Congenital Trigger digit and thumb is a steno sing tenosynovities of the flexor tendon that is relatively uncommon in children. Presented here, is an unusual case of congenital bilateral Trigger digits that was developed as bilateral Trigger thumb in a 4-year-old boy.

Introduction: Flexor tendon entrapment of the digits (FTED) is a disorder characterized by snapping or locking of the thumb or Fingers (with or without pain) and called Trigger Finger. Corticosteroid injections are one of the most commonly used treatments for chronic tendon disorders. Despite their popularity, the systematic evidence for their benefits are largely lacking. This study tries to determine the efficacy of local corticosteroid injection in treatment of Trigger Finger.Materials and Methods: This is a clinical trial research. Yariables including local tenderness, Triggering stage, pain during isometric flexion and passive stretching of the tendon (based on YAS) were evaluated before local injection of corticosteroid and then 3 weeks, 3 months and 6 months after the injection. Data was collected by special forms and analyzed using Chi square and ANOYA Tests.Results: The difference between presence of Al pulley tenderness in 4 examinations was significant (p<0.0001). The difference between pain induced by isometric flexion and pain induced by stretching the tendon passively in extension was also significant (both p<0.0001). The difference between frequency distribution of Triggering was significant (p<0.001). Patients satisfaction was 90%.Conclusion: The rate of success in local corticosteroid injection was 90% (only with one injection). The high rate of success and low side effects, make this method a suitable treatment for Trigger Finger.

Background and purpose: Evidence suggest high prevalence of Trigger Finger (TF) in diabetic patients. Corticosteroid injection in the area of tendon sheath thickening is the first-line treatment of choice for TF. However، some studies indicated low efficacy of this method in diabetic patients. This study aimed at investigating the effectiveness of oral corticosteroids in diabetic patients with TF. Materials and methods In a clinical trial، 50 diabetic patients with Trigger Finger (n=106 digits) enrolled. The patients were treated with oral prednisolone 5 mg، three times a day for 2 weeks. They were then followed up based on Quinnell grading at 3 and 6 weeks، and 3 months. Data analysis was done in SPSS V17 applying Repeated measures ANOVA. Results At the end of the three-month follow-up، 84 Fingers (79. 3%) of patients who took oral prednisolone improved. The reduction of Quinnell grading was significant after medication (p<0. 001). Positive correlation was observed between symptoms duration and disease severity at third month (r=0. 37، p<0. 0001). In addition، there were positive correlations between the number of Fingers affected and diabetes mellitus duration (r=0. 425، p=0. 002)، HbA1C (r=0. 319، p=0. 024)، and 2HPP (r=0. 29، p=0. 041). Conclusion Current study showed no local side effects of corticosteroids in patients receiving oral prednisolone. Therefore، it could be suggested as an influential treatment for Trigger Finger in diabetic patients، especially those with less than 6 months onset of symptoms، normal blood glucose control، less severity of the symptoms، and higher number of involved Fingers.

BACKGROUND AND OBJECTIVE: Trigger Finger is a condition in the Finger that is locked in flexion or has a heterogeneous movement and is one of the most common causes of pain in the hand; the first line of treatment is the use of corticosteroids. Due to the fact that corticosteroid injection has side effects in diabetic patients, therefore, this study was performed to compare the results of injecting non-steroidal anti-inflammatory drugs (NSAIDs) as an alternative treatment instead of corticosteroid injection in Trigger Finger therapy. METHODS: This double-blind clinical trial study was performed on 84 patients with Trigger Finger referred to Shahid Beheshti Hospital in Babol which were divided in two equal groups of 42 individuals of injections of diclofenac and methylprednisolone. The severity of the disease was compared according to the Quinnell classification (with a score of 0-4) and the rate of improvement in the two groups in the first, third, sixth weeks and third, sixth and twelfth months. FINDINGS: The mean age in the diclofenac injection group was 52± 9 years and in the prednisolone group was 53± 7 years. There was no statistically significant difference between the two groups in terms of age, sex, presence of underlying disease, symptoms and duration of disease. The need for re-injection due to no improvement in symptoms was 34 patients (81%) in the diclofenac group and 20 patients (46%) in the methylprednisolone group (p=0. 001). In the methylprednisolone group, the mean Quinnell rank was 1. 4± 0. 8. The rate of recovery was higher in the methylprednisolone injection group than in the diclofenac group. From the beginning of the study to week 6th and from the beginning of the study to the 12th month, the improvement rate in the methylprednisolone injection group was significantly better than the diclofenac group (p=0. 0001). CONCLUSION: The results of the study showed that both treatments are effective in improving the symptoms of Trigger Finger disease. But corticosteroid injections are associated with better and faster results in long-term and short-term studies.

