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BACKGROUND: Multimodal analgesia is crucial for effective postoperative pain management in minor hand surgeries, enhancing patient satisfaction. The use of local wound infiltration with Ketorolac as an adjuvant pain management strategy is proposed for open trigger finger release surgery. This study aims to compare pain scores and functional outcomes between local wound infiltration with Ketorolac and oral non-steroidal anti-inflammatory drugs. METHODS: This study is a double-blind, parallel design, randomized controlled trials. Sixty-nine patients underwent trigger finger surgery between December 2021 and October 2022 were randomized into one of three groups: oral Ibuprofen alone group, local Ketorolac alone group and local Ketorolac with oral Ibuprofen group. The assessment included postoperative numeric rating scale (NRS) pain score, Disabilities of the Arm, Shoulder, and Hand (DASH) score, grip strength, mobility of proximal interphalangeal (PIP) joint. and complications. RESULTS: NRS pain scores during movement of the operated fingers were significantly lower at 6 h in local Ketorolac alone group and local Ketorolac with oral Ibuprofen group compared to oral Ibuprofen alone group. However, there were no significant differences between the groups in postoperative DASH scores, grip strength, mobility of PIP joints, and complications. CONCLUSIONS: Local infiltration of Ketorolac as an adjunct in postoperative pain management has been shown to provide superior analgesia during finger movement within the initial 6 h following trigger finger surgery, in comparison to oral NSAIDs. CLINICAL TRIAL REGISTRATION: Thaiclinicaltrials.org identifier: TCTR20210825002. Registered 25/08/2021. https://www.thaiclinicaltrials.org/show/TCTR20210825002.
Assuntos
Anti-Inflamatórios não Esteroides , Ibuprofeno , Cetorolaco , Medição da Dor , Dor Pós-Operatória , Dedo em Gatilho , Humanos , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/prevenção & controle , Dedo em Gatilho/cirurgia , Dedo em Gatilho/tratamento farmacológico , Cetorolaco/administração & dosagem , Cetorolaco/uso terapêutico , Feminino , Masculino , Método Duplo-Cego , Pessoa de Meia-Idade , Anti-Inflamatórios não Esteroides/administração & dosagem , Anti-Inflamatórios não Esteroides/uso terapêutico , Ibuprofeno/administração & dosagem , Ibuprofeno/uso terapêutico , Idoso , Resultado do Tratamento , Adulto , Administração Oral , Manejo da Dor/métodos , Força da MãoRESUMO
BACKGROUND: Evidence supports the use of hand-based metacarpophalangeal joint (MCPJ) blocking splints as an intervention for trigger finger (TF). In practice, finger-based relative motion (RM) splints are also implemented without evidence. PURPOSE: This randomized comparative trial (RCT) aims to evaluate implementation of MCPJ blocking and RM splints for effectiveness, function, occupational performance and wearability after 6 weeks of TF management. METHODS AND ANALYSIS: Priori analysis determined 36 individuals were needed for random assignment to the RM or MCPJ blocking splint groups. Individuals must be aged ≥21 years, and diagnosed with TF involving ≥1 finger. For blinding purposes, the primary author screens for eligibility, fabricates the splints and educates. Therapist A administers the primary outcome measures Week-1 and Week-6-stage of stenosing tenosynovitis and secondary outcome measures- number of triggering events in 10 active fists, visual analog scales (VAS) for pain, splint comfort and satisfaction, Disabilities of the Arm, Shoulder and Hand, and Canadian Occupational Performance Measure. Therapist B in Week-3 instructs participants in deep tissue massage and administers splint wearability VASs. The RM pencil test is used to determine the affected finger(s) MCPJ splint position i.e., more extension or flexion based on participant response. The MCPJ blocking splint holds the MCPJ in a neutral position. Analysis involves a mixed-effects ANOVA to compare Week-1 and Week-6 primary and secondary outcomes. RESULTS: Recruitment and data collection are ongoing. DISCUSSION: Biomechanically RM splints control tendon excursion and reduce passive tendon tension while allowing unencumbered finger motion and hand function. Hence clinicians use RM splints as an intervention for TF, despite the lack of implementation evidence. This RCT implements a function-focused as well as patient-centered approach with partial blinding of assessors and participants. CONCLUSION: We anticipate that this study will provide evidence for the implementation of RM splints to manage adults with TF. TRIAL REGISTRATION: Clinical trial registration This trial is registered with ClinicalTrials.gov (NCT05763017).
