Diagnosis and Treatment of Trigger Finger in Brazil - A Cross-Sectional Study / Diagnóstico e tratamento do dedo de gatilho no Brasil - Estudo transversal

Abstract Objective The present paper aims to evaluate the therapeutic planning for trigger finger by Brazilian orthopedists. Methods This is a cross-sectional study with a population composed of participants from the 2018 Brazilian Congress on Orthopedics and Traumatology (CBOT-2018, in the Portuguese acronym), who answered a questionnaire about the conduct adopted for trigger finger diagnosis and treatment. Results A total of 243 participants were analyzed, with an average age of 37.46 years old; most participants were male (88%), with at least 1 year of experience (55.6%) and from Southeast Brazil (68.3%). Questionnaire analysis revealed a consensus on the following issues: diagnosis based on physical examination alone (73.3%), use of the Quinnell classification modified by Green (58.4%), initial nonsurgical treatment (91.4%), infiltration of steroids combined with an anesthetic agent (61.7%), nonsurgical treatment time ranging from 1 to 3 months (52.3%), surgical treatment using the open approach (84.4%), mainly the transverse open approach (51%), triggering recurrence as the main nonsurgical complication (58%), and open surgery success in > 90% of the cases (63%), with healing intercurrences (54%) as the main complication. There was no consensus on the remaining variables. Orthopedists with different practicing times disagree on treatment duration (p = 0.013) and on the complication rate of open surgery (p = 0.010). Conclusions Brazilian orthopedists prefer to diagnose trigger finger with physical examination alone, to classify it according to the Quinnell method modified by Green, to institute an initial nonsurgical treatment, to perform infiltrations with steroids and local anesthetic agents, to sustain the nonsurgical treatment for 1 to 3 months, and to perform the surgical treatment using a transverse open approach; in addition, they state that the main nonsurgical complication was triggering recurrence, and report open surgery success in > 90% of the cases, with healing intercurrences as the main complication.

Resumo Objetivo Avaliar o planejamento terapêutico para o dedo em gatilho por ortopedistas brasileiros. Métodos Estudo transversal, cuja população foi composta por participantes do Congresso Brasileiro de Ortopedia e Traumatologia 2018 (CBOT-2018). Foi aplicado um questionário sobre a conduta adotada no diagnóstico e tratamento do dedo em gatilho. Resultados Foram analisados 243 participantes com média de idade de 37.46 anos, na maioria homens (88%), tempo de experiência de pelo menos 1 ano (55,6%), e da região Sudeste (68.3%). A análise dos questionários evidenciou que há consenso nos seguintes quesitos: diagnóstico somente com exame físico (73,3%), classificação de Quinnell modificada por Green (58,4%), tratamento inicial não cirúrgico (91,4%), infiltração de corticoide com anestésico (61,7%) tempo de tratamento não cirúrgico de 1 a 3 meses (52,3%), tratamento cirúrgico pela via aberta (84,4%), principalmente via aberta transversa (51%), recidiva do engatilhamento como principal complicação não cirúrgica (58%), e o sucesso da cirurgia aberta em > 90% (63%), sendo a sua principal complicação as complicações cicatriciais (54%). Sem consenso nas demais variáveis. De acordo com a experiência, foram observadas diferenças referentes ao tempo de tratamento (p = 0.013) e a taxa de complicação da cirurgia aberta (p = 0.010). Conclusões O ortopedista brasileiro tem preferência pelo diagnóstico do dedo em gatilho apenas com exame físico, classifica segundo Quinnell modificado por Green, tratamento inicial não cirúrgico, infiltrações com corticoide e anestésico local, tempo de tratamento não cirúrgico de 1 a 3 meses, tratamento cirúrgico por via aberta transversa, principal complicação não cirúrgica a recidiva do engatilhamento, e considera o sucesso da cirurgia aberta em > 90% dos casos, tendo como principal complicação as complicações cicatriciais.

