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PURPOSE: Trigger finger (TF) is a common hand condition that can be treated with surgery. We conducted a systematic review and meta-analysis to assess whether ultrasound-guided (US-guided) percutaneous surgery is superior to other conventional surgical methods. METHODS: We conducted a comprehensive search in Medline, Embase, and the Cochrane Library to identify relevant studies. We included randomized clinical trials (RCTs) and observational studies comparing US-guided TF release with blind percutaneous or open approaches. We combined Risk Ratios (RR) and Mean Differences (MD) with 95% Confidence Intervals (CI) across studies. Data processing and analysis were conducted using R software, version 4.3.1. RESULTS: Our analysis included eight RCTs and two observational studies with 555 patients. US-guided surgery significantly reduced postoperative DASH scores (MD -3.75 points; 95% CI = -7.48, -0.02; p < 0.01), shortened time to resume activities (MD -11.52 days; 95% CI = -16.13, -6.91; p < 0.01), hastened discontinuation of oral analgesics (MD -4.44 days; 95% CI = -8.01, -0.87; p < 0.01), and improved patient satisfaction scores (RR 1.13; 95% CI = 1.04, 1.23; p = 0.75). There were no significant differences in VAS scores, time to movement recovery, or surgical success rate. CONCLUSION: Ultrasound-guided percutaneous release is a safe, effective, and superior alternative for treating TF compared to other methods, leading to improved DASH scores, quicker recovery, faster cessation of oral analgesics, and enhanced patient satisfaction.

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Objective The present paper aims to evaluate the therapeutic planning for trigger finger by Brazilian orthopedists. Methods This is a cross-sectional study with a population composed of participants from the 2018 Brazilian Congress on Orthopedics and Traumatology (CBOT-2018, in the Portuguese acronym), who answered a questionnaire about the conduct adopted for trigger finger diagnosis and treatment. Results A total of 243 participants were analyzed, with an average age of 37.46 years old; most participants were male (88%), with at least 1 year of experience (55.6%) and from Southeast Brazil (68.3%). Questionnaire analysis revealed a consensus on the following issues: diagnosis based on physical examination alone (73.3%), use of the Quinnell classification modified by Green (58.4%), initial nonsurgical treatment (91.4%), infiltration of steroids combined with an anesthetic agent (61.7%), nonsurgical treatment time ranging from 1 to 3 months (52.3%), surgical treatment using the open approach (84.4%), mainly the transverse open approach (51%), triggering recurrence as the main nonsurgical complication (58%), and open surgery success in > 90% of the cases (63%), with healing intercurrences (54%) as the main complication. There was no consensus on the remaining variables. Orthopedists with different practicing times disagree on treatment duration ( p = 0.013) and on the complication rate of open surgery ( p = 0.010). Conclusions Brazilian orthopedists prefer to diagnose trigger finger with physical examination alone, to classify it according to the Quinnell method modified by Green, to institute an initial nonsurgical treatment, to perform infiltrations with steroids and local anesthetic agents, to sustain the nonsurgical treatment for 1 to 3 months, and to perform the surgical treatment using a transverse open approach; in addition, they state that the main nonsurgical complication was triggering recurrence, and report open surgery success in > 90% of the cases, with healing intercurrences as the main complication.

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Abstract Objective The present paper aims to evaluate the therapeutic planning for trigger finger by Brazilian orthopedists. Methods This is a cross-sectional study with a population composed of participants from the 2018 Brazilian Congress on Orthopedics and Traumatology (CBOT-2018, in the Portuguese acronym), who answered a questionnaire about the conduct adopted for trigger finger diagnosis and treatment. Results A total of 243 participants were analyzed, with an average age of 37.46 years old; most participants were male (88%), with at least 1 year of experience (55.6%) and from Southeast Brazil (68.3%). Questionnaire analysis revealed a consensus on the following issues: diagnosis based on physical examination alone (73.3%), use of the Quinnell classification modified by Green (58.4%), initial nonsurgical treatment (91.4%), infiltration of steroids combined with an anesthetic agent (61.7%), nonsurgical treatment time ranging from 1 to 3 months (52.3%), surgical treatment using the open approach (84.4%), mainly the transverse open approach (51%), triggering recurrence as the main nonsurgical complication (58%), and open surgery success in > 90% of the cases (63%), with healing intercurrences (54%) as the main complication. There was no consensus on the remaining variables. Orthopedists with different practicing times disagree on treatment duration (p = 0.013) and on the complication rate of open surgery (p = 0.010). Conclusions Brazilian orthopedists prefer to diagnose trigger finger with physical examination alone, to classify it according to the Quinnell method modified by Green, to institute an initial nonsurgical treatment, to perform infiltrations with steroids and local anesthetic agents, to sustain the nonsurgical treatment for 1 to 3 months, and to perform the surgical treatment using a transverse open approach; in addition, they state that the main nonsurgical complication was triggering recurrence, and report open surgery success in > 90% of the cases, with healing intercurrences as the main complication.