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Articulação Metacarpofalângica , Contenções , Dedo em Gatilho , Humanos , Articulação Metacarpofalângica/fisiopatologia , Dedo em Gatilho/terapia , Feminino , Masculino , Adulto , Amplitude de Movimento Articular , Resultado do Tratamento , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Trigger thumb is a prevalent hand condition observed in children, and its management remains a topic of considerable debate, ranging from mere observation to surgical intervention. In recent times, there has been a growing interest in exploring nonoperative treatments as alternatives to surgical procedures for managing pediatric trigger thumb. Gaining insight into the prevalence of spontaneous resolution in pediatric trigger thumb is of paramount importance. However, the literature presents a wide variation in estimates regarding the prevalence of this spontaneous resolution, highlighting the need for further investigation and consensus. The aim of this review was to estimate the overall prevalence of spontaneous resolution among pediatric trigger thumb. METHODS: This study meticulously followed the PRISMA guidelines and registered in the PROSPERO. The PubMed, Embase, and Cochrane Library databases were searched for all relevant studies up to May 2024.Inclusion criteria were studies reported only observation spontaneous resolution pediatric trigger thumb, aged up to 14 years, reported at least 10 thumbs and followed up time at least 3 months. Confounded intervention treatment measure studies were excluded. To synthesize the prevalence rates from individual studies, we employed a random-effects meta-analysis. In order to uncover the sources of heterogeneity and to compare prevalence estimates across different groups, we performed sensitivity and subgroup analyses. To meticulously evaluate the quality of the included studies, the Joanna Briggs Institute's quality assessment checklist was employed. Furthermore, to assess the heterogeneity among the studies, both Cochran's Q test and the I² statistic were utilized. RESULTS: A total of eleven studies were included for the final analysis, with 599 pediatric trigger thumbs. Our final meta-analysis showed that more than one-third of these pediatric trigger thumb cases resolved spontaneously, with a resolution rate of 43.5% (95% CI 29.6-58.6). Subgroup analyses showed that in terms of age at the first visit, the prevalence of spontaneous resolution in the less than 24 months group and in the 24 months or older group was 38.7%(95% CI 18.1-64.4)and 45.8%(95% CI 27.4-65.4), respectively. There was no significant difference between the two groups(P = 0.690). When analyzing follow up time, the prevalence of spontaneous resolution in the 24 months or longer group and in the less than 24 months group was 58.9%(95% CI 41.6-74.2)and 26.8%(95% CI 14.7-43.8), respectively.There was significant statistical differences between the two groups(P = 0.009). Based on the initial severity of interphalangeal (IP) joint flexion contracture, the prevalence of spontaneous resolution in the 30 degrees or less group and in the other measurements group was 54.1%(95% CI 31.5-75.1)and 37.1%(95% CI 21.9-55.4), respectively.There was no significant difference between the two groups(P = 0.259). CONCLUSION: Our study demonstrates that a significant proportion of pediatric trigger thumbs resolve spontaneously. This finding highlights the benefits of early observation in managing this condition. By prioritizing non-operative observation, both parents and surgeons are better equipped to make informed decisions regarding the treatment of pediatric trigger thumb, potentially reducing the need for surgical intervention.