Randomized Controlled Trial on Combined Percutaneous Release and Steroid Injection Versus Percutaneous Release Alone for Trigger Finger in Adults

@#INTRODUCTION: Trigger finger is one of the most common causes of hand pain and disability. Surgical treatment consists of release of the A-1 pulley by open or percutaneous techniques. Many authors have noted that percutaneous release is convenient and cost-effective with a low complication rate. Only few studies have published results on combination of percutaneous release and steroid injection. OBJECTIVE: To compare the differences of outcomes in adults with trigger finger treated with combination of percutaneous release and corticosteroid injection to those treated with percutaneous release alone METHODS: We included all patients older than 18 years old in the UP-PGH Department of Orthopedics with a diagnosis of trigger finger who have consented to participate in this study. They were randomized into two treatment groups. One group was treated with percutaneous release only and the other group was treated with combined percutaneous release and corticosteroid injection. Outcomes measured were total active motion (TAM), postoperative pain, time to return-to-work, patient satisfaction, and complications. RESULTS: Post-procedure, both groups showed significant improvement in motion of the fingers (p = 0.034) and pain relief (p = 0.001). TAM scores of the combination group were better compared to the control at all time intervals (p = 0.03, 0.008, 0.004, 0.019) and better pain VAS scores in the 1st week (p = 0.009). Patients who received the combination treatment showed a trend toward better patient satisfaction, shorter duration of post-release pain and earlier return-to-work. CONCLUSION: significantly improves TAM and pain VAS scores.

Progress on treatment for stenosing tenosynovitis / 中国骨伤

Radial styloid stenosing tenosynovitis is a kind of common chronic motor system injuries, and could lead to joint pain and aggravates with activity, in further makes a great impact on people's daily life. At present, therapeutic methods for this disease could divid into conservative treatment and surgical treatment. What we pay attention to is cure. Conservative treatment could effectively relieve pain and improve wrist motion in acute phase, however, it make little difference on long--term effect and usually cause to reappear. Surgical treatment, as a kind of invasive therapies, is chosen only when facing recalcitrant radial styloid stenosing tenosynovitis with many complications for its high cure rate. The author thought that patient education should play an important role in the therapy of radial styloid stenosing tenosynovitis, comprehensive treatment could be applied according to the different conditions of disease development, and could increase cure disease.

Research progress of stenosing tenosynovitis of radial styloid process based on anatomical structure / 中国骨伤

Stenosing tenosynovitis of styloid process of radius(de Quervain's disease) which abductor pollicis longus and extensor pollicis brevis in the first extensor chamber are affected by resistance when sliding, the incidence is affected by anatomical variations. Symptoms, signs and auxiliary examinations can diagnose the disease. Slight dQS can be improved by rest, brace, restriction activities, and oral medications. Chinese medicine and physiotherapy also reduce the disease. Needle knife therapy is a Traditional Chinese medicine minimally invasive surgery, which is also a step-by-step treatment between conservative treatment and open surgery to loosening the compression of the first extensor chamber. Steroid injection is a more common treatment in this disease, and its efficacy is related to the accuracy of the injection and is affected by the severity of the patient's anatomical variation. Identifying the spacing within the first extensor chamber under ultrasound can help patients better choose conservative or surgical treatment. Surgical treatment can more completely change the condition of dQD from anatomical structure, and clinical should pay attention to the choice of surgical procedure to improve the efficacy and reduce the occurrence of surgical complications. This article discusses the pathogenesis, diagnosis and treatment of the disease from the perspective of anatomical structure. It mainly analyzes the therapeutic targets and the clinical application, which aims to provide reference for the diagnosis and treatment of de Quervain disease.

La vaginotomía percutánea en la tendovaginitis estenosante de los dedos largos de las manos / La ténotomie percutanée dans le traitement de la ténosynovite sténosante des doigts longs de la main / Percutaneous vaginotomy in stenosing tendovaginitis of hand long fingers

Introducción: La tendovaginitis estenosante de los dedos de la mano o dedo en resorte es una patología relativamente frecuente que puede afectar a personas durante su vida laboral. Existen diversos métodos para solucionar esta afección. Objetivo: Evaluar el empleo durante ocho años de la vaginotomía percutánea en la tendovaginitis estenosante de los dedos largos de las manos. Métodos: Se realizó un estudio de intervención longitudinal prospectivo con adultos mayores de 65 años de edad. La muestra estuvo constituida por 468 pacientes diagnosticados con tendovaginitis estenosante (dedo en resorte). Fueron intervenidos quirúrgicamente 532 dedos con la vagotomía percutánea entre el 1 de enero de 2008 y el 31 de octubre de 2015, en el Centro de Investigaciones en Longevidad, Envejecimiento y Salud. Se evaluaron los pacientes seis meses después del tratamiento. Las variables empleadas fueron: edad, sexo, tiempo de padecimiento, dedo afectado, tiempo quirúrgico, complicaciones perioperatorias, duración del dolor. Se utilizó la clasificación de Newport según el cuadro clínico y el método de Strickland para evaluar los resultados. Resultado: Hubo un predomino del sexo femenino en la sexta década de vida. Las mayores incidencias estuvieron en la mano dominante. Se obtuvo un 98,3 por ciento de resultados satisfactorios. Los tiempos promedios de las variables descritas fueron significativamente cortos. No se mostraron complicaciones serias. Los dedos más afectados fueron el cuarto y el tercero. Hubo predominio de los estadios II y III. Conclusión: La vaginotomía percutánea solucionó satisfactoriamente la morbilidad que produce el dedo en resorte(AU)