Although Trigger Finger is common, pediatric Trigger thumb is uncommon. In Trigger thumb the Finger is held in flexed position. The etiology of Trigger Finger is unknown and can occur isolated without any relation to other syndromes, however there are some evidences that suggest genetic etiology. We reported 2. 5 year old twins both having bilateral Trigger thumb. Grandfather of the twins had the disease. Although Trigger thumb and Finger have the same presentation, they can involve different anatomical structures. Bent or straightening of thumb or Finger would produce painful popping and clicking and the affected Finger or thumb can get stuck in bent and extended position. Based on physical examination and symptoms Trigger Finger are classified into four stages and each has its own treatment. There are evidences that support congenital hypothesis in pediatric Trigger thumb such as bilateral presentation in identical twins, first degree familiar association and etc. Before the 1st year of life, 30% of Trigger thumb will get resolved and it is better to postpone the surgery until 2 year of age. A1 pulley release has a good result in pediatric Trigger thumb treatment.

Maintaining intraoperative haemostasis is crucial when conducting wide-awake hand surgeries, this is particularly to improve visibility which will improve patient’s outcome. There are various methods that could achieve the aforementioned, some of which is wide awake local anaesthesia without tourniquet (WALANT) or Tourniquet alongside sedation. Each method has its own benefits and drawbacks. This study primarily focuses on Carpal Tunnel Syndrome and Trigger Finger release. A comprehensive literature review was conducted through PUBMED, Scopus, google scholar, and web of science. A total of 45 articles were included in the study. We aimed to assess whether the literature supports the use of a tourniquet alongside sedation, or only local anesthesia and epinephrine in wide awake hand surgeries. Moreover, we aimed to highlight the benefits and drawbacks of using a tourniquet, and determine the patient population most likely to benefit from tourniquet application.

Background: A Trigger Finger is recognized as the most common hand tendinopathies that reduce functional ability. The present study compares the clinical outcomes of open classic release surgery with ultrasound-guided percutaneous surgery in cases of multiple Finger involvement. Materials and Methods: A cohort study has been performed from March 2019 to December 2020 by participating 34 Trigger Finger patients with multiple involvements. These patients were treated using classical open release and ultrasound-guided percutaneous release methods and both methods were compared in patients. The pain severity and functional ability obtained from the quick disabilities of the arm, shoulder, and hand (Quick-DASH) test scores were compared. Results: The pain intensity in the classical open surgery patients was not significantly different from the ultrasound-guided group, and a one-month follow-up showed that the pain intensity in the ultrasound-guided patients was significantly less than in the other group (P = 0. 02). Besides, no significant difference was observed between the functional abilities before and after the one-month follow-up. Indeed, the two groups had the same situations. Also, the recovery time in the ultrasound-guided percutaneous release group was significantly faster than in the other group. These cases had statistical differences as P = 0. 001 and P < 0. 001, respectively. The surgical release was 100% successful in both groups. The patients' satisfaction rates in the ultrasound-guided and open classic surgery treatment methods were 94. 1 and 76. 4%, respectively. Conclusions: Classical open release and ultrasound-guided percutaneous surgery could successfully treat multiple Trigger Fingers. However, ultrasound-guided percutaneous surgery provided faster recovery and less pain intensity than the other method.

Trigger Finger is a common disease which particularly occurs in middle-aged women. We present a rare case of a male musician with six Trigger Fingers (five in the left hand and one in the right hand). Mostly these Fingers had been used for playing the guitar.The patient had previously been treated with local steroid injections in his Fingers, however no response was seen. Therefore, we performed a surgical procedure. Four weeks after surgery, the patient could play the guitar without discomfort in his hands.

Background: Entrapment of flexor pollicis longus at the level of A1 pulley is the most common cause of snapping or painful thumb upon flexion and extension motion, the so called which is called "Trigger Thumb". The aim of this study is to assess the efficacy of sonographically-guided intra tendon sheath corticosteroid injection in the management of Trigger thumb.Methods: In a prospective study 104 patients (7 males, 97 females, 112 Trigger thumbs) with the mean age of 52.11±7.63 who had Trigger thumb underwent intra flexor sheath corticosteroid injection under the guide of ultrasound in a 2 year period in Rasht-Iran. Improvement was measured using the "Quinnell" grading system before and in intervals after 3 and 6 weeks, 3, 6 and 12 months after injection.Results: From the 112 thumbs, 15 (13.4%) required reinjection and/or surgery. Twelve (80%) of these 15 thumbs were simply re-injected, 2 (13.3%) underwent surgery without re-injection but because of no improvement, underwent surgery. Reduction in Quinnell grade after the first injection was significant (p<.0001). One year after the first injection, 111 of 112 thumbs (99.1%) were symptom-free.Conclusion: Sonographically guided intra flexor sheath corticosteroid injections an effective method in the management of Trigger thumb and would reduce the need for surgical release.