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Remissão Espontânea , Dedo em Gatilho , Humanos , Dedo em Gatilho/epidemiologia , Criança , Prevalência , Adolescente , Pré-Escolar , Feminino , Masculino , LactenteRESUMO
Background: Pediatric trigger digit (TD) does not appear at birth but is diagnosed after birth by finding a flexion contracture of the thumb or other fingers. The reported incidence of pediatric TDs varies from 0.5 to 5 cases per 1,000 live births without sex-specific predominance. We performed a nationwide large-scale study to determine the prevalence and incidence of pediatric TDs and analyzed operative treatment for pediatric TDs using the National Health Insurance data of South Korea. Methods: Patients with pediatric TDs, aged 0-10 years between 2011 and 2020, were included in this study. Children born between 2011 and 2015 were set as the reference population and followed up until 2020. We calculated the prevalence and incidence rates of pediatric TDs according to age and sex and analyzed the operation rate, age at surgery, time interval from initial diagnosis to surgery, and follow-up period. Patient selection and treatment were based on International Classification of Diseases, 10th Revision (ICD-10). Results: The prevalence rates of pediatric TDs ranged from 0.063% to 0.084%. Girls had a higher prevalence rate (0.066%-0.094%) than boys (0.060%-0.075%). The total incidence rate was 77.6/100,000 person-years, and the incidence rate was higher in girls (84.8) than in boys (70.7). Among 2,181,814 children born between 2011 and 2015, 12,729 were diagnosed with pediatric TDs, of which 1,128 (8.9%) underwent operative management. The means of age at initial diagnosis, age at surgery, and the time interval between diagnosis and operation were 2.76 ± 1.91 years, 3.79 ± 2.19 years, and 1.15 ± 1.71 years, respectively. Conclusions: High prevalence and incidence rates of pediatric TDs were found in 2- to 3-year-old patients. Among pediatric patients, 8.9% underwent operative management that was most frequently conducted between 2 and 3 years of age (within 1 year of initial diagnosis).
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Dedo em Gatilho , Humanos , República da Coreia/epidemiologia , Feminino , Masculino , Criança , Pré-Escolar , Lactente , Prevalência , Incidência , Dedo em Gatilho/epidemiologia , Dedo em Gatilho/cirurgia , Recém-Nascido , Fatores Sexuais , Fatores EtáriosRESUMO
BACKGROUND/AIM: Osteoarthritis (OA) is a prevalent degenerative joint disease that significantly impacts quality of life, particularly when affecting the hands. However, whether patients with OA are associated with higher risk of developing upper limb disorders, specifically trigger finger (TF) and carpal tunnel syndrome (CTS), remains unclear. This study aimed to evaluate the risk of upper limb disease in OA patients. PATIENTS AND METHODS: Using the US Collaborative Network, a subset of the TriNetX research network, we identified patients diagnosed with OA and matched them 1:1 with non-OA controls based on propensity scores. Matching covariates included age, sex, race, and comorbidities. The cohort consisted of 1,554,182 patients in each group. The hazard ratio of TF and CTS, as well as related surgical interventions, was assessed over a 5-year follow-up period. RESULTS: Patients with OA had a 1.30-fold increased risk of TF [95% confidence interval (CI)=1.27-1.33] and a 1.50-fold increased risk of CTS (95%CI=1.48-1.53) compared to controls. The hazard ratios for undergoing surgical interventions were 1.61 for TF (95%CI=1.51-1.71) and 1.97 for CTS (95%CI=1.78-2.19). These risks remained significant across various sensitivity analyses and stratifications according to age and sex. CONCLUSION: OA significantly increases the risk of TF and CTS. These findings highlight the need for vigilant monitoring and management of upper limb disorders in OA patients to improve overall patient care and outcomes. Future research is warranted to focus on pathological mechanisms of OA and their impact on upper limb health to develop targeted interventions.