Introduction: Stenosing tendovaginitis of hand fingers or spring finger is a relatively frequent pathology that can affect people during their working life. There are several methods to solve this condition. Objective: To evaluate the used of percutaneous vaginotomy in stenosing tendovaginitis of the long fingers for eight years. Methods: A prospective longitudinal intervention was conducted with adults over 65 years of age. 468 patients formed the sample. They were diagnosed with stenosing tendovaginitis (spring finger). Surgery was performed on 532 fingers with percutaneous vagotomy from January 1, 2008 to October 31, 2015, at the Research Center on Longevity, Aging and Health. Patients were assessed six months after treatment. The variables used were age, sex, time of suffering, affected finger, surgical time, perioperative complications, and duration of pain. Newport classification was used according to the symptoms and Strickland method to assess the results. Result: There was predominance of the female sex in their sixth decade of life. The highest incidences were in the dominant hand. Satisfactory results were 98.3 percent. The average times of the variables described were significantly short. No serious complications were shown. The most affected fingers were the fourth and the third. There was predominance of stages II and III. Conclusion: Percutaneous vaginotomy satisfactorily resolved the morbidity produced by the spring finger(AU)

Introduction: La ténosynovite sténosante des doigts de la main, ou doigt à ressort, est une pathologie assez fréquente pouvant affecter les personnes tout au long de leur vie. Il y a plusieurs méthodes pour corriger cette affection. Objectif: Évaluer l'utilisation pendant huit ans de la ténotomie percutanée pour corriger la ténosynovite sténosante des doigts longs de la main. Méthodes: Une étude interventionnelle, longitudinale et prospective des personnes âgées de plus de 65 ans a été effectuée. L'échantillon a été composée de 468 patients diagnostiqués de ténosynovite sténosante (doigt à ressort). Un nombre significatif d'interventions chirurgicales (532 doigts) ont été effectuées entre le 1 janvier 2008 et le 31 octobre 2015 au Centre de recherches sur la longévité, le vieillissement et la santé. Les patients ont été évalués six mois après le traitement. On a utilisé des variables telles que l'âge, le sexe, la durée de l'affection, le doigt affecté, le temps chirurgical, les complications péri-opératoires, et la durée de la douleur. Afin d'évaluer les résultats, on a appliqué la classification de Newport, selon le tableau clinique et la méthode de Strickland. Résultats: On a trouvé que les femmes dans les soixante ans étaient les plus souvent touchées par cette affection, étant la main dominante la plus affectée. Il y a eu de très bons résultats (98.3 pourcent). Les temps moyens des variables décrites ont été notamment courts. Il n'y a pas eu de complications graves. Le troisième et le quatrième doigt ont été les plus fréquemment touchés. Dans la classification, le stade II et III ont été en prédominance. Conclusions: La ténotomie percutanée a réussi à corriger de manière satisfaisante la morbidité provoquée par le doigt à ressort(AU)

Tendon Problems of the Ulnar Wrist / 대한정형외과학회잡지

It is challenging for orthopedic surgeons to diagnose pain at the ulnar aspect of the wrist due to the small and complex anatomical structures involved. Ulnar-sided wrist pain can also result from tendon problems, including extensor carpi ulnaris tendon and flexor carpi ulnaris tendon. Disorders of the extensor carpi ulnaris tendon include subluxation, dislocation, stenosing tenosynovitis, and tendinopathy. Unlike the extensor carpi ulnaris tendon which is prone to subluxation, dislocation and stenosing tenosynovitis from passing through as sheath, a flexor carpi ulnaris tendon is unsheathed, and calcific tendinitis and crystal deposition disease can occur at the distal tendinous portion of the flexor carpi ulnaris tendon.

