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Digital Deformities in Rheumatoid Arthritis
Published in J. Terrence Jose Jerome, Clinical Examination of the Hand, 2022
The ulnar interossei and more specifically the abductor digiti minimi of the fifth finger, contribute not only to the MCP flexion but also to its ulnar deviation. At the level of the long and middle fingers, the palmar plate and the neighbouring structures which are detached from it move on the ulnar edge of the finger under the action of the flexors whose path is oblique with respect to the axis of the A1 pulley. Radial tilt of the wrist, collapsed wrist and flexion of the fourth and fifth metacarpals contribute to the aggravation of the ulnar deviation.
Surgery of the Hand
Published in Timothy W R Briggs, Jonathan Miles, William Aston, Heledd Havard, Daud TS Chou, Operative Orthopaedics, 2020
Norbert Kang, Ben Miranda, Dariush Nikkhah
In the thumb, the proximal border of the A1 pulley is at the level of the proximal digital skin crease over the MCP joint. A 1–1.5 cm transverse incision is created in the crease. Tenotomy scissors are used for blunt dissection through the subcutaneous fat and palmar fascia to expose the FPL tendon sheath and A1 pulley. The digital nerves and vessels running parallel to the FPL tendon are identified and protected with right-angle retractors. The A1 pulley is identified, and the radial attachment of the pulley is divided completely with a scalpel from proximal to distal. The thumb is then flexed and extended several times to test for any residual triggering. Any tourniquet is released and haemostasis is achieved. The wound is washed out with saline before closure.
Upper limb
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
The patient complains of painful locking or snapping of the finger, usually when attempting to straighten a bent finger. Occasionally, it may present as a finger that is too painful to bend, associated with pain and tenderness at the A1 pulley. There is often a palpable nodule in the tendon. Management is a steroid injection into the sheath, and if this fails then surgical tendon sheath (A1 pulley) release should be performed under local anaesthesia, taking care not to cut too much of the pulley and create bowstringing of the flexor tendon. Trigger digits, especially the thumb, can occur in infants and usually resolve spontaneously.
The association between trauma and paediatric trigger thumb deformity; experience from a single tertiary referral hospital
Published in Journal of Plastic Surgery and Hand Surgery, 2023
Nadia L. Salloum, Pauline McGee, Wee L. Lam
A summary of symptoms, examination findings and x-ray findings are presented in Table 2. Symptoms were noted to be unilateral or bilateral with bilateral symptoms identified in 10 individuals, accounting for 20 thumbs. Two children presented with a history of trauma on one side who subsequently developed symptoms in the contralateral thumb in the absence of trauma. Flexion deformity was reported as either fixed, where it could not be extended, or intermittent. Where pain was associated with the trigger thumb, this was either at rest or on attempted passive extension of the thumb. The presence of Notta’s nodule was not always commented on but where it was documented, this was included as reported in findings in Table 1. The overall proportion of individuals who had x-rays performed is shown in Table 1. All x-rays carried out were formally reported as normal by a radiologist. The only additional examination finding of note was a minor subungal haematoma in one case with a traumatic history. All patients underwent release of the A1 pulley through a transverse incision with complete resolution of symptoms.
Intra-sheath versus extra-sheath ultrasound guided corticosteroid injection for trigger finger: a triple blinded randomized clinical trial
Published in The Physician and Sportsmedicine, 2018
Mohsen Mardani-Kivi, Mahmoud Karimi-Mobarakeh, Ali Babaei Jandaghi, Sohrab Keyhani, Khashayar Saheb-Ekhtiari, Keyvan Hashemi-Motlagh
In addition to the surgical procedure of releasing A1 pulley (open or percutaneous), there are a number of noninvasive options for trigger finger. A popular, universally employed noninvasive management available to orthopedic and plastic surgeons is the administration of corticosteroid within the sheath of the flexor tendon at the level of A1 pulley [3]. Surgical release of A1 pulley has a lower chance of recurrence. However, surgical intervention may be associated with minor and major complications [4–6]. Corticosteroid injection has been employed for various musculoskeletal ailments including tendinitis and tenosynovitis [7,8]. The therapy is safe, freely available, cost effective, and low risk in trigger finger management. Various studies with local corticosteroid infiltration have shown a success rate of 45–96% [9–11].
Long-term functional outcome of trigger finger
Published in Disability and Rehabilitation, 2018
Danit Langer, Shai Luria, Michael Michailevich, Adina Maeir
Therapists, specializing in hand therapy, are often referred patients due to trigger finger (TF). TF, also called stenosing flexor tenosynovitis, is a common hand pathology in adulthood. Triggering of the finger commonly occurs at the fibro-osseous tunnel formed by the metacarpal neck and the first annular pulley. The initial complaints associated with TF are pain over the A1 pulley or clicking and may worsen to locking of the digit in flexion.[1,2] TF is one of the most common diseases seen in hand surgery clinics and is the fourth leading cause of referral to these clinics.[3,4] The incidence of TF is 28:100,000 per year or a lifetime risk of 2.6% in the general population, but it increases to 10% in the diabetic population.[5,6] The mean age of onset for TF is 58 years, and it is diagnosed in women two to six times more frequently than men.[2]