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Síndrome do Túnel Carpal , Osteoartrite , Pontuação de Propensão , Extremidade Superior , Humanos , Feminino , Masculino , Osteoartrite/epidemiologia , Osteoartrite/complicações , Osteoartrite/etiologia , Pessoa de Meia-Idade , Idoso , Síndrome do Túnel Carpal/epidemiologia , Síndrome do Túnel Carpal/etiologia , Síndrome do Túnel Carpal/cirurgia , Extremidade Superior/patologia , Estudos de Coortes , Fatores de Risco , Dedo em Gatilho/epidemiologia , Dedo em Gatilho/etiologiaRESUMO
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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Dedo em Gatilho , Ultrassonografia de Intervenção , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento , Dedo em Gatilho/diagnóstico por imagem , Dedo em Gatilho/cirurgia , Ultrassonografia de Intervenção/métodosRESUMO
Trigger finger (TF) is a disorder characterized by snapping or locking a finger. It has a prevalence of greater than 3% in the general population; however, this estimate could be increased to 5% up to 20% in diabetic patients. Some unreal ambiguity about definition, pathophysiology, site of lesion, and etiology are found among researchers and clinicians, leading to a lack of understanding of all aspects of the disease and improper management as many clinicians proceed to anti-inflammatory medications or steroids injection without in-depth patient evaluation. Original articles cited up to 2022, found through a Google search using the specified keywords, have been used in this review. Close-access articles were accessed through our researcher account with the Egyptian Knowledge Bank. In this review, we will focus on pathophysiology to present all possible findings and etiology to represent all risk factors and associated diseases to assess and confirm a diagnosis and the exact location of pathology hence better treatment modalities and reducing the recurrence of the pathology.
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Dedo em Gatilho , Humanos , Dedo em Gatilho/etiologia , Dedo em Gatilho/fisiopatologia , Fatores de RiscoRESUMO
California's Controlled Substance Utilization Review and Evaluation System (CURES) was mandated in 2018 to monitor and limit opiate prescriptions. This study evaluated the effects of this legislation on postoperative opioid prescriptions of patients undergoing soft tissue hand surgery. Patients receiving carpal tunnel release, trigger finger release, and ganglion excisions 18 months prior to and 18 months after CURES were selected. The primary outcome was milligram morphine equivalent (MME) prescribed at the surgical encounter and at first postoperative visit. There were 758 patients in the pre-CURES cohort and 701 patients in the post-CURES cohort. In the pre-CURES cohort, there was 116.9 ± 123.8 MME prescribed post op and 10.2 ± 70.8 at first follow-up, whereas post-CURES had 58.8 ± 68.4 MME and 1.1 ± 14.1 for post-op and first follow-up respectively. Findings of this study indicate state regulations may play a role in reducing narcotic consumption following soft tissue hand surgery. (Journal of Surgical Orthopaedic Advances 33(2):122-124, 2024).
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Analgésicos Opioides , Mãos , Dor Pós-Operatória , Humanos , Masculino , Dor Pós-Operatória/tratamento farmacológico , Pessoa de Meia-Idade , Feminino , Mãos/cirurgia , Analgésicos Opioides/uso terapêutico , Idoso , Síndrome do Túnel Carpal/cirurgia , Adulto , Estudos Retrospectivos , Dedo em Gatilho/cirurgia , Dedo em Gatilho/tratamento farmacológico , Prescrições de Medicamentos/estatística & dados numéricosRESUMO
CLINICAL FEATURES: The click phenomenon occurs when an acquired mechanical restriction of the elevation in adduction of the eye or of the extension of the finger/thumb, is forcefully overcome. The common cause is a nodule either of the superior oblique tendon posterior to the trochlea in the case of a Jaensch-Brown syndrome or of the digital flexor tendon anterior to the A1 annular pulley in the case of a trigger finger. Both locations share similar anatomical conditions for the development of the nodule and the pathomechanism of the click. RESULTS: From these identical findings in the eye and the hand in small children it can be assumed that the results from the studies of the hand in newborns and infants with a trigger thumb/finger are also applicable to the situation of the eye. 1. This motility disorder is not congenital. This is most likely due to an incomplete development at the time of birth of the sliding factors needed for a free passage of the tendon through the trochlea and the A1 annular pulley. 2. A distinction must be made between stages 0-3: stage 0â¯= no more restriction of the motility and no click phenomenon; stage 1â¯= forced active extension/elevation possible; stage 2â¯= only passive extension/elevation, each with a click phenomenon; stage 3â¯= no extension/elevation possible and no click phenomenon. 3. In most cases in early childhood there is a spontaneous complete recovery (75% after 6-7 years). In the eye this spontaneous course can only limitedly be shortened with motility exercises in combination with segmental occlusion. CONCLUSION: The click phenomenon is a symptom of stages 1 and 2 of an acquired mechanical restriction of the elevation in adduction of the eye or the extension of the finger/thumb. It should not be called a syndrome.