Operative Treatment of Stenosing Tenosynovitis of the Peroneus Longus Tendon Associated with Hypertrophy of the Peroneal Tubercle: A Case Report - 1 Case / 대한족부족관절학회지

An enlarged peroneal tubercle causes lateral ankle and foot pain, and which is a cause for stenosing peroneal tenosynovitis. In this report, we present a case of stenosing tenosynovitis of the peroneus longus tendon associated with hypertrophy of the peroneal tubercle without involvement of the peroneus brevis tendon. Surgical excision of the enlarged peroneal tubercle along with exploration of the peroneal tendons was successful.

Research on minimally invasive release treatment of stenosing tenosynovitis of flexor digitorum / 中国骨伤

The minimally invasive release treatment of TCM Small Needle-Knife for the stenosing tenosynovitis of flexor digtorum-"trigger finger" has a more satisfied efficacy. In recent years, many clinicians use self-made small sharp scalpels, iris knives, small sickles, push shear knives, and other improved alternatives to instead of the traditional small needle-knives. Changing the original small needle-knife vertical stabbed cutting method, take a mini-incision, along the traveling direction of flexor tendon make a vertical hook cut, pick cut, straight push cut and any other cuts, completely cut the stenosis of the tendon sheath pulley, to achieve the release therapeutic purposes. The experience of most scholars is: Detailed and thorough understanding refers to the anatomical level of the flexor tendon and surrounding tissue, the structural relationship; Strictly adhere to the indications of minimally invasive release therapy; Proficiency in a dedicated minimally invasive release needle-knives, scalpels, and standardized methods of operation; Accurate positioning before surgery, in surgery traveling direction along flexor tendon, continuous incision to release the middle along the tendon. It can achieve the same or even higher incision release efficacy than the traditional treatment, at the same time also avoids common adverse complications.

Comparative observation on curative effects of stenosing tenovaginitis of flexor digitorum treated with acupuncture knife therapy and blocking therapy / 中国针灸

<p><b>OBJECTIVE</b>To compare the curative effects on stenosing tenovaginitis of flexor digitorum treated with acupuncture knife therapy and blocking therapy so as to explore the better method.</p><p><b>METHODS</b>Three hundred and four cases were randomly divided into acupuncture knife therapy group (164 cases) and blocking therapy group (140 cases). In acupuncture knife therapy group, hooking and cutting were applied on the pressure points and scleromas with Ren's hooked acupuncture knife; routine blocking therapy was applied in blocking therapy group. The curative effects of both groups after 1-2 treatments and the recurrence after treatment in following 6 months were observed.</p><p><b>RESULTS</b>The curative rate was 98.2% (161/164)in acupuncture knife therapy group, superior to that of 65.7% (92/140) in blocking therapy group; the recurrence rate was 1.9% (3/161) in acupuncture knife therapy group, inferior to that of 37.0% (34/92) in blocking therapy group. The differences are significant between groups (both P < 0.01).</p><p><b>CONCLUSION</b>The curative effect of stenosing tenovaginitis of flexor digitorum treated with acupuncture knife therapy is superior to that of blocking therapy, with low recurrence rate.</p>

Tenossinovites De Quervain: uma nova proposta no tratamento cirúrgico / De Quervain’s tenosynovitis: a new proposal of surgical treatment

Introdução: A tenossinovite estenosante De Quervain caracteriza-se por ser a inflamação da bainha do abdutor longo e extensor curto do polegar, no primeiro compartimento dorsal do punho, acometendo mais frequentemente as mulheres na faixa etária entre 30 e 50 anos. Essa doença está associada principalmente a trauma crônico secundário e sobrecarga das atividades diárias das mãos e punho, podendo também ser causada por outros fatores, mas em muitos casos não há uma causa bem definida. Objetivo: O objetivo deste trabalho é apresentar nossa casuística de tenossinovite de De Quervain no Ambulatório de Cirurgia da Mão, os diferentes tratamentos e uma nova proposta cirúrgica utilizando um retalho fáscio-gorduroso de vizinhança. Resultados: Com a técnica proposta foram obtidos resultados satisfatórios, diminuindo as recidivas, com boa recuperação funcional e rápido retorno dos pacientes às atividades cotidianas.

