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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 To evaluate the open surgical treatment for carpal tunnel syndrome as a risk factor for the development of stenosing tenosynovitis that results in trigger finger and De Quervain disease. Materials and Methods A retrospective study analyzing the medical records of patients submitted to open surgical release of carpal tunnel syndrome between 2010 and 2021 in a secondary- and tertiary-level hospital. The following data were collected: pathological history, duration of the follow-up after the surgical treatment for carpal tunnel syndrome, development of trigger finger or De Quervain tenosynovitis, affected fingers, and the interval between the end of surgery and symptom onset. Results We evaluated 802 patients of both genders and with a mean age of 50.1 (±12.6) years. The mean follow-up was of 13 (±16.4) months. The mean time until the development of trigger finger was of 61.4 months, and of 73.7 months for De Quervain disease. The incidence of development of De Quervain disease was of 4.12%, and for trigger finger it was of 10.2%. The most affected digits were the thumb (47.6%), the middle (24.4%), and the ring finger (8.54%). Age was the only factor that showed an association with the risk of developing trigger finger, with an increase of 2% for each increase in age of 1 year. Conclusion The incidence rates for the development of De Quervain disease (4.12%) and trigger finger (10.2%) after the surgical treatment for carpal tunnel syndrome were like those described in the literature. Only age was a factor that influenced the development of trigger finger.

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Abstract Objective To evaluate the open surgical treatment for carpal tunnel syndrome as a risk factor for the development of stenosing tenosynovitis that results in trigger finger and De Quervain disease. Materials and Methods A retrospective study analyzing the medical records of patients submitted to open surgical release of carpal tunnel syndrome between 2010 and 2021 in a secondary- and tertiary-level hospital. The following data were collected: pathological history, duration of the follow-up after the surgical treatment for carpal tunnel syndrome, development of trigger finger or De Quervain tenosynovitis, affected fingers, and the interval between the end of surgery and symptom onset. Results We evaluated 802 patients of both genders and with a mean age of 50.1 (±12.6) years. The mean follow-up was of 13 (±16.4) months. The mean time until the development of trigger finger was of 61.4 months, and of 73.7 months for De Quervain disease. The incidence of development of De Quervain disease was of 4.12%, and for trigger finger it was of 10.2%. The most affected digits were the thumb (47.6%), the middle (24.4%), and the ring finger (8.54%). Age was the only factor that showed an association with the risk of developing trigger finger, with an increase of 2% for each increase in age of 1 year. Conclusion The incidence rates for the development of De Quervain disease (4.12%) and trigger finger (10.2%) after the surgical treatment for carpal tunnel syndrome were like those described in the literature. Only age was a factor that influenced the development of trigger finger.

Resumo Objetivo Avaliar o tratamento cirúrgico aberto da síndrome do túnel do carpo como fator de risco para o desenvolvimento das tenossinovites estenosantes formadoras do dedo em gatilho e da doença de De Quervain. Materiais e Métodos Estudo retrospectivo com análise dos prontuários de pacientes submetidos a liberação cirúrgica aberta da síndrome do túnel do carpo entre 2010 e 2021 em hospital de níveis secundário e terciário. Os seguintes dados foram coletados: histórico patológico, tempo de acompanhamento após o tratamento cirúrgico da síndrome do túnel do carpo, desenvolvimento de dedo em gatilho ou tenossinovite de De Quervain, dedos acometidos, e tempo decorrido entre o fim da cirurgia e o aparecimento dos sintomas. Resultados Foram avaliados 802 pacientes de ambos os sexos com média de idade de 50,1 (±12,6) anos. O tempo médio de seguimento foi de 13 (±16,4) meses. O tempo médio de desenvolvimento de dedo em gatilho foi de 61,4 meses, e o da doença de De Quervain, de 73,7 meses. A incidência de desenvolvimento da doença de De Quervain foi de 4,12% e a de dedo em gatilho, de 10,2%. Os dedos mais acometidos foram o polegar (47,6%), o médio (24,4%) e o anular (8,54%). A idade foi único fator que demonstrou associação com o risco de desenvolvimento de dedo em gatilho, com aumento de 2% a cada ano a mais de idade. Conclusão As taxas de incidência de desenvolvimento de doença de De Quervain (4,12%) e de dedo em gatilho (10,2%) após tratamento cirúrgico da síndrome do túnel do carpo foram semelhantes às descritas na literatura. Apenas a idade se apresentou como fator influenciador no desenvolvimento de dedo em gatilho.

