Sonographic Appearance of Trigger Fingers

Guérini, H.; Pessis, É.; Theumann, Nicolas; Quintrec, Janine-Sophie Le; Campagna, R.; Chevrot, A.; Feydy, A.; Drapé, Jean‐Luc

doi:10.7863/jum.2008.27.10.1407

Cited by 106 publications

(101 citation statements)

References 10 publications

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“…The A1 pulley is the most important in this condition because not only is it a stabilizer of the flexor tendons during finger flexion, but it also plays a role in the pathogenesis of the trigger finger. 11,12 Tenosynovitis, tendinitis, and cysts of the flexor tendon sheath (ie, ganglia) have been described on sonography in patients with triggering symptoms, but some investigators also observed fibrocartilaginous metaplasia within the inner layer of the A1 pulley. 12 The pulley system has also been evaluated with magnetic resonance imaging and computed tomography, 14 but we choose high-resolution sonography for its higher spatial resolution, the possibility to take reliable quantitative measurements, 12 and better patient acceptance.…”

Section: Discussionmentioning

confidence: 99%

“…This technique has been used previously. 11 On sonography, the hallmarks of a trigger finger as reported by Guerini et al 12 were investigated: thickening of the A1 pulley measured in millimeters in the center of the pulley on axial scans and distal flexor tendinosis (defined as segmental swelling of the flexor tendons) and tenosynovitis (hypoechoic or anechoic thickened tissue with or without fluid within the tendon sheath, which is seen in 2 perpendicular planes and may show a Doppler signal).…”

Section: Clinical Examination and Sonographic Studiesmentioning

confidence: 99%

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Sonographic Depiction of Trigger Fingers in Acromegaly

Tagliafico

Resmini²,

Holsbeeck

et al. 2009

Journal of Ultrasound in Medicine

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Objective. The purpose of this study was to compare the prevalence of trigger fingers in patients with acromegaly versus an unaffected control group. Methods. This study was performed with Institutional Review Board approval, and informed written consent was obtained from each patient and control participant. The diagnosis was made by a combination of clinical symptoms and sonographically measured thickening of the first annular (A1) pulley. The A1 pulley thickness was measured in 40 patients and 40 control participants by means of a 17-5 MHz high-resolution transducer. Thickening of the A1 pulley and abnormalities of the underlying flexor tendons associated with the clinical sign were diagnostic for a trigger finger. The acromegalic patients were divided into groups according to disease activity and therapy. The study was performed at the baseline and at a follow-up after 1 year. Results. At the baseline, clinical and sonographic findings were consistent with trigger fingers in 25% of patients (6 at presentation and 4 with uncontrolled disease). After 1 year, the trigger fingers recovered in the patients who were not receiving any treatment at the beginning of the study. In patients with uncontrolled disease, the condition remained unchanged. The A1 pulley thickness was greater in the acromegalic patients than control participants (mean ± SD, 0.44 ± 0.19 versus 0.24 ± 0.05 mm; P < .05). In the patients treated for acromegaly, the trigger fingers disappeared, and a reduction in the A1 pulley thickness was noted (P < .05) at the follow-up. Conclusions. Trigger fingers were observed in 25% of the acromegalic patients but in none of the control participants. The A1 pulley was significantly thicker in the acromegalic patients and normalized after 1 year in some who were treated for the disease.