Introduction: De Quervain’s stenosing tenosynovitis it is characterized by being the inflammation of the hem of the long and extending abductor short of the thumb, in the 1st number compartment of the fist, more frequently attacking the women in the age group between 30 and 50 years. That pathology is associated mainly to secondary chronic trauma and overload of the daily activities of the hands and fist, could also be caused by other factors, but in many cases no there is a very defined cause. Results: All the patients had a faster and satisfactory evolution with an amazing come back to their quotidian activities.

Diagnóstico precoce e o tratamento cirúrgico do polegar em gatilho congênito na criança utilizando o sistema de internação hospital-dia / Early diagnosis and surgical treatment of congenital trigger thumb in children using the day hospital admission system

Introdução: o polegar em gatilho congênito ou tenossinovite estenosante do polegar é a dificuldade de extensão do polegar, identificada nos primeiros meses de vida. Objetivo: a proposta deste estudo foi discutir o tratamento cirúrgico com os resultados, as complicações e as vantagens na utilização da internação hospital-dia. Método: no período de fevereiro de 2001 até janeiro de 2008, verificaram-se 25 crianças entre 3 meses e 6 anos, portadoras de polegar em gatilho congênito. Foram operadas 35 mãos, e 10 casos eram bilaterais. Observamos que a manifestação clínica quanto à dificuldade de extensão do polegar estava presente em todas as mãos operadas e nenhuma criança queixava-se de dor. As crianças foram submetidas à mesma técnica cirúrgica, anestesia geral inalatória, com incisão transversa na prega volar metacarpofalangeana do polegar acometido e abertura longitudinal da polia flexora A1. Não foi utilizado antibiótico e as crianças foram internadas pelo sistema hospital-dia. Resultados: Quinze crianças eram do sexo masculino e dez do sexo feminino. Dos pacientes com lesão bilateral, sete eram do sexo masculino e três do feminino. Quanto ao lado acometido, obtivemos sete polegares direitos, oito esquerdos e dez bilaterais. Como complicações, não houve nenhuma recidiva; um polegar evoluiu com infecção cutânea superficial e dois polegares apresentaram deiscência parcial da sutura após a retirada dos pontos. Conclusões: o polegar em gatilho congênito ou tenossinovite estenosante do polegar na criança pode ser tratado com segurança através da abertura simples da polia flexora A1, utilizando-se a internação hospital-dia.

The congenital trigger disorder or stenosing tenosynovitis of the thumb is the difficulty of extending the thumb, identified in early months of life. Objective: The purpose this study was to discuss the operative results, complications and advantages of the day hospital system. Method: This study was carried out from February 2001 to January 2008, with 25 children aging from 3 months to 6 years old with congenital trigger finger thumb. Thirty-five hands were submitted to surgery, and ten children had both hands attacked. The limited extension of the thumb was the clinical characteristic observed in all operated hands and no child had pain complaint. All children were submitted to the same surgical technique, by the use of inhalational general anesthetics, with transversal incision in the metacarpophalangeal volar pleat of the thumb and longitudinal resection of the flexor pulley A1. Antibiotic therapy was not used and all children were admitted by the day hospital system. Results: fifteen were boys and ten were girls. Seven boys and three girls had the pathology in both hands. Comparing the incidence of each side, we have found seven right congenital trigger thumbs, eight left and ten occurring in both sides. The complications found were: one thumb had superficial cutaneous infection and two thumbs presented dehiscence of the incision after the removal of the suture. There were no cases of recurrence of the disease after surgery. Conclusion: we concluded that congenital trigger disorder or stenosing tenosynovitis in children can be safely treated with simple incision of flexor pulley A1 and with day hospital system.

Case control study of hook needle knife for the treatment of stenosing tenovaginitis of flexor digitorum / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the effect and safety of the hook needle knife for the treatment of stenosing tenovaginitis of flexor digitorum.</p><p><b>METHODS</b>From September 2007 to September 2008, 60 outpatients with stenosing tenovaginitis of flexor digitorum were randomized divided into the treatment group and the control group, 30 cases in each group. Among the patients, 44 patients were female and 16 patients were male, aged from 34 to 69 years, averaged 56 years, the duration of disease ranged from 1 month to 1 year, averaged 3 months. All the patients were treated with hook needle knife and local-blocking respectively. The patients were followed up for 6 months, and the relief of moving-pain, tender-pain, stretching-pain and resist-ing--pain were observed respectively. All the patients were evaluated by the symptoms with numerical rating scale.</p><p><b>RESULTS</b>The relief of moving-pain, tender-pain, stretching-pain and resisting-pain in the treatment group were significantly better than those of the control group; and the therapeutic effects of treatment group were better than those of the control group.</p><p><b>CONCLUSION</b>The method for treating stenosing tenovaginitis of flexor digitorum with hook needle knife has advantages of definite effects, micro-invasion and safety.</p>

