Outcome of trigger finger treatment in diabetes

doi:10.1016/S1056-8727(96)00076-1

Journal of Diabetes and its Complications

Volume 11, Issue 5, September–October 1997, Pages 287-290

https://doi.org/10.1016/S1056-8727(96)00076-1 Get rights and content

Abstract

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.

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Cited by (95)

Treatment of advanced trigger finger by ulnar superficialis slip resection: Long-term outcome and predictive factors for poor prognosis
2023, Hand Surgery and Rehabilitation
The aim of this study was to evaluate the outcome of ulnar superficialis slip resection and to determine predictive factors for poor prognosis in patients with advanced trigger finger. Over a 5-year-period, 55 patients (58 fingers) were included. After surgery, two groups were identified: group 1, with complete extension or <10° extension deficit in the proximal interphalangeal (PIP) joint (n = 27 fingers/27 patients); and group 2, with ≥10° residual PIP extension deficit (n = 31 fingers/28 patients). Factors associated with PIP extension deficit were assessed on logistic regression. There was a median extension gain of 20° (range, 10−30°) after surgery. The difference between pre- and post-operative extension deficits was significant (p < 0.001). There was no significant inter-group difference in DASH score (p > 0.9). Two predictive factors were found: >12 months’ preoperative symptom duration (OR = 1.02; p = 0.045), and lack of self-rehabilitation (OR = 20; p < 0.001). Ulnar superficialis slip resection was effective in advanced trigger finger. Hand surgeons should operate early on these patients, and encourage self-rehabilitation.
4
Le but de cette étude était d'évaluer le résultat à long terme de la résection de la bandelette ulnaire du fléchisseur superficiel et de déterminer les facteurs prédictifs de mauvais pronostic chez les patients présentant un doigt à ressaut avancé. Sur une période de 5 ans, 55 patients (58 doigts) présentant un doigt à ressaut avancé, opérés par résection de la bandelette ulnaire du fléchisseur superficiel ont été inclus. Après la chirurgie, un groupe 1 (extension complète ou déficit d’extension <10° de l'interphalangienne proximale, n = 27 doigts/27 patients) et un groupe 2 (déficit d'extension résiduel de l'interphalangienne proximale ≥10°, n = 31 doigts/28 patients) ont été identifiés. Les facteurs associés au déficit d’extension de l'articulation interphalangienne proximale ont été recherchés en utilisant un modèle de régression logistique multivariée. Il y a eu un gain médian de 20° (extrêmes, 10−30°) après la chirurgie. La différence entre le déficit d'extension pré et postopératoire était statistiquement significative (p < 0,001). Il n'y avait pas de différence statistiquement significative entre les deux groupes pour le score DASH (p > 0,9). Deux facteurs prédictifs étaient associés à un déficit d'extension résiduel de l'articulation interphalangienne proximale : la durée des symptômes avant l'opération de plus de 12 mois (OR = 1,02 ; p = 0,045) et l’absence d'auto-rééducation (OR = 20 ; p < 0,001). Cette technique est efficace pour les patients présentant un doigt à ressaut avancé. Il serait bénéfique pour le chirurgien de la main d’opérer précocement ces patients et de les encourager à faire l’auto-rééducation.
Effectiveness of Corticosteroid Injections in Diabetic Patients With De Quervain Tenosynovitis
2022, Journal of Hand Surgery
We sought to determine the effectiveness of corticosteroid injections (CSIs) for de Quervain tenosynovitis in patients with diabetes mellitus.
We retrospectively identified all patients with diabetes receiving a CSI for de Quervain tenosynovitis by 16 surgeons over a 2-year period. Data collected included demographic information, medical comorbidities, number and timing of CSIs, and first dorsal compartment release. Success was defined as not undergoing an additional CSI or surgical intervention. The mixture of a corticosteroid and local anesthetic provided in each injection was at the discretion of each individual surgeon.
Corticosteroid injections were given to 169 wrists in 169 patients with diabetes. Out of 169 patients, 83 (49%) had success following the initial CSI, 44 (66%) following a second CSI, and 6 (67%) following a third CSI. A statistically significant difference was identified in the success rates between the first and second CSIs. Ultimately, 36 of 169 wrists (21%) underwent a first dorsal compartment release.
Patients with diabetes mellitus have a decreased probability of success following a single CSI for de Quervain tenosynovitis in comparison to nondiabetic patients, as described in the literature. However, the effectiveness of each additional CSI does not appear to diminish.
Therapeutic IV.
Shared genetic susceptibility between trigger finger and carpal tunnel syndrome: a genome-wide association study
2022, The Lancet Rheumatology
Citation Excerpt :
Although some studies have argued that the risk of trigger finger is increased after carpal tunnel syndrome surgical decompression, which could lead to confounding of the observed association, a retrospective longitudinal study from 2019 showed no temporal correlation between ipsilateral trigger finger and carpal tunnel syndrome surgery.7 Both conditions are characterised by synovitis and fibrosis around the flexor tendons8 and share multiple risk factors, including repetitive movements, diabetes, obesity, pregnancy, and rheumatoid arthritis.1,9 Furthermore, trigger finger and carpal tunnel syndrome can both be treated with a corticosteroid injection and surgical decompression.
Trigger finger and carpal tunnel syndrome are the two most common non-traumatic connective tissue disorders of the hand. Both of these conditions frequently co-occur, often in patients with rheumatoid arthritis. However, this phenotypic association is poorly understood. Hypothesising that the co-occurrence of trigger finger and carpal tunnel syndrome might be explained by shared germline predisposition, we aimed to identify a specific genetic locus associated with both diseases.