Resumo Objetivo Avaliar o planejamento terapêutico para o dedo em gatilho por ortopedistas brasileiros. Métodos Estudo transversal, cuja população foi composta por participantes do Congresso Brasileiro de Ortopedia e Traumatologia 2018 (CBOT-2018). Foi aplicado um questionário sobre a conduta adotada no diagnóstico e tratamento do dedo em gatilho. Resultados Foram analisados 243 participantes com média de idade de 37.46 anos, na maioria homens (88%), tempo de experiência de pelo menos 1 ano (55,6%), e da região Sudeste (68.3%). A análise dos questionários evidenciou que há consenso nos seguintes quesitos: diagnóstico somente com exame físico (73,3%), classificação de Quinnell modificada por Green (58,4%), tratamento inicial não cirúrgico (91,4%), infiltração de corticoide com anestésico (61,7%) tempo de tratamento não cirúrgico de 1 a 3 meses (52,3%), tratamento cirúrgico pela via aberta (84,4%), principalmente via aberta transversa (51%), recidiva do engatilhamento como principal complicação não cirúrgica (58%), e o sucesso da cirurgia aberta em > 90% (63%), sendo a sua principal complicação as complicações cicatriciais (54%). Sem consenso nas demais variáveis. De acordo com a experiência, foram observadas diferenças referentes ao tempo de tratamento (p = 0.013) e a taxa de complicação da cirurgia aberta (p = 0.010). Conclusões O ortopedista brasileiro tem preferência pelo diagnóstico do dedo em gatilho apenas com exame físico, classifica segundo Quinnell modificado por Green, tratamento inicial não cirúrgico, infiltrações com corticoide e anestésico local, tempo de tratamento não cirúrgico de 1 a 3 meses, tratamento cirúrgico por via aberta transversa, principal complicação não cirúrgica a recidiva do engatilhamento, e considera o sucesso da cirurgia aberta em > 90% dos casos, tendo como principal complicação as complicações cicatriciais.

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Flexor tendon tenosynovitis is an entrapment of the flexor tendons at its entrance to the pulley system. Because there is a high incidence of this pathology, it should be well known by physicians, rheumathologists and orthopaedic surgeons. On this paper we present a literature review, analyzing the anatomic facts, biomechanics, diagnosis, classification, therapeutic options and we propose some general recommendations for physicians.

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Abstract Background: Tarsus hyperflexion alters locomotion biomechanics in horses. This alteration is of frequent presentation in the Colombian creole horse (CCH). Objective: To determine the echographic alterations of lateral digital extensor (LDE) muscle, tendon, and synovial sheath in CCH with clinical signs of tarsus hyperflexion. Methods: Thirty horses were divided into two groups: 15 healthy horses with no history of locomotion defects (Group 1; control), and 15 horses with clinical signs of tarsus hyperflexion (Group 2). A cross-sectional and a longitudinal echocardiographic examination of the LDE muscle and tendon was performed in all horses, and a histopathological study was performed only to Group 2. Results: 86.7% of the horses showed echographic alterations, with 53.4% showing signs of adhesions in the LDE muscle and tendon in the lateral surface of the hock, where it crosses the tarsus. 33.3% presented increased tendon synovial sheath fluid. 13.3% showed no echographic alterations and 53.3% presented histopathological alterations. Conclusion: These findings may be related to the presentation of tarsus hyperflexion that could characterize the classic stringhalt in CCH.

Resumen Antecedentes: la hiperflexión del tarso (corvejon) altera la biomecánica del desplazamiento en los caballos. Esta alteración es de presentación frecuente en el caballo criollo colombiano (CCC). Objetivo: determinar las alteraciones ecográficas del músculo extensor digital lateral (EDL), tendón y vaina sinovial en CCC con signos clínicos de hiperflexión del corvejón. Métodos: treinta caballos fueron divididos en dos grupos: 15 equinos clínicamente sanos, sin historia de defectos de locomoción (Grupo 1; considerado como control), y 15 equinos con signos clínicos de hiperflexión del corvejón (Grupo 2). Se realizó un examen ecográfico transversal y longitudinal del músculo y tendón del EDL en todos los animales, y un estudio histopatológico solo al Grupo 2. Resultados: el 86,7% de los caballos mostraron alteraciones ecográficas. El 53,4% mostró signos de adherencias en el músculo y tendón del EDL, en donde la superficie lateral del corvejón se cruza con el tarso. El 33,3% presentó un aumento en el líquido de la vaina sinovial del tendón. El 13,3% no presentó ninguna alteración ecográfica, y el 53,3% mostró alteraciones histopatológicas. Conclusión: estos hallazgos podrían estar relacionados con la presentación de hiperflexión del tarso que puede caracterizar el arpeo clásico en el CCC.

Resumo Antecedentes: a hiperflexão do tarso altera a biomecânica da locomoção dos cavalos. Esta alteração é de frequente apresentação no cavalo crioulo colombiano (CCC). Objetivo: determinar as alterações no ultrassom do músculo extensor digital lateral (EDL), o tendão e a bainha sinovial em CCC com sinais clínicos de hiperflexão do jarrete. Métodos: trinta cavalos foram divididos em dois grupos: 15 cavalos clinicamente saudáveis sem histórico de alterações em locomoção (Grupo 1; considerada como controlo), e 15 cavalos com sinais clínicos de hiperflexão do jarrete (Grupo 2). Se realizaram avaliações ultrassonográficas transversais e longitudinais do músculo e do tendão do EDL na totalidade dos animais e estudo histopatológico só ao Grupo 2. Resultados: o 86.7% dos equinos mostraram alterações no ultrassom, o 53.4% mostrou aderências no tendão do EDL na proximidade onde cruza a superfície lateral do jarrete, o 33.3% apresentou aumento do líquido da bainha sinovial do tendão, o 13.3% não apresentou nenhuma alteração ultrassonográfica e o 53.3% mostrou alterações histopatológicas. Conclusão: esses achados podem estar relacionados à apresentação da hiperflexão do tarso que poderiam caracterizar o arpejamento clássico no CCC.