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"Locking" of the digits is a relatively common patient complaint in hand surgery. Typically, this phenomenon arises from either triggering of tendons at the A1 pulley or subluxation of tendons around the metacarpal head. Although trigger digit and sagittal band injury comprise most diagnoses, clinicians must be aware of rarer entities that alter the underlying osseous anatomy and predispose the digits to "locking." Here, we present a case of metacarpal neck osteochondroma causing subluxation of the index metacarpophalangeal joint radial collateral ligament.

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PURPOSE: Pediatric trigger finger (PTF) is an acquired condition that is uncommon and anatomically complex. Currently, the literature is characterized by a small number of retrospective case series with limited sample sizes. This investigation sought to evaluate the presentation, management, and treatment outcomes of PTF in a large, multicenter cohort. METHODS: A retrospective review of pediatric patients with a diagnosis of PTF between 2009 and 2020 was performed at three tertiary referral hospitals. Patient demographics, PTF characteristics, treatment strategies, and outcomes were abstracted from the electronic medical records. Patients and families also were contacted by telephone to assess the downstream persistence or recurrence of triggering symptoms. RESULTS: In total, 321 patients with 449 PTFs were included at a mean follow-up of 3.9 ± 4.0 years. There were approximately equal numbers of boys and girls, and the mean age of symptom onset was 5.4 ± 5.1 years. The middle (34.7%) and index (11.6%) fingers were the most and least commonly affected digits, respectively. Overall, PTFs managed operatively achieved significantly higher rates of complete resolution compared with PTFs managed nonsurgically (97.1% vs 30.0%). Seventy-five percent of PTFs that achieved complete resolution with nonsurgical management did so within 6 months, and approximately 90% did so within 12 months. Patients with multidigit involvement, higher Quinnell grade at presentation, or palpable nodularity were significantly more likely to undergo surgery. There was no significant difference in the rate of complete resolution between splinted versus not splinted PTFs or across operative techniques. CONCLUSIONS: Only 30% of the PTFs managed nonsurgically achieved complete resolution. Splinting did not improve resolution rates in children treated nonsurgically. In contrast, surgical intervention has a high likelihood of restoring motion and function of the affected digit. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

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Trigger finger is a frequent condition. Although tenosynovitis and the alteration of pulley A1 are identified as triggering factors, there is no consensus on the true cause in the literature, and its true etiology remains unknown. The diagnosis is purely clinical most of the time. It depends solely on the existence of finger locking during active bending movement. Trigger finger treatment usually begins with nonsurgical interventions that are instituted for at least 3 months. In patients with initial presentation with flexion deformity or inability to flex the finger, there may be earlier indication of surgical treatment due to pain intensity and functional disability. In the present review article, we will present the modalities and our algorithm for the treatment of trigger finger.

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Abstract Trigger finger is a frequent condition. Although tenosynovitis and the alteration of pulley A1 are identified as triggering factors, there is no consensus on the true cause in the literature, and its true etiology remains unknown. The diagnosis is purely clinical most of the time. It depends solely on the existence of finger locking during active bending movement. Trigger finger treatment usually begins with nonsurgical interventions that are instituted for at least 3 months. In patients with initial presentation with flexion deformity or inability to flex the finger, there may be earlier indication of surgical treatment due to pain intensity and functional disability. In the present review article, we will present the modalities and our algorithm for the treatment of trigger finger.

