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David Ring - One of the best experts on this subject based on the ideXlab platform.
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assessment of decisional conflict about the treatment of Trigger Finger comparing patients and physicians
The archives of bone and joint surgery, 2016Co-Authors: Michiel G J S Hageman, Annecarolin Doring, Silke A Spit, Thierry G Guitton, David RingAbstract:Background: As an early step in the development of a decision aid for idiopathic Trigger Finger (TF) we were interested in the level of decisional conflict experienced by patients and hand surgeons. This study tested the null hypothesis that there is no difference in decisional conflict between patients with one or more idiopathic Trigger Fingers and hand surgeons. Secondary analyses address the differences between patients and surgeons regarding the influence of the DCS-subcategories on the level of decisional conflict, as well as the influence of patient and physician demographics, the level of self-efficacy, and satisfaction with care on decisional conflict. Methods: One hundred and five hand surgeon-members of the Science of Variation Group (SOVG) and 84 patients with idiopathic TF completed the survey regarding the Decisional Conflict Scale. Patients also filled out the Pain Self-efficacy Questionnaire (PSEQ) and the Patient Doctor Relationship Questionnaire (PDRQ-9). Results: On average, patients had decisional conflict comparable to physicians, but by specific category patients felt less informed and supported than physicians. The only factors associated with greater decisional conflict was the relationship between the patient and doctor. Conclusions: There is a low, but measurable level of decisional conflict among patients and surgeons regarding idiopathic Trigger Finger. Studies testing the ability of decision aids to reduce decisional conflict and improve patient empowerment and satisfaction with care are merited.
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association between psychosocial factors and pain in patients with Trigger Finger
Journal of Hand and Microsurgery, 2016Co-Authors: Stephen A Kennedy, Anamaria Vranceanu, Fiesky Nunez, David RingAbstract:Purpose To test the hypothesis that psychological factors correlate with pain intensity in Trigger Finger (TF).
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adverse events of open a1 pulley release for idiopathic Trigger Finger
Journal of Hand Surgery (European Volume), 2012Co-Authors: Hanneke Bruijnzeel, Chaitanya S Mudgal, Jesse B Jupiter, Valentin Neuhaus, Sigrid Fostvedt, David RingAbstract:Purpose To classify and report adverse events of Trigger Finger release in a large cohort of patients. Methods We retrospectively reviewed 1,598 Trigger Finger releases performed by 12 surgeons in 984 patients between 2001 and 2011. Adverse events were classified based on a system derived from the Centers for Disease Control and Prevention criteria and clinical experience. Risk factors for various adverse events were sought in bivariate and multivariable statistical analysis. Results At the latest follow-up, 66 patients (7%), or 84 operated Trigger digits (5%), experienced a documented adverse event. The most common adverse events were recovery issues in 46 patients (3%) (such as postoperative symptoms treated with steroid injection or slow recovery of motion treated with hand therapy), wound problems in 30 patients (2%) (consisting of suture abscess, superficial infection, or wound separation), persistent postoperative Triggering in 10 patients (0.6%), and recurrent Triggering in 4 patients (0.3%). Diabetes mellitus was associated with wound problems, slow recovery of motion, and recurrence. Concomitant carpal tunnel release on the same side was associated with slow recovery. Conclusions Fourteen patients, less than 1%, in this cohort experienced an adverse event, such as persistent or recurrent Triggering, requiring secondary surgery. No nerve injury or deep infection occurred in our cohort. One in 15 patients experienced a minor transient or treatable adverse event, and patients with diabetes were at greater risk. Type of study/level of evidence Therapeutic IV.