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Dedo em Gatilho , Humanos , Dedo em Gatilho/fisiopatologia , Dedo em Gatilho/diagnóstico , Síndrome , Transtornos da Motilidade Ocular/fisiopatologia , Transtornos da Motilidade Ocular/etiologia , Lactente , Recém-Nascido , CriançaAssuntos
Anestesia Local , Dedo em Gatilho , Humanos , Anestesia Local/métodos , Dedo em Gatilho/cirurgia , CriançaRESUMO
OBJECTIVES: The occurrence of hand and forearm disorders related to vibration exposure, adjusted for relevant background factors, is scarcely reported. We analysed the prevalence of such conditions in a large population cohort, stratified by sex, and associations with exposure to vibrating hand-held tools. DESIGN: This is a retrospective cohort study. SETTING: Individuals in the Malmö Diet and Cancer Study cohort (MDCS; inclusion 1991-1996; followed until 2018) were asked, 'does your work involve working with vibrating hand-held tools?' (response: 'not at all', 'some' and 'much'). Data were cross-linked with national registers to identify treatment for carpal tunnel syndrome (CTS), ulnar nerve entrapment (UNE), Dupuytren's disease, trigger finger or first carpometacarpal joint (CMC-1) osteoarthritis (OA). Cox regression models, unadjusted and adjusted (age, sex, prevalent diabetes, smoking, hypertension and alcohol consumption), were performed to analyse the effects of reported vibration exposure. PARTICIPANTS: Individuals in the MDCS who had answered the questionnaire on vibration exposure (14 342 out of the originally 30 446 individuals in MDCS) were included in the study. RESULTS: In total, 12 220/14 342 individuals (76%) reported 'no' exposure, 1392/14 342 (9%) 'some' and 730/14 342 (5%) 'much' exposure to vibrating hand-held tools. In men, 'much' exposure was independently associated with CTS (HR 1.71 (95% CI 1.11 to 2.62)) and UNE (HR 2.42 (95% CI 1.15 to 5.07)). 'Some' exposure was independently associated with UNE in men (HR 2.10 (95% CI 1.12 to 3.95)). 'Much' exposure was independently associated with trigger finger in women (HR 2.73 (95% CI 1.49 to 4.99)). We found no effect of vibration exposure on Dupuytren's disease or CMC-1 OA. 'Much' vibration exposure predicted any hand and forearm diagnosis in men (HR 1.44 (95% CI 1.08 to 1.80)), but not in women. CONCLUSIONS: Vibration exposure by hand-held tools increases the risk of developing CTS and UNE and any common hand and forearm conditions in men, whereas women only risk trigger finger and CMC-1 OA. Adjustment for relevant confounders in vibration exposure is crucial.
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Síndrome do Túnel Carpal , Exposição Ocupacional , Vibração , Humanos , Masculino , Feminino , Estudos Retrospectivos , Suécia/epidemiologia , Pessoa de Meia-Idade , Vibração/efeitos adversos , Síndrome do Túnel Carpal/epidemiologia , Síndrome do Túnel Carpal/etiologia , Idoso , Exposição Ocupacional/efeitos adversos , Doenças Profissionais/epidemiologia , Doenças Profissionais/etiologia , Dedo em Gatilho/epidemiologia , Contratura de Dupuytren/epidemiologia , Mãos , Prevalência , Fatores de Risco , Síndromes de Compressão do Nervo Ulnar/epidemiologia , Síndromes de Compressão do Nervo Ulnar/etiologia , Adulto , Modelos de Riscos ProporcionaisRESUMO
We describe the case of a 6-year-old female who presented with tender nodules and fixed flexion of her thumbs, diagnosed as bilateral pediatric trigger thumb. Though present since infancy, her condition was not diagnosed in prior clinical visits. Pediatric trigger digit is a clinical diagnosis, often missed if the digit's range of motion is not assessed routinely. Given the duration, pain, and severity of her condition, conservative management was deferred, and she was referred for surgery. An approach to clinical management is discussed. Ultimately, further study is required to develop structured management guidelines for pediatric trigger digit.