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Section: Discussionmentioning

confidence: 99%

Section: Clinical Examination and Sonographic Studiesmentioning

confidence: 99%

Sonographic Depiction of Trigger Fingers in Acromegaly

Tagliafico

Resmini²,

Holsbeeck

et al. 2009

Journal of Ultrasound in Medicine

View full text Add to dashboard Cite

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“…However, increasingly, high-resolution US imaging is being used to complement the clinical assessment in the diagnosis and management of trigger fingers. It allows the direct visualization of the A1 pulley-flexor tendon complex in cases of flexor tendon involvement [6,[9][10][11]. US can show combination of findings including thickening, hypoechogenecity and hyper-vascularization of A1 pulley that overlies the metacarpal heads, alteration in echotexture of the flexor tendons that pass through the digital tunnel and synovial sheath effusion around the tendons [6,[9][10][11].…”

Section: Discussionmentioning

confidence: 99%

“…Only few case reports describe the impingement of an extensor tendon within the extensor retinaculum (ER) resulting in trigger [3][4][5]. There are a few reports on sonographic evaluation of trigger fingers describing only about the flexor tendon involvement [6]. We have not come across any report in the literature on real-time ultrasound (US) imaging in the diagnosis of extensor tendon triggering.…”

Section: Introductionmentioning

confidence: 99%

Sonographic findings of extensor digiti minimi triggering caused by thickened extensor retinaculum

2014

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Trigger finger is a common well recognized condition and involves the flexor tendons at the A1 pulley in the palm. Triggering of the extensor tendons is a very rare clinical entity. We report a rare case of extensor triggering of little finger caused by constriction of the extensor digiti minimi by a markedly thickened extensor retinaculum (ER) at the wrist, well delineated dynamically by real-time high-resolution ultrasound. The patient underwent release of thickened ER and was asymptomatic immediately.Keywords Extensor Á Tendon Á Trigger Á Retinaculum Á Ultrasound Sommario Il dito a scatto è una condizione frequente, ben riconosciuta, che coinvolge i tendini flessori a livello della puleggia A1. A livello dei tendini estensori è un'entith clinica molto rara. Riportiamo un raro caso di dito a scatto dell'estensore del mignolo causato da un marcato ispessimento del retinacolo degli estensori (ER) a livello del polso, ben evidenziato con ecografia dinamicamente ad alta risoluzione. Il paziente è stato sottoposto a intervento con resezione dell'ER ispessito con conseguente, completa, risoluzione della patologia.

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“…For example, although occupational therapy practitioners often equate trigger finger with swelling of the involved flexor tendon, sonographic data have indicated that fewer than half of people with trigger finger have tendonopathy (Guerini et al, 2008). Instead, regardless of the presence of tendonopathy, nearly all people with trigger finger have a thickened pulley, limiting tendon gliding (Guerini et al, 2008;Sato, Ishii, Noguchi, & Takeda, 2012).…”

Section: Clinical Reasoningmentioning

confidence: 99%

Role of Sonographic Imaging in Occupational Therapy Practice

Roll

2015

The American Journal of Occupational Therapy

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Occupational therapy practice is grounded in the delivery of occupation-centered, patient-driven treatments that engage clients in the process of doing to improve health. As emerging technologies, such as medical imaging, find their way into rehabilitation practice, it is imperative that occupational therapy practitioners assess whether and how these tools can be incorporated into treatment regimens that are dually responsive to the medical model of health care and to the profession’s foundation in occupation. Most medical imaging modalities have a discrete place in occupation-based intervention as outcome measures or for patient education; however, sonographic imaging has the potential to blend multiple occupational therapy practice forms to document treatment outcomes, inform clinical reasoning, and facilitate improved functional performance when used as an accessory tool in direct intervention. Use of medical imaging is discussed as it relates to occupational foundations and the professional role within the context of providing efficient, effective patient-centered rehabilitative care.

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Sonographic Appearance of Trigger Fingers

Abstract: Thickening and hyper-vascularization of the A1 pulley are the hallmarks of trigger fingers on sonography. Other frequently observed features include distal flexor tendinosis and tenosynovitis.

Cited by 106 publications

References 10 publications

Sonographic Depiction of Trigger Fingers in Acromegaly

Sonographic Depiction of Trigger Fingers in Acromegaly

Sonographic findings of extensor digiti minimi triggering caused by thickened extensor retinaculum

Role of Sonographic Imaging in Occupational Therapy Practice

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