Resumo O dedo em gatilho é uma afecção frequente. Não obstante a tenossinovite e a alteração da polia A1 serem identificados como fatores desencadeantes, não há consenso sobre a verdadeira causa na literatura, sendo que a sua verdadeira etiologia permanece desconhecida. O diagnóstico é puramente clínico na maior parte das vezes. Ele depende unicamente da existência do travamento do dedo no decorrer da movimentação flexão ativa. O tratamento do dedo em gatilho geralmente se inicia com intervenções não cirúrgicas que são instituídas por pelo menos 3 meses. Nos pacientes em quem haja apresentação inicial com deformidade em flexão ou incapacidade de flexão do dedo, pode haver indicação mais precoce do tratamento cirúrgico em razão da intensidade do quadro álgico e da incapacidade funcional do paciente. No presente artigo de revisão, apresentaremos as modalidades e o nosso algoritmo para o tratamento do dedo em gatilho.

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Resumen: Introducción: la asociación del síndrome del túnel del carpo con tenosinovitis estenosante de la mano es muy rara, aún más, si es generada por un fibrolipoma a nivel del túnel del carpo. El estudio de imagen para detectar este tipo de lesiones en la mano incluye: desde una radiografía con proyección para el túnel del carpo, tomografía axial computarizada y resonancia magnética nuclear; pero éstos no se utilizan habitualmente para el estudio protocolizado del síndrome del túnel del carpo y mucho menos para los dedos en gatillo. Objetivo: el objetivo de este trabajo es reportar un caso en el cual se presenta la sintomatología característica de un síndrome de túnel del carpo, asociada a tercer dedo en gatillo, el cual se maneja con la liberación del nervio mediano por medio de un abordaje de mínima invasión, además de la polea A1. Caso clínico: la paciente persistió con ambas alteraciones y en la revisión secundaria se detectó bloqueo a nivel de la muñeca. Se intervino nuevamente a la paciente y se encontró una tumoración encapsulada, que midió 3.0 × 2.0 × 1.0 cm, con superficie externa lisa, blanquecina, de aspecto ovoide y consistencia blanda «ahulada¼. El estudio anatomopatológico la identificó como un fibrolipoma encapsulado que ocasionó la compresión nerviosa y el bloqueo del tendón flexor. Conclusión: la importancia de este reporte de caso radica en agregar los tumores al repertorio etiológico, que además pueden provocar una compresión del nervio mediano y en que sean aún menos frecuentes como causa de atrapamiento de los tendones flexores de la mano.

Abstract: Introduction: the association of carpal tunnel syndrome with stenosing tenosynovitis of the hand is very rare, even more, if it is generated by a fibrolipoma at the carpal tunnel. The imaging study useful to detect this type of hand injuries are X-ray screening for carpal tunnel, computed tomography and magnetic resonance imaging. But these are not commonly used for the study of protocolized carpal tunnel syndrome and much less trigger finger. Objective: the aim of this work is to report a case of a middle-aged female with carpal tunnel syndrome characteristic symptoms, associated with the third trigger finger; she was handled with the release of the median nerve by a minimally invasive approach, in addition to the A1 pulley release. Clinical case: the patient persists with both problems and at a secondary surgical review, we detected wrist locking sensation. The patient was reoperated finding an ovoid encapsulated tumor, measuring 3.0 × 2.0 × 1.0 cm, with smooth outer surface, whitish appearance, and soft rubbery consistency. The biopsy pathology outlines identified an encapsulated fibrolipoma, causing nerve compression and locking flexor tendon. Conclusion: the importance of this writing is in adding tumors to the etiological repertoire, which can cause compression of the median nerve and even less frequent as a cause of the flexor tendons of the hand snagging.

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INTRODUCTION: the association of carpal tunnel syndrome with stenosing tenosynovitis of the hand is very rare, even more, if it is generated by a fibrolipoma at the carpal tunnel. The imaging study useful to detect this type of hand injuries are X-ray screening for carpal tunnel, computed tomography and magnetic resonance imaging. But these are not commonly used for the study of protocolized carpal tunnel syndrome and much less trigger finger. OBJECTIVE: the aim of this work is to report a case of a middle-aged female with carpal tunnel syndrome characteristic symptoms, associated with the third trigger finger; she was handled with the release of the median nerve by a minimally invasive approach, in addition to the A1 pulley release. CLINICAL CASE: the patient persists with both problems and at a secondary surgical review, we detected wrist locking sensation. The patient was reoperated finding an ovoid encapsulated tumor, measuring 3.0 × 2.0 × 1.0 cm, with smooth outer surface, whitish appearance, and soft rubbery consistency. The biopsy pathology outlines identified an encapsulated fibrolipoma, causing nerve compression and locking flexor tendon. CONCLUSION: the importance of this writing is in adding tumors to the etiological repertoire, which can cause compression of the median nerve and even less frequent as a cause of the flexor tendons of the hand snagging.

