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Fulltext Giant cell tumour of tendon sheath masquerading as trigger finger

Rahimawati N, Roohi SA, Naicker AS, Zanariah O

Malays Orthop J, 2010;4(3):32-35.
MyJurnal

We report a case of a 59-year-old female who presented in the general orthopaedic clinic with triggering of her right middle finger. She did not respond to conventional treatment methods; subsequently she underwent surgical open release under local anaesthesia. Five months postoperatively, the patient presented with signs and symptoms of acute flexor tenosynovitis, and was thought to have a postoperative infection. Re-examination by a hand surgeon raised the possibility of a different aetiology. Based on clinical findings and response to initial treatment, giant cell tumour of the flexor tendon sheath was suspected and later confirmed following surgical biopsy. A high index of suspicion and knowledge of the variegated presentations of giant cell tumour in the hand are beneficial in these types of cases.

Matched MeSH terms: Trigger Finger Disorder*
Flexor pollicis longus rupture following acupuncture for trigger thumb: a case report

Liew SK, Teh KK

Acupunct Med, 2021 08;39(4):398-399.
PMID: 33256436 DOI: 10.1177/0964528420959085
Matched MeSH terms: Trigger Finger Disorder/surgery*; Trigger Finger Disorder/therapy
Steroid injection versus NSAID injection for trigger finger: a comparative study of early outcomes

Shakeel H, Ahmad TS

J Hand Surg Am, 2012 Jul;37(7):1319-23.
PMID: 22721455 DOI: 10.1016/j.jhsa.2012.03.040

Stenosing tenosynovitis of the flexor tendon sheath of the digits of the hand results from a discrepancy between the diameter of the flexor tendon and its sheath at the A1 pulley. The treatment options for trigger digits include oral nonsteroidal anti-inflammatory drugs (NSAIDs) and local NSAID applications, splintage, steroid injection, and percutaneous and open release of the A1 pulley. Injectable NSAID is used intramuscularly and locally in other sites. The hypothesis is that an injectable NSAID is as effective as the traditionally used steroid injection in the treatment of trigger digit, based on Quinnell grading, and that the treatment works as well in patients with diabetes as in those without diabetes.

Matched MeSH terms: Trigger Finger Disorder/complications; Trigger Finger Disorder/drug therapy*
Trigger finger, a report on a series of cases

An HK

Med J Malaysia, 1978 Sep;33(1):7-9.
PMID: 750899
Matched MeSH terms: Trigger Finger Disorder*
Outcome of corticosteroid injection versus physiotherapy in the treatment of mild trigger fingers

Salim N, Abdullah S, Sapuan J, Haflah NH

J Hand Surg Eur Vol, 2012 Jan;37(1):27-34.
PMID: 21816888 DOI: 10.1177/1753193411415343

We compared the effectiveness of physiotherapy and corticosteroid injection treatment in the management of mild trigger fingers. Mild trigger fingers are those with mild crepitus, uneven finger movements and actively correctable triggering. This is a single-centred, prospective, block randomized study with 74 patients; 39 patients for steroid injection and 35 patients for physiotherapy. The study duration was from Jun 2009 until August 2010. Evaluation was done at 6 weeks, 3 months and 6 months post-treatment. At 3 months, the success rate (absence of pain and triggering) for those receiving steroid injection was 97.4% and physiotherapy 68.6%. The group receiving steroid injection also had lower pain score, higher rate of satisfaction, stronger grip strength and early recovery to near normal function (findings were all significant, p triggering). Those who received corticosteroid injections had a significant recurrence rate of pain but not triggering. The physiotherapy group had no recurrence of pain or triggering due to the type of triggering responsive to physiotherapy or possibly due to awareness of physiotherapy exercises. Perhaps they were able to institute self-treatment on early onset of symptoms of trigger fingers. We conclude that corticosteroid injection has a better outcome compared to physiotherapy in the treatment of mild trigger fingers but physiotherapy may have a role in prevention of recurrence.
Study site: Hand clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia

Matched MeSH terms: Trigger Finger Disorder/drug therapy*; Trigger Finger Disorder/rehabilitation*
A randomized controlled trial of trigger finger release under digital anesthesia with (WALANT) and without adrenaline

Mohd Rashid MZ, Sapuan J, Abdullah S

J Orthop Surg (Hong Kong), 2019 3 12;27(1):2309499019833002.
PMID: 30852960 DOI: 10.1177/2309499019833002

BACKGROUND:: Trigger finger release utilizing wide-awake local anesthesia no tourniquet (WALANT) usage in extremity surgery is not widely used in our setting due to the possibility of necrosis. Usage of a tourniquet is generally acceptable for providing surgical field hemostasis. We evaluate hemostasis score, surgical field visibility, onset and duration of anesthesia, pain score, and the duration of surgery and potential side effects of WALANT.
METHODS:: Eighty-six patients scheduled for trigger finger release between July 2016 and December 2017 were randomized into a control group (1% lignocaine and 8.4% sodium bicarbonate with arm tourniquet; given 10 min prior to procedure) and an intervention group (1% lignocaine, 1:100,000 of adrenaline and 8.4% sodium bicarbonate; given 30 min prior to procedure), with a total of 4 ml of solution injected around the A1 pulley. The onset of anesthesia and pain score upon injection of the first 1 ml were recorded. After the procedure, the surgeon rated for the hemostasis score (1-10: 1 as no bleeding and 10 being profuse bleeding). Duration of surgery and return of sensation were recorded.
RESULTS:: Hemostasis score was grouped into visibility score as 1-3: good, 4-6: moderate, and 7-10: poor. The intervention group (with adrenaline) had a 74% of good surgical field visibility compared to 44% from the controlled group (without adrenaline; p < 0.05). Duration of anesthesia was longer in the intervention group (with adrenaline), with a 2.77-h difference.
CONCLUSION:: WALANT provides excellent surgical field visibility and is safe and on par with conventional methods but without the usage of a tourniquet and its associated discomfort.

Matched MeSH terms: Trigger Finger Disorder
Fulltext Bowling: Occupational Hazards of the Wrist and Hand in Elite Tenpin Bowlers

Lee YJ, Harmony T, Jamal-Azmi IS, Gunasagaran J, Ahmad TS

Malays Orthop J, 2021 Mar;15(1):113-118.
PMID: 33880157 DOI: 10.5704/MOJ.2103.017

Introduction: Bowling is an immensely popular, but scarcely researched sport associated with overuse injuries in its participants. The purpose of this study was to investigate and report on the incidence of common upper extremity complaints in elite bowling athletes.
Materials and methods: All Malaysian national level bowlers (n=39) were evaluated via questionnaire on their upper limb symptoms. A focused, relevant clinical examination was performed on each subject to exclude de Quervain's tenosynovitis, tennis and golfer's elbow, carpal tunnel syndrome and trigger finger. The athletes were then allowed to resume bowling for two hours before completing another symptom-related questionnaire.
Results: Pain was the predominantly observed symptom, with a predilection for the wrist, ring and middle fingers, and thumb. De Quervain's tenosynovitis was found in 53.8% (n=21) of the subjects, with 52.4% and 42.9% of them experiencing pain during and after training, respectively. Other repetitive injury-related disorders were also considerably more common than in their non-playing limb and the general population.
Conclusion: The incidence of de Quervain's tenosynovitis was exceptionally high in this population. Further studies on sports kinematics are needed to prevent long term morbidities in these athletes.

Matched MeSH terms: Trigger Finger Disorder