A Case of Trigger Finger Following Longitudinal Tear of Flexor Digitorum Superficialis after Repeated Closed Injury

PURPOSE: Many causes for triggering or locking of the fingers have been discussed in other literatures. The most common one is known stenosing tenosynovitis, which causes, a mismatch between the volume of the flexor tendon sheath and its contents. However, repeated trauma to the hand is uncommon cause of trigger finger. Therefore, we present a case of a rare condition of stenosing tenosynovitis which developed from a repeated relatively weak superficial flexor tendon injury. METHODS: The patient was a 62-year-old woman who showed a painless, fixed and round mass on her right hand with no particular cause. Active and passive range of motion of the metacarpophalangeal joint of long finger was limited in flexion and extension. Ultrasonographic finding showed injured flexor digitorum superficialis tendon had fibrillar architecture with swelling between hyperechoic synovial membrane and hypoechoic surrounding area. Surgical exploration revealed that a bunched portion of the flexor digitorum superficialis and A1 pulley cause triggering during operation after adhesiolysis of scar tissue. RESULTS: After releasing the A1 pulley, the range of motion of the metacarpophalangeal joint of long finger showed no limitation and histological examination of the subcutaneous tissue revealed fibrous fatty degeneration. In this case, releasing the A1 pulley with adhesiolysis of the subcutaneous scar tissue was successful and we obtained good functional outcome. CONCLUSION: We examined a patient in whom a repetitive impact forces to the palm caused longitudinal tear of the flexor tendon, leading to trigger finger. We experienced a rare case of stenosing tenosynovitis and trigger finger caused after close injury to flexor digitorum superficialis and its degenerative changes that caused mass like effect. To the best of authors' knowledge, our case of close injury to the flexor digitorum superficialis and unique morphologic change before rupture of tendon is rarely to be reported.

Tenosinovitis estenosante de los tendones peroneos: reporte de dos caso / Peroneal stenosing tendonitis: two case report

La tenosinovitis estenosante de los peroneos que resulta de la hipertrofia del tubérculo peroneo ha sido bien descrita en la literatura, pero la descripción de casos en nuestro medio es escasa. El tratamiento quirúrgico adecuado trata el tubérculo peroneo hipertrofiado, la polea peronea y cualquier patología intrínseca del tendón. Se reportan dos casos de pacientes con dolor crónico y aparición de masa en la región inframaleolar externa de un tobillo, con poca respuesta al manejo conservador. Los pacientes fueron llevados a cirugía con resolución de sus síntomas. En el primer caso, se encontró una hipertrofia de la polea sin prominencia del tubérculo y, en el segundo caso, una hipertrofia del tubérculo con un quiste retinacular (ganglión) asociado.

Flexor Tendon Entrapment at the Malunited Base Fracture of the Proximal Phalanx of the Finger in Child : A Case Report

The proximal phalangeal base is the most commonly fractured hand bone in children. Such fractures are rarely reported to be irreducible as a consequence of flexor tendon entrapment. A 12-year-old male sustained a malunited base fracture of the proximal phalanx of the small finger on the right hand and was unable to flex the finger. 6 weeks ago he was treated with closed reduction and percutaneous K-wire fixation, at another hospital. In a subsequent operation, it was found that the flexor tendon was entrapped at the fracture site. Flexor tenolysis and realignment of the fracture and internal fixation with K-wires were performed. The patient could perform his work without discomfort in his hand and a normal range of motion was possible in the small finger 12 months after the operation.