INTRODUCCIÓN: la asociación del síndrome del túnel del carpo con tenosinovitis estenosante de la mano es muy rara, aún más, si es generada por un fibrolipoma a nivel del túnel del carpo. El estudio de imagen para detectar este tipo de lesiones en la mano incluye: desde una radiografía con proyección para el túnel del carpo, tomografía axial computarizada y resonancia magnética nuclear; pero éstos no se utilizan habitualmente para el estudio protocolizado del síndrome del túnel del carpo y mucho menos para los dedos en gatillo. OBJETIVO: el objetivo de este trabajo es reportar un caso en el cual se presenta la sintomatología característica de un síndrome de túnel del carpo, asociada a tercer dedo en gatillo, el cual se maneja con la liberación del nervio mediano por medio de un abordaje de mínima invasión, además de la polea A1. CASO CLÍNICO: la paciente persistió con ambas alteraciones y en la revisión secundaria se detectó bloqueo a nivel de la muñeca. Se intervino nuevamente a la paciente y se encontró una tumoración encapsulada, que midió 3.0 × 2.0 × 1.0 cm, con superficie externa lisa, blanquecina, de aspecto ovoide y consistencia blanda "ahulada". El estudio anatomopatológico la identificó como un fibrolipoma encapsulado que ocasionó la compresión nerviosa y el bloqueo del tendón flexor. CONCLUSIÓN: la importancia de este reporte de caso radica en agregar los tumores al repertorio etiológico, que además pueden provocar una compresión del nervio mediano y en que sean aún menos frecuentes como causa de atrapamiento de los tendones flexores de la mano.

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Objective The present study aimed to determine the frequency of trigger finger (TF) onset after surgery for carpal tunnel syndrome (CTS) using an open (OT) or an endoscopic technique (ET). As a secondary endpoint, the present study also compared paresthesia remission and residual pain rates in patients submitted to both techniques. Methods Trigger finger onset and remission rates of paresthesia and pain at the median nerve territory was verified prospectively in a series of adult patients submitted to an OT procedure ( n = 34). These findings were compared with a retrospective cohort submitted to ET ( n = 33) by the same surgical team. Patients were evaluated with a structured questionnaire in a return visit at least 6 months after surgery. Results Sixty-seven patients were evaluated. There was no difference regarding trigger finger onset (OT, 26.5% versus ET, 27.3%; p = 0.94) and pain (OT, 76.5% versus ET, 84.8%; p = 0.38). Patients submitted to OT had fewer paresthesia complaints compared with those operated using ET (OT, 5.9% versus ET, 24.2%; p = 0.03). Conclusions In our series, the surgical technique did not influence trigger finger onset and residual pain rates. Patients submitted to OT had less complaints of residual postoperative paresthesia.

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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 study aimed to determine the frequency of trigger finger (TF) onset after surgery for carpal tunnel syndrome (CTS) using an open (OT) or an endoscopic technique (ET). As a secondary endpoint, the present study also compared paresthesia remission and residual pain rates in patients submitted to both techniques. Methods Trigger finger onset and remission rates of paresthesia and pain at the median nerve territory was verified prospectively in a series of adult patients submitted to an OT procedure (n = 34). These findings were compared with a retrospective cohort submitted to ET (n = 33) by the same surgical team. Patients were evaluated with a structured questionnaire in a return visit at least 6 months after surgery. Results Sixty-seven patients were evaluated. There was no difference regarding trigger finger onset (OT, 26.5% versus ET, 27.3%; p = 0.94) and pain (OT, 76.5% versus ET, 84.8%; p = 0.38). Patients submitted to OT had fewer paresthesia complaints compared with those operated using ET (OT, 5.9% versus ET, 24.2%; p = 0.03). Conclusions In our series, the surgical technique did not influence trigger finger onset and residual pain rates. Patients submitted to OT had less complaints of residual postoperative paresthesia.

