A Critical Appraisal of Adult Trigger Finger: Pathophysiology, Treatment, and Future Outlook

Abstract

Background:Trigger finger (TF) is a common referral to a hand surgeon, with people with diabetess being the most at-risk population. Abnormal thickening, scarring, and inflammation occur at the A1 pulley and flexor tendon, and histological changes correlate well with the clinical severity of TF. Corticosteroid injections decrease the thickness of the A1 pulley and are considered a first-line treatment. However, corticosteroids are only moderately effective, especially for people with diabetes. Patients may elect for surgery if nonoperative treatments prove ineffective; some may choose immediate surgical release instead. To release the A1 pulley, patients have the option of an open or percutaneous approach. The open approach has a greater risk of infection and scar tissue formation in the short run but an overall superior long-term outcome compared with the percutaneous approach.Methods:We critically reviewed the efficacy and cost-effectiveness of the treatment methods for TF through a comprehensive search of the PubMed Database from 2003 to 2019.Results:To reduce costs, while still delivering the best possible care, it is critical to consider the likelihood of success for each treatment method in each subpopulation. Furthermore, some patients may need to return to work promptly, which ultimately may influence their desired treatment method.Conclusions:Currently, there is no universal treatment algorithm for TF. From a purely financial standpoint, women without diabetes presenting with a single triggering thumb should attempt 2 corticosteroid trials before percutaneous release. It is the most cost-effective for all other subpopulations to elect for immediate percutaneous release.

Trigger finger in children with hurler syndrome – distribution pattern and treatment options

“…Whereas usually the A1 pulley is affected in trigger finger in adults and children with pollex flexus congenitus, we observed predominantly the A2 and A3 pulley being affected in Hurler children [ 7 ], [ 8 ].…”

Diabetic hand: prevalence and incidence of diabetic hand problems using data from 1.1 million inhabitants in southern Sweden

“…Both TF and DD are considered to be fibroproliferative disorders with alterations in the flexor tendon pulley system23 and palmar apeneurosis,24 respectively. The exact pathophysiology behind the diagnoses is still not fully understood, especially in the presence of DM 1.…”

“…21 Taking this together, pathologic structural and biochemical alterations in the peripheral nerve and surrounding tissue due to DM and chronic hyperglycemia might lower the threshold for symptom development when the nerve is compressed, and thus increase the prevalences of CTS and possibly also UNE. 4 TF and DD Both TF and DD are considered to be fibroproliferative disorders with alterations in the flexor tendon pulley system 23 and palmar apeneurosis, 24 respectively. The exact pathophysiology behind the diagnoses is still not fully understood, especially in the presence of DM.…”

An Ultrasound-guided Percutaneous Surgical Technique for Trigger Finger Release Using a Minimally Invasive Surgical Knife

“…Stenosing tenovaginitis or TF is a common inflammatory condition located at the A1 pulley of the fingers. Thickening of the A1 pulley, as well as of the flexor tendon have been observed 7. Most surgical procedures intended to treat TFs are designed to release the A1 pulley and thus relieve the painful flexor tendon triggering.…”

“…Thickening of the A1 pulley, as well as of the flexor tendon have been observed. 7 Most surgical procedures intended to treat TFs are designed to release the A1 pulley and thus relieve the painful flexor tendon triggering.…”