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Diagnóstico Tardio , Dedo em Gatilho , Humanos , Feminino , Dedo em Gatilho/diagnóstico , Criança , Amplitude de Movimento Articular , Polegar/fisiopatologiaRESUMO
PURPOSE: Anabolic steroid therapy has been associated with tendon injury, but there is a paucity of evidence associating physiologic testosterone replacement therapy (TRT) with tenosynovitis of the hand, specifically trigger finger and de Quervain tenosynovitis. The purpose of this study was to evaluate the relationship between TRT and tenosynovitis of the hand. METHODS: This was a one-to-one exact matched retrospective cohort study using a large nationwide claims database. Records were queried between 2010 and 2019 for adult patients who filled a prescription for TRT for 3 consecutive months. Rates of new onset trigger finger and de Quervain tenosynovitis and subsequent steroid injection or surgery were identified using ICD-9, ICD-10, and Current Procedural Terminology billing codes. Single-variable chi-square analyses and multivariable logistic regression were used to compare rates in the TRT and control cohorts while controlling for potential confounding variables. Both unadjusted and adjusted odds ratios (OR) are reported for each comparison. RESULTS: In the adjusted analysis, patients undergoing TRT were more than twice as likely to develop trigger finger compared to their matched controls. TRT was also associated with an increased likelihood of experiencing de Quervain tenosynovitis. Of the patients diagnosed with either trigger finger or de Quervain tenosynovitis over the 2-year period, patients with prior TRT were roughly twice as likely to undergo steroid injections or surgical release for both trigger finger and de Quervain tenosynovitis compared to the controls. CONCLUSIONS: TRT is associated with an increased likelihood of both trigger finger and de Quervain tenosynovitis, and an increased likelihood of requiring surgical release for both conditions. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.
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Doença de De Quervain , Terapia de Reposição Hormonal , Testosterona , Dedo em Gatilho , Humanos , Doença de De Quervain/tratamento farmacológico , Masculino , Estudos Retrospectivos , Dedo em Gatilho/tratamento farmacológico , Pessoa de Meia-Idade , Feminino , Testosterona/uso terapêutico , Adulto , IdosoRESUMO
PURPOSE: With variable and conflicting results to date, it remains unclear whether the percutaneous or open surgical A1 pulley release technique is superior regarding safety and efficacy. The goal of this meta-analysis was to compare the two techniques. METHODS: PubMed, Cochrane, and Google Scholar (pages 1-20) were searched through August 2023. Eight randomized controlled trials met the inclusion criteria and were included in this meta-analysis. RESULTS: Of the eight included studies and 548 total patients, there were 278 subjects in the percutaneous release group and 270 subjects in the open release group. There was no significant difference between the two surgical techniques in postoperative rates of revision, complications, or pain. CONCLUSIONS: This meta-analysis found no significant difference between open and percutaneous techniques regarding the need for revision procedures, complications, or postoperative pain. Therefore, both open and percutaneous releases are appropriate. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic I.