Resumo Objetivo Determinar a frequência do aparecimento de dedo em gatilho (DG) no pós-operatório da síndrome do túnel do carpo (STC) em duas técnicas: aberta (TA) e endoscópica (TE). Como desfecho secundário, comparar as taxas de remissão da parestesia e dor residual entre as duas técnicas. Métodos De forma prospectiva, verificamos o aparecimento de dedo em gatilho e taxa de remissão da parestesia e dor no território do nervo mediano em série de pacientes adultos operados pela TA (n = 34). Comparamos com coorte retrospectiva operada pela TE (n = 33), pela mesma equipe de cirurgiões. A avaliação dos pacientes ocorreu por meio de questionário estruturado em consulta de retorno, com mínimo de 6 meses de pós-operatório. Resultados Sessenta e sete pacientes foram avaliados. Não houve diferença quanto ao aparecimento de dedo em gatilho (TA, 26,5% versus TE, 27,3%; p = 0,94) e dor (TA, 76,5% versus TE, 84.8%; p = 0,38). Os pacientes operados pela TA apresentaram menos queixas de parestesia do que os operados pela TE (TA 5,9% versus TE 24,2%; p = 0,03). Conclusões Em nossa série, a técnica cirúrgica não influenciou o aparecimento de dedos em gatilho e dor residual. Os pacientes operados pela técnica aberta apresentaram menos queixa de parestesia residual pós-operatória.

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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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Objective: The aim of this study was to identify the main diseases related to trigger finger. Methods: A retrospective, observational study was performed with data obtained through a computerized record of 75 patients with trigger finger diagnosis between July 2011 and October 2015. The diagnosis of metabolic syndrome was performed following National Cholesterol Education Program Adult Treatment Panel III (2001). Results: Patients' ages ranged from 50 to 84 years, with a mean age of 63 years. The ring finger was the most affected, followed by the middle finger, index finger, and little finger. Most had a grade 2 trigger finger classified by Green; the right hand involvement was more prevalent, as was the dominant hand. The incidence in women was twice as high as in men. Arterial hypertension, diabetes mellitus, and dyslipidemia were shown to be important associated diseases, but metabolic syndrome was the main association found. Conclusions: Metabolic syndrome in the group of patients studied in this scientific article seems to be the main associated disease.

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Introducción. El dedo en gatillo es una anomalía infrecuente en niños que afecta principalmente al dedo pulgar, de etiología desconocida. El manejo puede ser conservador o quirúrgico. Reporte de caso. Paciente pediátrica escolar de 4 años y 7 meses de edad es remitida al servicio de cirugía plástica por deformidad en flexión fija del pulgar derecho, de 4 meses de evolución asociada a nódulo palpable. Se interviene quirúrgicamente de forma efectiva, sin complicaciones, secuelas ni recurrencia. Discusión. La paciente fue manejada quirúrgicamente de forma efectiva Se hizo un seguimiento durante 3 años con una evolución satisfactoria, teniendo una recuperación total de la función del pulgar, sin secuelas y adecuada adaptabilidad al medio. Conclusión. Este artículo tiene como objetivo presentar un caso clínico que busca llamar la atención sobre las indicaciones del tratamiento conservador versus quirúrgico que existen en la literatura, corresponde a una paciente pediátrica de nuestro medio con dedo pulgar en gatillo bilateral, su manejo y los resultados postoperatorios. El dedo pulgar en gatillo pediátrico tiene una baja prevalencia en el mundo. No hay estudios de incidencia ni prevalencia en nuestro medio. La edad de presentación es variable, los signos y síntomas no son iguales a los del adulto, el compromiso puede ser bilateral, su diagnóstico es clínico y el tratamiento quirúrgico, dependiendo del grado de compromiso, puede ser el más efectivo. Cómo citar: Bretón Gómez GA, Vargas Rueda JJ, Ardila Forero PA, López Villegas A. Dedo pulgar en gatillo bilateral, tratamiento quirúrgico y conservador en paciente de 4 años de edad. MedUNAB. 2020;23(1):131-136. doi:10.29375/01237047.3616