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predictors of pain during and the day after corticosteroid injection for idiopathic Trigger Finger
Journal of Hand Surgery (European Volume), 2012Co-Authors: Abhishek Julka, Anamaria Vranceanu, Apurva S Shah, Frank Peters, David RingAbstract:Purpose Some patients report a transient increase in pain the day after a corticosteroid injection. We investigated factors associated with greater pain during and the day after a corticosteroid injection for idiopathic Trigger Finger. Methods A total of 100 patients with Trigger Finger completed questionnaires measuring heightened illness concern, catastrophic thinking, depression, perceived health, expected pain, pain with injection, and pain the day after injection. We performed bivariate analysis to determine variables associated with pain with injection, next-day pain, and next-day pain greater than 4 points on an 11-point ordinal scale. We entered variables with a significant correlation into multivariable linear regression models. Results The average pain with injection and the day after injection were 4.3 (SD 2.8) and 1.8 (SD 2.0), respectively. Expected pain, heightened illness concern, catastrophic thinking, depression, physician, and gender correlated with pain with injection. A multivariable regression model conducted in backward stepwise fashion demonstrated that physician, depression, expected pain, and female gender explained 28% of the variance in pain with injection. Pain with injection was the only significant predictor of next-day pain and pain greater than 4 points the day after injection. Conclusions Our data suggest that psychosocial factors are the strongest correlates of pain with corticosteroid injection, but a large portion of the variability remains unexplained. Future research will investigate cognitive/behavioral methods for decreasing pain with injection. Type of study/level of evidence Prognostic I.
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a prospective randomized controlled trial of injection of dexamethasone versus triamcinolone for idiopathic Trigger Finger
Journal of Hand Surgery (European Volume), 2008Co-Authors: David Ring, Santiago A Lozanocalderon, Robert Shin, Peter Bastian, Chaitanya S Mudgal, Jesse B JupiterAbstract:Purpose This study was designed to test the null hypothesis that there is no difference in resolution of Triggering 3 months after injection with either a soluble (dexamethasone) or insoluble (triamcinolone) corticosteroid for idiopathic Trigger Finger. Methods Eighty-four patients were enrolled in a prospective randomized controlled trial comparing dexamethasone and triamcinolone injection for idiopathic Trigger Finger. Sixty-seven patients completed the 6-week follow-up (35 triamcinolone arm, 32 dexamethasone arm), and 72 patients completed the 3-month follow-up (41 triamcinolone arm, 31 dexamethasone arm). Outcome measures included the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, Trigger Finger grading according to Quinnell, and satisfaction on a visual analog scale. To preserve autonomy, patients were permitted additional injections and operative treatment at any time. Twenty-five patients requested a second injection (10 triamcinolone arm, 15 dexamethasone arm), and 21 elected operative treatment (10 triamcinolone arm, 11 dexamethasone arm) during the study period. The analysis was according to intention to treat principles. Results Six weeks after injection, absence of Triggering was documented in 22 of 35 patients in the triamcinolone cohort and in 12 of 32 patients in the dexamethasone cohort. The rates 3 months after injection were 27 of 41 in the triamcinolone cohort and 22 of 31 in the dexamethasone cohort. The triamcinolone cohort had significantly better satisfaction and Quinnell grades than did the dexamethasone cohort at the 6-week follow-up but not at the 3-month follow-up. There were no significant differences between Disabilities of the Arm, Shoulder, and Hand scores at the 6-week follow-up and the 3-month follow-up. After the close of the study, there were 8 recurrences among patients with documented absence of Triggering in the triamcinolone cohort and 1 in the dexamethasone cohort. Conclusions Although there were no differences 3 months after injection, our data suggest that triamcinolone may have a more rapid but ultimately less durable effect on idiopathic Trigger Finger than does dexamethasone. Type of study/level of evidence Therapeutic I.
Donald S Bae - One of the best experts on this subject based on the ideXlab platform.
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management of pediatric Trigger thumb and Trigger Finger
Journal of The American Academy of Orthopaedic Surgeons, 2012Co-Authors: Apurva S Shah, Donald S BaeAbstract:Pediatric Trigger thumb and Trigger Finger represent distinct conditions and should not be treated like adult acquired Trigger Finger. Over the last two decades, our understanding of the natural history of pediatric Trigger thumb and the etiology and surgical management of pediatric Trigger Finger has improved. Pediatric Trigger thumb may spontaneously resolve, although resolution may take several years. Open surgical release of the A1 pulley of the thumb is an alternative option that nearly uniformly restores thumb interphalangeal joint motion. Surgical management of pediatric Trigger Finger with isolated release of the A1 pulley has been associated with high recurrence rates. Awareness of the anatomic factors that may contribute to Triggering in the pediatric Finger and willingness to explore and address other involved components of the flexor mechanism can prevent surgical failure.