De Quervain's tendovaginitis stenosans in Jordanians

To study the De Quervain's Tendovaginitis Stenosans in Jordanians for triggering, septation and the presence or absence of tendons and their number. We operated on sixty-two wrists with the diagnosis of De Quervain's Tendovaginitis Stenosans, the mean age was 46 years old ranging from 28 to 77 years, amongst them were 44 females and 17 males. The right hand was the one affected in 37 and the left in 25, one of them had Bilateral. The dominant hand was affected in 35 cases while, the rest were not recorded. Occupation has some bearing as it has ranged from housewives, hairdressers, office secretaries, managerial jobs, heavy labor workers, handy men, farm hands and recent pregnancy and child birth. Twelve of the cases were of the triggering type; two of them had full septation, while three had partial septation. As for nodularity, five demonstrated a nodule in the Abductor Pollicis Longus [APL] or Extensor Pollicis Brevis [EPB]. Three had synovitis of Abductor Pollicis Longus and four had no nodularity or synovitis. Of the remaining fifty, 18 had full septation and a partial septation in 9, while the rest were in a single compartment. The number of tendons varied, fifty-five had a single [EPB] with no cases of APL absence. However, eighteen had one APL tendons, 33 had two, while six had 3 -4 or more slips of tendons. Fifty-eight patients of them attended for follow up. Forty-seven had full satisfaction; two reported scar hypertrophy, scar adherence in 3 and two cases of dysesthesis in the Superficial Branch of the radial Nerve [SBN]

High frequency sonographic assessment of dequervain's disease and US-guided therapeutic steroid injection

DeQuervain's disease is a stenosing tenosynovitis. There is inflammation of the cellular lining membrane of the fibrous tube through which the tendons of abductor pollicis Iongus [APL] and extensor pollicis brevis [EPB] move, at the radial styloid process. There is pain and weakness of hand grip. It may occur in association, with rheumatoid arthritis, other inflammatory synovitis, direct trauma, and pregnancy. The purpose of this study was to investigate the value of ultrasound [US] in diagnosis of DeQuervain's disease, to describe US-guided injection technique and demonstration of changes in tendon sheath following US-guided local steroid injection. A cohort of thirty patients with clinical diagnosis of DeQuen,ain's disease and 10 normal subjects were studied prospectively. US examination was performed using HDI 3000 from ATL-USA and linear array transducer 11MHz. The affected tendon sheath was in filtrated with 15 mg triamcinolone diacetate, 2 ml saline and 2 ml of 2% lidociane. The injection was delivered under direct sonographic guidance. US examination was performed following clinical evaluation and repeated at 1 and 12 weeks later. The marginal appearance of tendon sheathes was measured. We used VAS [visual analog scale] 0-10 and hand's grip strength to measure pain. The normal tendons show normal fibrillar hyperechogenicity with no tears or hematoma. The affected tendons of APL and EPB show diffuse circumferential hypoechogenicity around the tendons, distension in the tendon sheath and a surrounding fluid film at the radial styloid process. The US; recognized 3 patients with a different diagnosis of tenosynovitis of the flexor carpiradialis tendon that results in pain at the base of the thenar muscles eminence. The tendons of APL and EPB became inflamed and thickened. US measurements of tendon sheathes showed a significant increase in thickness [range 1.8-2.6 mean 2.4 +/- 0.2 mm], compared with normal subjects [range 0.7-1.2 mean 0.9 +/- 0.3 mm], [P<0.00 1]. In all of our patients, a significant decrease in the thickness of the affected tendon sheath was observed one week after US-guided local steroid injection, [range 1.1-1.5 mean 1.2 +/- 0.2 mm]. Complete relief of symptoms and signs was further observed at 12 weeks. The VAS 0-10 scale and hand's grip strength were significantly improved [P<0.001]. US examination of tendon sheathes is simple, sensitive, easy, safe and quick to perform and reproducible. The US-guided local corticosteroid injection will avoid inappropriate direct injury into the tendon. It was proved to be safe and effective in treatment of DeQuervain's. Therefore. US procedure should be considered early in diagnosis and management of DeQuervain's disease

Lesões por esforços repetitivos (LER) sua importância atual / Repetitive strain injuries (RSI) its importance today

Atualmente na prática de Medicina do Trabalho, as queixas álgicas músculo esqueléticas associada aos movimentos repetitivos é conhecida a bastante tempo. São relacionadas ao aumento do ritmo e velocidade no trabalho, causado por aumento de produtividade no trabalho e incapacidade física. Sua incid~encia e dimensões em nossa vida, não são totalmente conhecidas. Consequência do não diagnóstico, da subnotificação e do subregistro. Nas lesões por esforços repetitivos, protocolo de investigação e estadiamento são usados. Este trabalho visa dar melhor compreensão, diagnóstico precoce e melhores condições de trabalho nos casos de LER.