Introduction. Trigger finger is a rare anomaly in children; it is of unknown etiology and mainly affects the thumb. Management may be conservative or surgical. Case report. Pediatric patient of 4 years and 7 months of age is referred to plastic surgery service for fixed flexion deformity of the right thumb, after 4 months of evolution associated with a palpable nodule. It is successfully intervened surgically, without complications, sequels or recurrence. Discussion. The patient was effectively treated via surgery. Follow-up was carried out for three years with satisfactory evolution, showing full recovery of the function of the thumb, with no after-effects and with adequate adaptability to the environment. Conclusion. The objective of this article is to present a clinical case that aims to draw attention to the indications for conservative versus surgical treatment existing in the literature, corresponding to a pediatric patient from our milieu with a bilateral trigger finger, its treatment and postoperative results. Pediatric trigger finger has low prevalence in the world. There are no incidence or prevalence studies in the cases that were reviewed. The age at which it arises is variable; the signs and symptoms are not the same as those of adults; involvement may be bilateral; diagnosis is clinical and surgery may be the most effective treatment, depending on the degree of involvement. Cómo citar: Bretón Gómez GA, Vargas Rueda JJ, Ardila Forero PA, López Villegas A. Dedo pulgar en gatillo bilateral, tratamiento quirúrgico y conservador en paciente de 4 años de edad. MedUNAB. 2020;23(1):131-136. doi:10.29375/01237047.3616

Introdução. O dedo em gatilho é uma anomalia incomum em crianças, que afeta principalmente o polegar, de etiologia desconhecida. O tratamento pode ser conservador ou cirúrgico. Relato de caso. Paciente pediátrica de quatro anos e sete meses de idade é encaminhada ao serviço de cirurgia plástica para deformidade em flexão fixa do polegar direito, com quatro meses de evolução associada a nódulo palpável. Foi tratada cirurgicamente de forma eficaz, sem complicações, sequelas ou recorrência. Discussão. A paciente foi tratada cirurgicamente de forma eficaz. Foi feito um acompanhamento por três anos com uma evolução satisfatória, com recuperação total da função do polegar, sem sequelas e adaptabilidade adequada ao ambiente. Conclusão. Este artigo tem como objetivo apresentar um caso clínico que busca chamar a atenção para as indicações do tratamento conservador versus cirúrgico, existentes na literatura, que corresponde a uma paciente pediátrica em nosso meio com um polegar de gatilho bilateral, seu manejo e resultados pós-operatórios. O polegar em gatilho pediátrico tem uma baixa prevalência no mundo. Não há estudos de incidência ou prevalência nos casos consultados. A idade de apresentação é variável, os sinais e sintomas não são iguais aos do adulto, o comprometimento pode ser bilateral, o diagnóstico é clínico e o tratamento cirúrgico, dependendo do grau de comprometimento, pode ser o mais eficaz. Cómo citar: Bretón Gómez GA, Vargas Rueda JJ, Ardila Forero PA, López Villegas A. Dedo pulgar en gatillo bilateral, tratamiento quirúrgico y conservador en paciente de 4 años de edad. MedUNAB. 2020;23(1):131-136. doi:10.29375/01237047.3616

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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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Resumen: Introducción: El dedo en gatillo es muy frecuente en la población, con un riesgo de vida de padecer la enfermedad de 2.6% en la población general y con un aumento de 4 a 10% en diabéticos. Dado que no hay un estándar de oro de tratamiento quirúrgico y aún hay controversia en ello, es importante evaluar los resultados de las distintas técnicas quirúrgicas. El objetivo de este estudio es evaluar resultados postoperatorios de ambas técnicas quirúrgicas en pacientes con seguimiento de uno a 12 meses de postoperatorio. Material y métodos: Se trata de un estudio prospectivo, longitudinal, descriptivo y observacional realizado en un período de Enero de 2015 a Diciembre de 2017. Se incluyeron pacientes postoperados de liberación con técnica abierta (grupo 1) y percutánea con aguja (grupo 2). Se llevó a cabo la revisión de expedientes de todos los pacientes y se les hizo una encuesta mediante vía telefónica. Los resultados de la comparación de ambas técnicas se analizaron mediante χ2 para resultados paramétricos y mediante la prueba de Fisher para los no paramétricos. Resultados: Se encontró que los pacientes del grupo 2 manifestaron mayor satisfacción, de los cuales 21.8% (n = 12) estuvieron totalmente satisfechos con el procedimiento percutáneo, a diferencia de los del grupo 1 quienes manifestaron satisfacción total sólo en 3.8% (n = 2). Conclusiones: En este estudio podemos concluir que ambas técnicas son efectivas para el tratamiento de dedo en gatillo, siendo la liberación percutánea con aguja la que ofrece mayor grado de satisfacción en los pacientes.