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surgical treatment of the pediatric Trigger Finger
Journal of Hand Surgery (European Volume), 2007Co-Authors: Donald S Bae, Samir Sodha, Peter M WatersAbstract:Purpose The purpose of this investigation is to assess the efficacy of a standardized surgical technique in the treatment of symptomatic Trigger Fingers in pediatric patients. Methods A retrospective study was performed of 18 consecutive patients with 23 Trigger Fingers treated at our institution between 1996 and 2006. Average age at the time of presentation was 4.5 years (range, 1–12 years). Involved digits included 2 index, 12 long, 3 ring, and 6 small Fingers. All patients had surgical treatment consisting of A1 pulley release and resection of a single slip of the flexor digitorum superficialis (FDS) tendon. Average clinical follow-up evaluation was 43 months (range, 3–111 months). Results In almost half of the cases, Triggering was noted to occur at the level of the FDS tendon decussation. In 9 cases, specific tendon pathology was observed, including fusiform thickening, nodular thickening, calcific tendonitis, and cyst formation. Overall, 21 of 23 (91%) Fingers demonstrated successful resolution of Triggering without recurrence after surgical treatment. One patient had recurrent Triggering, which was successfully treated by a second procedure to resect the remaining FDS slip. Another patient was successfully treated with excision of an aberrant muscle belly from the FDS. Both of these patients remained asymptomatic after their revision procedures. No other complications were observed. All patients returned to full activities, and 17 of 18 (94%) patients were satisfied with the results of surgery at most recent follow-up evaluation. Conclusions The pediatric Trigger Finger may be safely and predictably treated by surgical release of the A1 pulley and resection of a single FDS tendon slip. Type of study/level of evidence Therapeutic IV.
Philip E Blazar - One of the best experts on this subject based on the ideXlab platform.
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needle free jet lidocaine administration for preinjection anesthesia in Trigger Finger injection a randomized controlled trial
Journal of Hand Surgery (European Volume), 2017Co-Authors: Brandon E Earp, Spencer J Stanbury, Ariana N Mora, Philip E BlazarAbstract:Purpose To evaluate the efficacy of needle-free jet lidocaine (J-tip) administration for pain reduction in Trigger Finger corticosteroid injection compared with simultaneous lidocaine injection with corticosteroid. Methods A prospective randomized clinical trial was performed in which patients received either 0.25 mL of 2% lidocaine administered by J-tip just prior to 0.5 mL of corticosteroid injection by needle or 0.5 mL of 1% lidocaine and 0.5 mL of corticosteroid administered simultaneously through a needle for the treatment of Trigger Finger. Both the expected pain preinjection and the actual pain experienced postinjection were measured with a visual analog scale (VAS). Pain catastrophizing scale (PCS) scores were recorded before injection. Results The use of the J-tip demonstrated a lower mean actual pain, 3.3 VAS, compared with the control group, 4.6 VAS. Both study groups anticipated more pain than they actually experienced. The PCS did not correlate to pre- or post-injection scores. Conclusions Needle-free jet administration of lidocaine reduces the pain associated with Trigger Finger injection. Patients anticipate more pain than they experience with Trigger Finger injection. Type of study/level of evidence Therapeutic I.
