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Results for “Trigger Finger Disorder”

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Trigger thumb.

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Disease↗

A technique for accurate and safe injection of steroid in trigger digits using ultrasound guidance.

Steroid injections have long been the main stay of conservative treatment of trigger digits. This procedure gives variable results, which is dependent on a number of factors. The injection of the steroid in the right place improves the success rate and also prevents complications associated with the procedure. We describe a technique using ultrasound for accurate injection of steroid to maximise its beneficial effects in treatment of trigger digits.

Humans↗

Intraarticular corticosteroids in treatment of osteoarthritis.

The history of the use of intraarticular corticosteroids in the treatment of osteoarthritis and the various available corticosteroid preparations, their possible mechanism of action, side effects, and results of treatment are presented. The longest-lasting effects in the alleviation of joint symptomatology are produced by the tertiary-butyl acetate esters of the various corticosteroid preparations. The effect produced by triamcinolone appears to be of the longest duration. The anti-inflammatory action of corticosteroids seems to be responsible for the alleviation of joint symptomatology in osteoarthritis. Significant adverse effects, such as steroid arthropathy and tendon rupture, may result from excessive intraarticular use. Infection is an uncommon complication when adequate skin preparation is performed. The major disadvantage of intraarticular corticosteroids is their short duration of action, averaging two to three weeks. However, a small percentage of patients with osteoarthritis may sustain prolonged relief from one or two injections. Acute self-limited disorders, such as trigger finger and inflamed bursae, seem to lend themselves best to this form of therapy.

Adrenal Cortex Hormones↗

Increased median nerve latency at the carpal tunnel of patients with "trigger finger": comparison of 62 patients and 13 controls.

An association between symptomatic compression neuropathy of the median nerve at the carpal tunnel and "trigger finger" has been reported in endocrine and metabolic disorders. We assessed the incidence of increased median nerve latency in subjects with "trigger finger". 62 consecutive patients with "trigger finger" and no signs or symptoms of median nerve compression underwent nerve conduction studies of the median nerve. 13 healthy adults served as controls. 39/62 patients had increased distal motor latency in the median nerve. Only 1 of 13 subjects in the control group had a borderline value of distal motor latency.

Adult↗

Median nerve compression and trigger finger in the mucopolysaccharidoses and related diseases.

Patients with Hurler's syndrome (MPS-1H), I-cell disease (ML-II) and pseudo-Hurler's syndrome (ML-III) had median nerve compression and triggering of the fingers which limited finger extension. To our knowledge, this combination has not been reported previously in patients with mucopolysaccharidoses and related disorders. In all of our 3 cases the median nerve was compressed by thickened flexor tenosynovium. Synovectomy and resection of the volar carpal ligament improved the hand function in all, including the mentally retarded patient with Hurler's syndrome. Release of the fibroosseous tunnel in two patients was followed by an increased range of motion (but not full extension). A fourth patient, without a mucopolysaccharide storage disorder, also had the combination of trigger finger and carpal tunnel syndrome.

Carpal Tunnel Syndrome↗

Flexor tendon entrapment of the digits (trigger finger and trigger thumb).

Flexor tendon entrapment of the digits is a disorder characterized by snapping or locking of the thumb or fingers (with or without pain). Most cases are secondary to thickening of the digit's A1 pulley, but other pathogeneses include tendon abnormalities at the level of the carpal tunnel, thickening of other pulleys, and abnormalities of the metacarpal-phalangeal joint. Its historical name, stenosing tenosynovitis of the digits, is inappropriate because histological studies document a lack of inflammation. Flexor tendon entrapment of the digits is a relatively common, uncomplicated, and non-controversial musculotendinous disorder of the distal upper extremity. The purpose of this invited review is to summarize information from the medical literature on aspects of this condition likely to be of interest and relevant to occupational medicine practitioners. Topics covered include normal anatomy and kinesiology, history, clinical observations related to diagnosis, pathology, pathophysiology, clinical observations on etiology, descriptive epidemiology, epidemiological studies, and case management. Models for the pathogenesis of flexor tendon entrapment of the digits are proposed, and opportunities for future research are presented.

Fingers↗

Outcome of trigger finger treatment in diabetes.

Trigger finger is an underdiagnosed hand disorder causing disability in longstanding diabetic patients. Sixty diabetic patients [39 insulin-dependent diabetes mellitus (IDDM) and 21 non-insulin-dependent diabetes mellitus (NIDDM)] and 60 nondiabetic patients were examined. All were initially treated by steroid injections: failure to alleviate symptoms was the indication for surgery. The incidence of multiple digit involvement was higher in IDDM patients as compared with the control group (p < 0.001). The diffuse type was 1.45 times more frequent in IDDM and NIDDM than in nondiabetic patients (p < 0.008). The diabetic patients had a relatively longer duration of symptoms (p < 0.003). Significantly, a higher recovery rate upon steroid injection was achieved in control patients as compared with the diabetic ones (p < 0.001). IDDM patients required more surgery compared with NIDDMs and, in 13.3% of diabetic patients, the surgical outcome was not successful. Diabetic patients should be diagnosed early for multiple and diffuse types of trigger digits. Steroid injection as the first mode of therapy is highly recommended although not always successful. Surgery is the definitive treatment but requires a long course of physiotherapy and may be associated with some complications.

Adult↗

Primary care of the injured hand, part 2.

Nerve injuries in the forearm and hand are common, especially with concomitant tendon lacerations. The optimal time for repair of a clean sharp laceration is within the first 24 to 48 hours using magnification to achieve precise surgical reapproximation. Transfer to a facility equipped to perform replantation is indicated for multiple digit amputations, any thumb amputation, transmetacarpal amputation, wrist and arm amputation, and major amputations in children. Acute paronychial infections are treated with warm soaks, antibiotics, elevation, and immobilization. Surgical drainage is often indicated for a felon and should be done through a high midaxial incision. fractures of the hand are extremely common and require accurate diagnosis and precise anatomic reduction. Ensheathment syndromes--carpal tunnel syndrome, trigger finger, de Quervain's disease--are the most common nontraumatic disorders of the hand. If recognized and treated early they may resolve without need for surgery.

Abscess↗