Trigger finger – Poor outcome of surgery associated with younger age, pain, psoriatic arthritis and atopic disease

Björn Holm; Johan  Rönnelid; Eva Baecklund; Monica Wiig

doi:10.48101/ujms.v129.10361

Björn Holm Department of Surgical Sciences, Uppsala University, Uppsala, Sweden https://orcid.org/0000-0002-1933-9405
Johan Rönnelid Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden https://orcid.org/0000-0003-1186-3226
Eva Baecklund Department of Medical Sciences, Uppsala University, Uppsala, Sweden https://orcid.org/0000-0001-5033-0188
Monica Wiig Department of Surgical Sciences, Uppsala University, Uppsala, Sweden https://orcid.org/0000-0002-1933-9405

DOI: https://doi.org/10.48101/ujms.v129.10361

Keywords: Trigger finger, outcome, atopy, diabetes, rheumatic disease

Abstract

Background: Trigger finger, or stenosing tendovaginitis, is one of the most common causes of hand disability, where a finger or thumb painfully snaps and locks due to a tendon-sheath size mismatch at the A1 pulley. The exact aetiology of trigger finger is unknown, though it is associated with factors like diabetes, rheumatic disease and carpal tunnel syndrome. The main purpose of this prospective study was to explore clinical characteristics and comorbidities in a cohort of 139 patients who underwent surgery for trigger finger and find factors of importance for the outcome 1 year postoperatively.

Methods: Pain, range of motion, hand function evaluated by the Disabilities of the Arm Shoulder and Hand questionnaire as well as Quinnell grade of triggering were examined preoperatively. Symptom duration, working status, medical history and comorbidities at baseline were also noted. Further, range of motion was evaluated 3 months after surgery, pain and hand function were evaluated 3 and 12 months after surgery. An outcome scale with three levels was defined. The development of any new comorbidities was monitored during an extended postoperative observation period, with a mean duration of 70 months (range: 56–88 months).

Results: Poor outcome was strongly associated with younger age (P = 0.0009), a high level of preoperative pain in the operated hand (P = 0.0027), psoriatic arthritis (P = 0.021) and atopic disease (P = 0.028; odds ratio [OR]: 3.87, 95% confidence interval [CI]: 1.15–13.04). A low range of motion preoperatively did not affect the outcome. Carpal tunnel syndrome was the most common comorbidity but did not affect the outcome. A good preoperative range of motion, good hand function and less pain were associated with better outcomes.

Conclusion: Younger age, a high level of preoperative pain, psoriatic arthritis and atopic disease were factors associated with a worse outcome of trigger finger surgery. Pain and disability decreased 3 months postoperatively and continued to decrease between 3 and 12 months.

Downloads

Download data is not yet available.

References

1. Moore JS. Flexor tendon entrapment of the digits (trigger finger and trigger thumb). J Occup Environ Med. 2000;42:526–45. doi: 10.1097/00043764-200005000-00012

2. Makkouk AH, Oetgen ME, Swigart CR, Dodds SD. Trigger finger: etiology, evaluation, and treatment. Curr Rev Musculoskelet Med. 2008;1:92–6. doi: 10.1007/s12178-007-9012-1

3. Chammas M, Bousquet P, Renard E, Poirier JL, Jaffiol C, Allieu Y. Dupuytren’s disease, carpal tunnel syndrome, trigger finger, and diabetes mellitus. J Hand Surg Am. 1995;20:109–14. doi: 10.1016/S0363-5023(05)80068-1

4. Lim MH, Lim KK, Rasheed MZ, Narayanan S, Beng-Hoi Tan A. Outcome of open trigger digit release. J Hand Surg Eur Vol. 2007;32:457–9. doi: 10.1016/J.JHSB.2007.02.016

5. Thorpe AP. Results of surgery for trigger finger. J Hand Surg Br. 1988;13:199–201. doi: 10.1016/0266-7681_88_90138-6

6. Lange-Riess D, Schuh R, Honle W, Schuh A. Long-term results of surgical release of trigger finger and trigger thumb in adults. Arch Orthop Trauma Surg. 2009;129:1617–9. doi: 10.1007/s00402-008-0802-8

7. Cakmak F, Wolf MB, Bruckner T, Hahn P, Unglaub F. Follow-up investigation of open trigger digit release. Arch Orthop Trauma Surg. 2012;132:685–91. doi: 10.1007/s00402-011-1440-0