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cost of immediate surgery versus non operative treatment for Trigger Finger in diabetic patients
Journal of Hand Surgery (European Volume), 2016Co-Authors: Gaurav Luther, Praveen Murthy, Philip E BlazarAbstract:Purpose As health care costs continue to rise, providers must increasingly identify and implement cost-effective practice measures without sacrificing quality of care. Corticosteroid injections are an established treatment for Trigger Finger; however, numerous clinical trials have documented the limited efficacy of these injections in the diabetic population. Furthermore, the most cost-effective treatment strategy for diabetic Trigger Finger has not been determined. The purpose of this study was to perform a decision analysis to identify the least costly strategy for effective treatment of diabetic Trigger Finger using existing evidence in the literature. Methods Four treatment strategies for diabetic Trigger Finger were identified: (1) 1 steroid injection followed by surgical release, (2) 2 steroid injections followed by surgical release, (3) immediate surgical release in the operating room, and (4) immediate surgical release in the clinic. A literature review was conducted to determine success rates of the different treatment strategies. Costing analysis was performed using our institutional reimbursement from Medicare. One-way sensitivity and threshold analysis was utilized to determine the least costly treatment strategy. Results The least costly treatment strategy was immediate surgical release in the clinic. In patients with insulin-dependent diabetes mellitus, this strategy results in a 32% and a 39% cost reduction when compared with treatment with 1 or 2 corticosteroid injections, respectively. For 1 or 2 corticosteroid injections to be the most cost-effective strategy, injection failure rates would need to be less than 36% and 34%, respectively. The overall cost of care for immediate surgical release in the clinic was $642. Conclusions Diabetic Trigger Finger is a common problem faced by hand surgeons, with a variety of acceptable treatment algorithms. Management of diabetic Trigger Finger with immediate surgical release in the clinic is the most cost-effective treatment strategy, assuming a corticosteroid injection failure rate of at least 34%. Type of study/level of evidence Economic/decision III.
Pirko Maguina - One of the best experts on this subject based on the ideXlab platform.
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ultrasound assisted percutaneous Trigger Finger release is it safe
Hand, 2009Co-Authors: Karina Paulius, Pirko MaguinaAbstract:Trigger Fingers can be treated by open or percutaneous division of the A1 pulley. The open approach allows for visualization of the pulley, the tendon, and the adjacent neurovascular bundles. The percutaneous Trigger Finger release (PTFR) lacks an incision and is thought to lead to a quicker recovery, but the safety and efficacy of this blind procedure are often questioned. Ultrasound imaging has recently been introduced as an adjunct for guiding the needle during percutaneous Trigger Finger release. This study was designed to evaluate the safety and efficacy of needle Trigger Finger release with added ultrasound imaging. Eighteen fresh cadaver A1 pulleys were divided percutaneously and then evaluated by converting to an open technique and examining the pulleys, the tendons, and the neurovascular bundles. This study’s ultrasound images demonstrated repeated puncture of the tendon sheath and of the neurovascular bundle during PTFR. The subsequent dissection revealed three out of 18 tendons with visible lacerations and 15 out of 18 A1 pulleys with incomplete division. We concluded that ultrasound-guided PTFR can be complicated by flexor tendon lacerations, potential injury to neurovascular bundles, and incomplete division of the A1 pulleys. While the clinical significance of these findings is unclear to us, it does raise questions regarding the safety and efficacy of percutaneous Trigger Finger release, even when adding ultrasound guidance.
Kuna Lee - One of the best experts on this subject based on the ideXlab platform.
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the thickness of the a2 pulley and the flexor tendon are related to the severity of Trigger Finger results of a prospective study using high resolution ultrasonography
Journal of Hand Surgery (European Volume), 2016Co-Authors: Sungjae Kim, Changhun Lee, Wan Sun Choi, Bitnara Lee, Joohak Kim, Kuna LeeAbstract:We aimed to investigate the relationship between the pulley-tendon complexes and the severity of Trigger Finger. The thickness of the A1 and A2 pulleys, and the cross-sectional area of the flexor tendon under the pulleys, were prospectively assessed using 17 MHz high-resolution ultrasonography, in 20 patients with Trigger Finger (31 Fingers). A control group comprised 15 asymptomatic Fingers. The thickness of the A1 pulley and the proximal part of the A2 pulley, and the cross-sectional area of the flexor tendon under the A2 pulley, were significantly increased in the patient group. Clinical grade was significantly correlated with the thickness of the A1 pulley, the thickness of the proximal part of the A2 pulley, and the cross-sectional area of the flexor tendon under the proximal part of the A2 pulley. This study confirmed that the thickness of the A2 pulley and flexor tendon under the A2 pulley seems to be related to the severity of Trigger Finger. Level of evidences Level III.