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Dedo em Gatilho , Humanos , Dedo em Gatilho/cirurgia , Reoperação/estatística & dados numéricos , Dor Pós-Operatória , Complicações Pós-Operatórias , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do TratamentoRESUMO
BACKGROUND: The non-genetic factors predisposing to trigger finger (TF) have mostly been characterised in small studies from individual institutions. Here, we aimed to provide a more complete picture of TF and its associations. METHODOLOGY: This case-control study used cross-sectional data from the UK Biobank population-based cohort to identify and determine the strength of associations of phenotypic variables with TF. We performed multivariable logistic regression of a multitude of phenotypic factors associated with TF. RESULTS: We identified 2250 individuals with medical and surgical diagnostic codes for TF, and 398,495 controls. TF was found to be significantly associated with age (OR 1.04, 95% CI 1.03-1.04, P < 2.23×10-308), female sex (OR 1.22, 95% CI 1.08-1.39, P = 2.35×10-3), body mass index (OR 1.10, 95% CI 1.04-1.16, P = 5.52×10-4), carpal tunnel syndrome (OR 9.59, 95% CI 8.68-10.59, P < 2.23×10-308), Dupuytren's disease (OR 4.89, 95% CI 4.06-5.89, P < 2.23×10-308), diabetes mellitus without complications (OR 1.35, 95% CI 1.15-1.58, P = 2.03×10-4) and with complications (OR 2.46, 95% CI 1.90-3.17, P = 4.98×10-12), HbA1c (OR 1.01, 95% CI 1.01-1.02, P = 8.99×10-9), hypothyroidism (OR 1.24, 95% CI 1.07-1.43, P = 4.75×10-3) and rheumatoid arthritis (OR 1.33, 95% CI 1.06-1.68, P = 0.014). CONCLUSION: Our results provide evidence supporting the well-known risk factors such as diabetes mellitus, carpal tunnel syndrome, age and female sex. Furthermore, we can confirm putative associations such as hypothyroidism, obesity and rheumatoid arthritis, while providing evidence against others such as hypertension and hyperlipidaemia. A novel finding arising from this study is the strong association with Dupuytren's disease. Our study design allowed us to identify these associations as being independent from carpal tunnel syndrome, thereby indicating a shared pathophysiology between this disease and TF.
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Dedo em Gatilho , Humanos , Dedo em Gatilho/genética , Dedo em Gatilho/epidemiologia , Feminino , Masculino , Estudos de Casos e Controles , Pessoa de Meia-Idade , Estudos Transversais , Fatores de Risco , Reino Unido/epidemiologia , Idoso , Fatores Sexuais , Adulto , Fatores Etários , Índice de Massa Corporal , Síndrome do Túnel Carpal/genética , Contratura de Dupuytren/genética , Contratura de Dupuytren/epidemiologiaRESUMO
INTRODUCTION: ChatGPT and its application in producing patient education materials for orthopedic hand disorders has not been extensively studied. This study evaluated the quality and readability of educational information pertaining to common hand surgeries from patient education websites and information produced by ChatGPT. METHODS: Patient education information for four hand surgeries (carpal tunnel release, trigger finger release, Dupuytren's contracture, and ganglion cyst surgery) was extracted from ChatGPT (at a scientific and fourth-grade reading level), WebMD, and Mayo Clinic. In a blinded and randomized fashion, five fellowship-trained orthopaedic hand surgeons evaluated the quality of information using a modified DISCERN criteria. Readability and reading grade level were assessed using Flesch Reading Ease (FRE) and Flesch-Kincaid Grade Level (FKGL) equations. RESULTS: The Mayo Clinic website scored higher in terms of quality for carpal tunnel release information (p = 0.004). WebMD scored higher for Dupuytren's contracture release (p < 0.001), ganglion cyst surgery (p = 0.003), and overall quality (p < 0.001). ChatGPT - 4th Grade Reading Level, ChatGPT - Scientific Reading Level, WebMD, and Mayo Clinic written materials on average exceeded recommended reading grade levels (4th-6th grade) by at least four grade levels (10th, 14th, 13th, and 11th grade, respectively). CONCLUSIONS: ChatGPT provides inferior education materials compared to patient-friendly websites. When prompted to provide more easily read materials, ChatGPT generates less robust information compared to patient-friendly websites and does not adequately simplify the educational information. ChatGPT has potential to improve the quality and readability of patient education materials but currently, patient-friendly websites provide superior quality at similar reading comprehension levels.