8. Stirling PHC, Jenkins PJ, Duckworth AD, Clement ND, McEachan JE. Functional outcomes of trigger finger release in non-diabetic and diabetic patients. J Hand Surg Eur Vol. 2020;45:1078–82. doi: 10.1177/1753193420925027

9. Quinnell RC. Conservative management of trigger finger. Practitioner. 1980;224:187–90.

10. Atroshi I, Gummesson C, Andersson B, Dahlgren E, Johansson A. The disabilities of the arm, shoulder and hand (DASH) outcome questionnaire: reliability and validity of the Swedish version evaluated in 176 patients. Acta Orthop Scand. 2000;71:613–8. doi: 10.1080/000164700317362262

11. van den Berg C, van der Zwaard B, Halperin J, van der Heijden B. Factors associated with conversion to surgical release after a steroid injection in patients with a trigger finger. Bone Joint J. 2022;104-B:1142–7. doi: 10.1302/0301-620X.104B10.BJJ-2022-0058.R3

12. Koopman JE, Hundepool CA, Wouters RM, Duraku LS, Smit JM, Selles RW, et al. Factors associated with self-reported pain and hand function following surgical A1 pulley release. J Hand Surg Eur Vol. 2022;47:734–41. doi: 10.1177/17531934221085401

13. Young Kim J, Jin Choi G, Mo Kang D. Clinical significance of proximal interphalangeal joint pain in patients with trigger fingers. J Hand Surg Eur Vol. 2019;44:379–84. doi: 10.1177/1753193418809771

14. Furlan A, Stramare R. The thickening of flexor tendons pulleys: a useful ultrasonographical sign in the diagnosis of psoriatic arthritis. J Ultrasound. 2018;21:309–14. doi: 10.1007/s40477-018-0325-2

15. Tinazzi I, McGonagle D, Aydin SZ, Chessa D, Marchetta A, Macchioni P. ‘Deep Koebner’ phenomenon of the flexor tendon-associated accessory pulleys as a novel factor in tenosynovitis and dactylitis in psoriatic arthritis. Ann Rheum Dis. 2018;77:922–5. doi: 10.1136/annrheumdis-2017-212681

16. Namaldi S, Kuru CA, Kuru I. Prediction of disability in trigger finger: a cross-sectional and longitudinal study. J Hand Surg Eur Vol. 2023;48:131–6. doi: 10.1177/17531934221131883

17. Han X, Krempski JW, Nadeau K. Advances and novel developments in mechanisms of allergic inflammation. Allergy. 2020;75:3100–11. doi: 10.1111/all.14632

18. Lehner C, Spitzer G, Langthaler P, Jakubecova D, Klein B, Weissenbacher N, et al. Allergy-induced systemic inflammation impairs tendon quality. EBioMedicine. 2022;75:103778. doi: 10.1016/j.ebiom.2021.103778

19. Ho SWL, Chia CY, Rajaratnam V. Characteristics and clinical outcomes of open surgery for trigger digits in diabetes. J Hand Microsurg. 2019;11:80–3. doi: 10.1055/s-0038-1670927

20. Baek JH, Chung DW, Lee JH. Factors causing prolonged postoperative symptoms despite absence of complications after A1 pulley release for trigger finger. J Hand Surg Am. 2019;44:338.e1–e6. doi: 10.1016/j.jhsa.2018.06.023

21. Koopman JE, Zweedijk BE, Hundepool CA, Duraku LS, Smit J, Wouters RM, et al. Prevalence and risk factors for postoperative complications following open A1 pulley release for a trigger finger or thumb. J Hand Surg Am. 2022;47:823–33. doi: 10.1016/j.jhsa.2022.04.017

22. Langer D, Maeir A, Michailevich M, Luria S. Evaluating hand function in clients with trigger finger. Occup Ther Int. 2017;2017:9539206. doi: 10.1155/2017/9539206

23. Langer D, Luria S, Bar-Haim Erez A, Michailevich M, Rogev N, Maeir A. Stenosing flexor tenosynovitis: validity of standard assessment tools of daily functioning and quality of life. J Hand Ther. 2015;28:384–7. doi: 10.1016/j.jht.2015.04.005