective study was conducted to identify the cause and trend of the observed complications by instruments (HAKI knife or needle). In the HAKI knife group, there was a tendency for damage to normal structures, while in the needle group, an insufficient release or serious soft tissue necrosis was observed. Based on these cases, our findings confirm the existence and characteristics of infectious complications following the percutaneous A1 pulley release. We further identify that the type of instrument used predicts the nature of complications. Thus, reliable and skilled performance of the procedure by experts is essential for safe treatment.

Finger flexor rigidity in the healthy population

The involvement of the hand flexors in trigger finger is not clear. This study aimed to examine the rigidity of the flexor tendon in the first pulley territory in the hand by using ultrasound in a healthy population, as well as to create a reference scale of rigidity for the flexor tendons to compare those values in trigger fingers. We tested 35 healthy volunteers using a linear ultrasound transducer and the color Doppler method. Rigidity levels below the first pulley were examined and compared between the different fingers of the hand and the relationship between rigidity and sex and the three different age groups was evaluated. In the healthy population, the rigidity of the flexor tendons of the hand in the territory of the first pulley varied between 233.1 and 962.8 kPa, with an average of 486.42 kPa and standard deviation of 114.85. We showed that the flexors in the dominant hand were more rigid, there was a difference between the rigidity of the flexor tendons of the thumb and the other fingers of the same hand, and the ring finger of the dominant hand had stiffer flexor tendons than the fingers of the other hand in the male population. We created a value scale for the rigidity of the flexor tendons of the fingers. This base scale can be compared between different pathologies, including trigger finger. The study and all experimental protocols were approved by the local ethical committee.

Surgery for Pediatric Trigger Finger.

Pediatric trigger finger (PTF) is an uncommon condition that is 10 times less common than trigger thumb. The Quinnell grade is utilized to quantify the extent of the triggering on a 4-point scale (0 = normal movement, 1 = uneven movement, 2 = actively correctable triggering, 3 = passively correctable triggering, and 4 = fixed deformity)1. Less extensive triggering can be treated nonoperatively with use of monitoring or splinting; however, the reported resolution rates are low, with only 30% of PTF cases treated nonoperatively achieving complete resolution1. Splinting has also been shown to not improve resolution rates in pediatric cases treated nonoperatively. In contrast, operative intervention has a high likelihood of restoring motion and function of the affected digit2,3. Overall, PTF has been shown to have significantly higher rates of resolution when treated operatively (97.1%) versus nonoperatively (30.0%)2. PTF may be safely and predictably treated with use of operative release of the A1 pulley and resection of a single flexor digitorum superficialis (FDS) tendon slip. PTF treated with this technique predictably results in resolution with restoration of motion. The present video article demonstrates the surgical treatment of a 7-year-old with a locked right ring finger. Operative steps include (1) general anesthesia, (2) tourniquet control, (3) loupe magnification, (4) neurovascular identification, (5) A3 and A1 pulley release, (6) excision of the ulnar slip of the FDS, (7) and simple closure. The primary alternative to this procedure is nonoperative treatment with continued monitoring and/or splinting. PTF differs from pediatric trigger thumb. Simple release of the A1 pulley may not resolve the triggering, requiring additional excision of the ulnar slip of the FDS. Jia et al. reported that only 30% of nonoperatively treated cases of PTF achieved complete resolution, and splinting did not improve resolution rates3. In contrast, operative intervention has a high likelihood of restoring motion and function of the affected digit. Overall, operatively treated PTF showed significantly higher rates of complete resolution compared with nonoperatively treated PTF (97.1% compared with 30.0%, respectively)3. Additionally, Cardon et al. reported residual triggering in 44% (8) of 18 cases of PTF treated with isolated A1 pulley release2. Bae et al. reported a 91% success rate (21 of 23) when PTFs were treated uniformly with A1 pulley release combined with FDS slip excision1. We conclude that PTF may be safely and predictably treated with use of operative release of the A1 pulley and resection of a single FDS tendon slip. General anesthesia will limit inadvertent patient movement for a safer surgery.Identify neurovascular bundles to prevent inadvertent injury.Utilize loupe magnification to aid in identification of neurovascular bundles.Perform a Bruner incision for wide exposure and excision of the ulnar FDS. FDP = flexor digitorum profundusFDS = flexor digitorum superficialisDIP = distal interphalangeal joint.

Incidence, Prevalence, and Outcomes of Hand Manifestations in Patients With Diabetes Mellitus: A Comprehensive Literature Review.

Diabetes mellitus is a metabolic disease that results in long-term hyperglycemia. Among the many long-term complications associated with diabetes, manifestations in the hand include Dupuytren's contracture, trigger finger, compressive neuropathies, and infections. These conditions can have a profound impact on a patient's quality of life, highlighting the importance of timely recognition and treatment of these manifestations. This review aims to provide updated information regarding the incidence and outcomes of these clinical manifestations in the diabetic versus nondiabetic population. A systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was performed. The literature search included the use of PubMed and Ovid databases to find relevant articles that were then selected based on an inclusion criterion that required level 4 evidence. Diabetes mellitus results in an increased incidence of Dupuytren's contracture, trigger finger, carpal tunnel syndrome, cubital tunnel syndrome, and hand infections. Dupuytren's, trigger finger, and carpal tunnel syndrome all had similar outcomes, while diabetic patients had worse outcomes related to infections. There was a lack of data regarding the effect of diabetes on cubital tunnel syndrome. Future studies should be performed to analyze the effects of diabetes mellitus on hand manifestations, particularly regarding the outcomes of diabetic patients with cubital tunnel syndrome.

Retrograde Percutaneous Release of Trigger Finger or Thumb Using Sono-Instruments®: Detailed Technique, Pearls, and Pitfalls.

Percutaneous release is a common treatment option for trigger finger stenosing tenosynovitis. While surgical and conservative treatments are available, percutaneous techniques offer several advantages, including faster recovery time, reduced complications, and simultaneous treatment of multiple trigger fingers. The sono-instrument is a minimally invasive device designed for surgical release of the A1 pulley in adults. The device is efficient and safe, and in addition, several design features enhance the visibility of the instrument under ultrasound imaging. The technique is truly percutaneous, as the whole operation is done through a single needle puncture. This minimizes postoperative discomfort and allows an immediate return to daily living and professional activities. The technique can be performed in an outpatient clinic under local anesthesia. The learning curve is quick; however, surgeons must acquire experience in hand sonography to master this new form of surgery. The aim of this article is to provide an in-depth exposition of the technical nuances, pearls, and pitfalls of this novel retrograde percutaneous release method. To our knowledge, this is the first retrograde truly percutaneous release technique yet described, facilitated by the novel Sono-Instruments®.