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Inteligência Artificial , Compreensão , Internet , Educação de Pacientes como Assunto , Humanos , Mãos/cirurgia , Contratura de Dupuytren/cirurgia , Cistos Glanglionares/cirurgia , Dedo em Gatilho/cirurgia , Letramento em Saúde , Síndrome do Túnel Carpal/cirurgiaRESUMO
BACKGROUND: Trigger 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. METHODS: In 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. RESULTS: The 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%). CONCLUSIONS: All 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.
Assuntos
Endoscopia , Satisfação do Paciente , Dedo em Gatilho , Humanos , Dedo em Gatilho/cirurgia , Estudos Retrospectivos , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Idoso , Idoso de 80 Anos ou mais , Adulto JovemRESUMO
Trigger finger causes pain and a persistent functional limitation of the hand, which can lead to permanent blockage of the flexor tendon. Ultrasonography-guided percutaneous release has been widely reported as a successful technique for trigger finger involving the A1 pulley. This article describes for the first time the use of this technique in an unusual location, the A3 pulley of the fifth finger. A 71-year-old patient presented with a 3-month history of pain and blockage in the fifth finger of the right hand and was diagnosed with a grade III trigger finger, according to the Froimson scale. We performed an ultrasonography-guided percutaneous release technique on the A3 pulley to release the flexor tendon of the fifth finger. Ultrasonography-guided percutaneous polectomy to treat trigger finger in the A1 pulley is an effective alternative treatment to surgery and even has certain advantages over it. The anatomical similarity between the A1 and A3 pulleys was the key factor that supported the use of this technique in this clinical case. Based on past experience in similar cases, we conclude that ultrasonography-guided percutaneous polectomy of the A3 pulley of the fifth finger was a surgical technique which could lead to a satisfactory outcome in the treatment of this condition.
Assuntos
Dedo em Gatilho , Humanos , Idoso , Dedo em Gatilho/diagnóstico por imagem , Dedo em Gatilho/cirurgia , Ultrassonografia , Dedos/diagnóstico por imagem , Dedos/cirurgia , Tendões/diagnóstico por imagem , Tendões/cirurgia , DorRESUMO
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.
Assuntos
Amplitude de Movimento Articular , Dedo em Gatilho , Humanos , Dedo em Gatilho/cirurgia , Estudos Retrospectivos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Adulto , Satisfação do Paciente , Tendões/cirurgiaRESUMO
BACKGROUND: The metacarpophalangeal joint blocking orthosis (MCPJ-BO) is one of the first-line orthotic treatment for patients with trigger finger (TF). Relative motion extension orthosis (RME-O) has recently emerged as a treatment option for various hand disorders involving TF. PURPOSE: The primary objective of this study was to compare the effectiveness of 6 weeks of orthotic treatment with the MCPJ-BO and the RME-O for pain relief. Function and satisfaction with the orthosis were assessed as secondary objectives. STUDY DESIGN: Randomized clinical study. METHODS: Thirty patients with an average age of 50 years with Froimson stage 1-3 A1 pulley triggering participated in the study. They were randomly assigned to either the MCPJ-BO (n = 15; 10 females, five males) or the RME-O group (n = 15; 12 females, three males). The orthoses were worn full time for 6 weeks. All patients received patient education, activity modification, and flexor tendon gliding exercises as part of the rehabilitation program. Pre- and post-assessments included Numeric Pain Rating Scale, Disability of the Arm, Shoulder, and Hand questionnaire, and Quebec User Evaluation of Satisfaction with Assistive Technology questionnaire. The Mann-Whitney U test was conducted to analyze the difference between the two groups. RESULTS: There were no significant differences between the two groups in pain and function before treatment (p < 0.05). Within-group comparisons indicated that both orthoses relieved pain, but the MCPJ-BO group achieved greater pain relief (p = 0.001). There was a significant improvement in function in the MCPJ-BO group, with a mean change of 12.7 (p = 0.0001). The overall success rates for the MCPJ-BO group and RME-O group were 60% and 27%, respectively. Patients in both groups had high satisfaction with the orthosis. CONCLUSIONS: MCPJ-BO and RME-O could be used for pain relief in the treatment of TF. The MCPJ-BO appears to be more effective than the RME-O in improving function.