Abstract: Indroduction: Trigger finger is very common in the population, with a life-threatening risk of developing the disease of 2.6% in the general population and increasing to 4 to 10% in diabetics. Since there is no standard gold of surgical treatment and there is still controversy in this, it is important to evaluate the results of the different surgical techniques. The objective of this study is to evaluate postoperative results of both surgical techniques in patients with follow-up of 1 to 12 months postoperative. Material and methods: It is a prospective, longitudinal, descriptive and observational study carried out in a period from January 2015 to December 2017. Postoperative open (group 1) and percutaneous needle (group 2) patients were included. All patients were reviewed and surveyed by telephone. The comparison results of both techniques were analyzed using χ2 for parametric results and by the Fisher test for nonparametric results. Results: It was found that patients in group 2 expressed greater satisfaction, where 21.8% (n = 12) were fully satisfied with the percutaneous procedure, unlike those in group 1 where total satisfaction was only manifested at 3.8% (n = 2). Conclusions: In this study we can conclude that both techniques are effective for the treatment of trigger finger, with percutaneous needle release offering the highest degree of satisfaction in patients.

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Abstract Background: A patient's ability to move his/her fingers during hand surgery may be helpful to surgeons because it allows the effectiveness of the intervention evaluation and prediction of hand function in the postoperative period. The purpose of this case series is to demonstrate the efficacy of an ultrasound-guided peripheral nerve block technique to maintain the hand flexor and extensor muscles motor function and discuss the benefits of the technique for trigger finger surgery. Case report: Ten patients scheduled to undergo trigger finger surgery were selected. The goal was to maintain flexion and extension of the fingers during the procedure. Thus, ultrasound-guided ulnar, radial, and medial nerve block was performed in the distal third of the forearm, at 5-7 cm proximal to the wrist. The block was performed with 5 mL of 0.375% bupivacaine on each nerve. All procedures were uneventfully performed maintaining the flexion and extension of the fingers. In two cases, it was observed that the motricity maintenance and the patients' ability to move their fingers when requested allowed the success of the surgical procedure after the third intraoperative evaluation. Conclusion: This case series shows that it is possible to maintain the motor function of the hand flexor and extensor muscles to perform finger trigger surgeries using specific ultrasound-guided distal blocks.

Resumo Justificativa: A capacidade de um paciente mover os dedos durante a cirurgia da mão pode ser útil para o cirurgião porque permite a avaliação da eficácia da intervenção e a predição da função da mão no pós-operatório. O objetivo desta série de casos é demonstrar a eficácia de uma técnica de bloqueio de nervo periférico guiado por ultrassom na manutenção da função motora dos músculos flexores e extensores da mão e discutir os benefícios da técnica para cirurgias de liberação de dedo em gatilho. Relato de caso: Foram selecionados 10 pacientes em programação para cirurgia de liberação de dedo em gatilho. O objetivo era manter a flexão e a extensão dos dedos durante o procedimento. Dessa forma, o bloqueio dos nervos ulnar, radial e mediano, guiados por ultrassom, foi feito no terço distal do antebraço, 5 a 7 cm proximais ao punho. O bloqueio foi feito com 5 mL de bupivacaína a 0,375% em cada nervo. Todos os procedimentos foram feitos sem complicações e com manutenção da flexão e extensão dos dedos. Em dois casos, observou-se que a manutenção da motricidade e a capacidade dos pacientes de mover os dedos quando solicitado permitiu o sucesso do procedimento cirúrgico após a terceira avaliação intraoperatória. Conclusão: Esta série de casos mostra que é possível manter a função motora dos músculos flexores e extensores da mão em cirurgias de liberação de dedo em gatilho por meio de bloqueios distais específicos guiados por ultrassom.

