Sonographic Depiction of Trigger Fingers in Acromegaly

Abstract

Objective. The purpose of this study was to compare the prevalence of trigger fingers in patients with acromegaly versus an unaffected control group. Methods. This study was performed with Institutional Review Board approval, and informed written consent was obtained from each patient and control participant. The diagnosis was made by a combination of clinical symptoms and sonographically measured thickening of the first annular (A1) pulley. The A1 pulley thickness was measured in 40 patients and 40 control participants by means of a 17-5 MHz high-resolution transducer. Thickening of the A1 pulley and abnormalities of the underlying flexor tendons associated with the clinical sign were diagnostic for a trigger finger. The acromegalic patients were divided into groups according to disease activity and therapy. The study was performed at the baseline and at a follow-up after 1 year. Results. At the baseline, clinical and sonographic findings were consistent with trigger fingers in 25% of patients (6 at presentation and 4 with uncontrolled disease). After 1 year, the trigger fingers recovered in the patients who were not receiving any treatment at the beginning of the study. In patients with uncontrolled disease, the condition remained unchanged. The A1 pulley thickness was greater in the acromegalic patients than control participants (mean ± SD, 0.44 ± 0.19 versus 0.24 ± 0.05 mm; P < .05). In the patients treated for acromegaly, the trigger fingers disappeared, and a reduction in the A1 pulley thickness was noted (P < .05) at the follow-up. Conclusions. Trigger fingers were observed in 25% of the acromegalic patients but in none of the control participants. The A1 pulley was significantly thicker in the acromegalic patients and normalized after 1 year in some who were treated for the disease.

Musculoskeletal complications of acromegaly: what radiologists should know about early manifestations

“…It is known that the bone and hyaline cartilage are typical targets of GH and IGF-1 excess, and normalisation of GH and IGF-1 levels is only partly effective in reversing advanced arthropathy of acromegaly [3]. However, the role of GH and IGF-1 on the fi brous tissue of retinacula, such as the A1 pulley, has only recently been investigated [26]. High-resolution ultrasound provides such a high degree of spatial resolution that suffi cient visualisation of the A1 pulleys and their quantitative measurement is possible [24].…”

“…La cartilagine ialina e l'osso sono tipici bersagli di GH e IGF-1 e la normalizzazione di questi valori ormonali non è suffi ciente a rendere reversibili i segni avanzati dell'artropatia acromegalia [3]. Tuttavia il ruolo di GH e IGF-1 a livello del tessuto fi broso dei retinacoli è stato studiato solo recentemente [26]. L'ecografi a ad alta risoluzione ha permesso un così alto grado di accuratezza nel valutare la puleggia A1 tale da permettere anche misure quantitative [24].…”

“…Uno studio recente cha ha studiato una numerosa coorte di pazienti acromegalici ha dimostrato una prevalenza del dito a scatto del 25%, l'85% di questi casi risultavano di nuova diagnosi (Fig. 9) [26]. Le pulegge dei pazienti acromegalici si sono rivelate ispessite rispetto a quelle dei controlli.…”

“…9). [26]. Measuring the thick- era in media 0,472 mm a livello del terzo dito, mentre nei controlli normali era 0,268 (Fig.…”

Tendinosis in Trigger Finger

“…Amyloidosis can be dialysis-related [130][131][132] or familial 133 . There could be an infection as tuberculosis 17 , a side effect of anti-oestrogens (letrozole and exemestane) 134 or an effect of acromegaly 135 . There might be an exostosis 136 or a soft tissue tumour, either in the tendon sheath 120 or in the tendon 137,138 , at the level of the wrist 139,140 , on the dorsum of the hand 141 or both 142 .…”