In this genome-wide association study (GWAS), we identified 2908 patients with trigger finger and 436 579 controls from the UK Biobank prospective cohort. We conducted a case-control GWAS for trigger finger, followed by co-localisation analyses with carpal tunnel syndrome summary statistics. To identify putative causal variants and establish their biological relevance, we did fine-mapping analyses and expression quantitative trait loci (eQTL) analyses, using fibroblasts from healthy donors (n=79) and tenosynovium samples from patients with carpal tunnel syndrome (n=77). We conducted a Cox regression for time to trigger finger and carpal tunnel syndrome diagnosis against plasma IGF-1 concentrations in the UK Biobank cohort.
Phenome-wide analyses confirmed a marked association between carpal tunnel syndrome and trigger finger in the participants from UK Biobank (odds ratio [OR] 11·97, 95% CI 11·1–13·0; p<1 × 10⁻³⁰⁰). GWAS for trigger finger identified five independent loci, including one locus, DIRC3, that was co-localised with carpal tunnel syndrome and could be fine-mapped to rs62175241 (0·76, 0·68–0·84; p=5·03 × 10⁻¹³). eQTL analyses found a fibroblast-specific association between the protective T allele of rs62175241 and increased DIRC3 and IGFBP5 expression. Increased plasma IGF-1 concentrations were associated with both carpal tunnel syndrome and trigger finger in participants from UK Biobank (hazard ratio >1·04, p<0·02).
In this GWAS, the DIRC3 locus on chromosome 2 was significantly associated with both carpal tunnel syndrome and trigger finger, possibly explaining their co-occurrence. The disease-protective allele of rs62175241 was associated with increased expression of long non-coding RNA DIRC3 and its transcriptional target, IGBP5, an antagonist of IGF-1 signalling. These findings suggest a model in which IGF-1 is a driver of both carpal tunnel syndrome and trigger finger, and in which the DIRC3-IGFBP5 axis directly antagonises fibroblastic IGF-1 signalling.
Wellcome Trust, National Institute for Health Research, Medical Research Council.
Diabetes mellitus: Impact on common hand disorders
2020, Diabetes Mellitus: Impact on Bone, Dental and Musculoskeletal Health
Diabetic patients are prone to a variety of hand disorders, many of which cause limited motion, pain, and loss of function. In many cases, severity of symptoms and progression of disease are thought to be linked to poor glycemic control. While some of these conditions have straightforward, low-risk solutions—both non-surgical and surgical—others, such as cheiroarthropathy, remain difficult to treat and do not have satisfactory solutions available.
The Feasibility and Usability of a Ranking Tool to Elicit Patient Preferences for the Treatment of Trigger Finger
2019, Journal of Hand Surgery
Shared decision making is an approach where physicians and patients collaborate to make decisions based on patient values. This requires eliciting patients’ preferences for each treatment attribute before making decisions; a structured process for preference elicitation does not exist in hand surgery. We tested the feasibility and usability of a ranking tool to elicit patient preferences for the treatment of trigger finger. We hypothesized that the tool would be usable and feasible at the point of care.
Thirty patients with a trigger finger without prior treatment were recruited from a hand surgery clinic. A preference elicitation tool was created that presented 3 treatment options (surgical release, injection, and therapy and orthosis) and described attributes of each treatment extracted from literature review (eg, success rate, complications). We presented these attributes to patients using the tool and patients ranked the relative importance (preference) of these attributes to aid in their decision making. The System Usability Scale and tool completion time were used to evaluate usability and feasibility, respectively.
The tool demonstrated excellent usability (System Usability Scale: 88.7). The mean completion time was 3.05 minutes. Five (16.7%) patients chose surgery, 20 (66.7%) chose an injection, and 5 (16.7%) chose therapy and orthosis. Patients ranked treatment success and cost as the most and least important attributes, respectively. Twenty-nine (96.7%) patients were very to extremely satisfied with the tool.
A preference elicitation tool for patients to rank treatment attributes by relative importance is feasible and usable at the point of care. A structured process for preference elicitation ensures that patients understand the trade-offs between choices and can assist physicians in aligning treatment decisions with patient preferences.
A ranking tool is a simple, structured process physicians can use to elicit preferences during shared decision making and highlight trade-offs between treatment options to inform treatment choices.
Management of Diabetic Trigger Finger
2019, Journal of Hand Surgery
Diabetics have a much greater prevalence of trigger finger than nondiabetics and are more likely to have severe symptoms. Diabetic trigger finger may be more accurately described on a spectrum of diabetic hand pathology alongside carpal tunnel syndrome and cheiroarthropathy. Recent publications have called into question the current treatment algorithm for diabetic trigger finger. Although some evidence supports the use of corticosteroid injections, a recent cost analysis reported that immediate surgical release of the A1 pulley in the clinic is the most cost-effective management of diabetic trigger finger. In addition to traditional treatment with injection and open release, percutaneous release with or without simultaneous corticosteroid injection has shown promising results and may have a role in patient care. The appropriate treatment algorithm in terms of efficacy, safety, and cost remains controversial.

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Original articleOutcome of trigger finger treatment in diabetes

Abstract

J Hand Surg

J Hand Surg

J Hand Surg

Surg Clin North Am

J Hand Surg

J Hand Surg

Treatment of trigger finger

Acta Orthop Scand

Original article
Outcome of trigger finger treatment in diabetes