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INDRODUCTION: Trigger finger is very common in the population, with a life-threatening risk of developing the disease of 2.6% in the general population and increasing to 4 to 10% in diabetics. Since there is no standard gold of surgical treatment and there is still controversy in this, it is important to evaluate the results of the different surgical techniques. The objective of this study is to evaluate postoperative results of both surgical techniques in patients with follow-up of 1 to 12 months postoperative. MATERIAL AND METHODS: It is a prospective, longitudinal, descriptive and observational study carried out in a period from January 2015 to December 2017. Postoperative open (group 1) and percutaneous needle (group 2) patients were included. All patients were reviewed and surveyed by telephone. The comparison results of both techniques were analyzed using 2 for parametric results and by the Fisher test for nonparametric results. RESULTS: It was found that patients in group 2 expressed greater satisfaction, where 21.8% (n = 12) were fully satisfied with the percutaneous procedure, unlike those in group 1 where total satisfaction was only manifested at 3.8% (n = 2). CONCLUSIONS: In this study we can conclude that both techniques are effective for the treatment of trigger finger, with percutaneous needle release offering the highest degree of satisfaction in patients.

INTRODUCCIÓN: El dedo en gatillo es muy frecuente en la población, con un riesgo de vida de padecer la enfermedad de 2.6% en la población general y con un aumento de 4 a 10% en diabéticos. Dado que no hay un estándar de oro de tratamiento quirúrgico y aún hay controversia en ello, es importante evaluar los resultados de las distintas técnicas quirúrgicas. El objetivo de este estudio es evaluar resultados postoperatorios de ambas técnicas quirúrgicas en pacientes con seguimiento de uno a 12 meses de postoperatorio. MATERIAL Y MÉTODOS: Se trata de un estudio prospectivo, longitudinal, descriptivo y observacional realizado en un período de Enero de 2015 a Diciembre de 2017. Se incluyeron pacientes postoperados de liberación con técnica abierta (grupo 1) y percutánea con aguja (grupo 2). Se llevó a cabo la revisión de expedientes de todos los pacientes y se les hizo una encuesta mediante vía telefónica. Los resultados de la comparación de ambas técnicas se analizaron mediante 2 para resultados paramétricos y mediante la prueba de Fisher para los no paramétricos. RESULTADOS: Se encontró que los pacientes del grupo 2 manifestaron mayor satisfacción, de los cuales 21.8% (n = 12) estuvieron totalmente satisfechos con el procedimiento percutáneo, a diferencia de los del grupo 1 quienes manifestaron satisfacción total sólo en 3.8% (n = 2). CONCLUSIONES: En este estudio podemos concluir que ambas técnicas son efectivas para el tratamiento de dedo en gatillo, siendo la liberación percutánea con aguja la que ofrece mayor grado de satisfacción en los pacientes.

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BACKGROUND: A patient's ability to move his/her fingers during hand surgery may be helpful to surgeons because it allows the effectiveness of the intervention evaluation and prediction of hand function in the postoperative period. The purpose of this case series is to demonstrate the efficacy of an ultrasound-guided peripheral nerve block technique to maintain the hand flexor and extensor muscles motor function and discuss the benefits of the technique for trigger finger surgery. CASE REPORT: Ten patients scheduled to undergo trigger finger surgery were selected. The goal was to maintain flexion and extension of the fingers during the procedure. Thus, ultrasound-guided ulnar, radial, and medial nerve block was performed in the distal third of the forearm, at 5-7cm proximal to the wrist. The block was performed with 5mL of 0.375% bupivacaine on each nerve. All procedures were uneventfully performed maintaining the flexion and extension of the fingers. In two cases, it was observed that the motricity maintenance and the patients' ability to move their fingers when requested allowed the success of the surgical procedure after the third intraoperative evaluation. CONCLUSION: This case series shows that it is possible to maintain the motor function of the hand flexor and extensor muscles to perform finger trigger surgeries using specific ultrasound-guided distal blocks.

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