Efficacy of Minimally Invasive Ulnar Superficialis Slip Resection for Unfavourable Results after Trigger Finger Release.

Background: This study aimed to evaluate the efficacy of ulnar superficial slip resection (USSR) for improving hand function after unfavourable results after triggering finger release using a minimally invasive approach. Methods: We evaluated 17 consecutive fingers of 16 patients who complained of unfavourable outcomes after primary trigger finger release. The chief complaints of the two index and 15 middle fingers were proximal interphalangeal (PIP) joint pain during movement, flexion contracture of the PIP joint and snapping at the A2 pulley in eight, seven and two fingers, respectively. The joint arc of the active range of motion and extension loss of the PIP joint, grip strength, visual analogue score (VAS) of PIP joint pain and Quick Disability of the Arm, Shoulder and Hand were evaluated before and after surgery. Results: Thirteen fingers could release joint contracture and snapping by the USSR procedure. However, four fingers of three patients required total flexor digitorum superficialis resection to resolve the unsatisfactory conditions of the intraoperative decision. The joint arc of active range of motion and extension loss of the PIP joint, grip strength and VAS score significantly improved (mean of 16.1 months follow-up). Finally, 15 patients (88.2%) were satisfied with the symptom relief outcomes. Conclusions: USSR is an effective and satisfactory procedure for unfavourable conditions after trigger finger release, including PIP joint pain, joint contracture and snapping at the A2 pulley. Level of Evidence: Level IV (Therapeutic).

[Trigger finger: to operate or to inject?] / Trigger finger: opereren of injecteren?

Trigger finger is a common hand disorder in which swelling of the affected flexor-tendon results in triggering, locking or pain at the A1-pulley and impaired function of the finger. In this clinical lesson we describe 4 cases of patients with this condition, illustrating the clinical picture of trigger finger and how decisions regarding treatment are made. In typical cases the diagnosis is straight forward, but if the clinical presentation is less clear (e.g. in case if there is only pain at the A1-pully or a locked finger) making the diagnosis can be challenging. Conservative (doing nothing, orthosis, injection) and operative treatment options are discussed. Guiding principles are formulated which may help in choosing the most appropriate treatment for individual patients.

Prognostic factors related to recurrence of trigger finger after open surgical release in adults.

INTRODUCTION: Recurrent trigger finger after surgery is one of the major adverse events. However, studies to identify factors associated with recurrence after open surgical release in adult trigger finger patients are still limited. PURPOSE: To identify factors associated with recurrent trigger finger after open surgical release. METHODS: This 12-year retrospective observational study included 723 patients with 841 trigger fingers who underwent open A1 pulley release. Patients were categorized into 2 groups: those with recurrent trigger finger after surgery and those without. Associations between potential predictors including age, sex, duration of symptoms, occupation status, active smoker status, number of steroid injections before surgery, and types of comorbidities and the outcome of interest, recurrence of trigger finger, were examined using univariable and multivariable analyses. The results are presented as hazard ratios (HR) with a 95% confidence interval (95% CI). RESULTS: The recurrence rate after trigger finger release was 2.39% (20 of 841 fingers). After adjusting for confounders, more than 3 steroid injections before surgery and manual labor were the independent predictors of recurrent trigger finger (HR = 4.87, 95%CI = 1.06-22.35 and HR = 3.43, 95%CI = 1.15-10.23, respectively). CONCLUSIONS: More than 3 steroid injections before surgery and manual labor increase the risk of recurrent trigger finger after an open A1 pulley release. There may be limited benefit in administering a fourth steroid injection.

Trigger Finger Treatment / Tratamento do Dedo em Gatilho

Abstract Trigger finger is a frequent condition. Although tenosynovitis and the alteration of pulley A1 are identified as triggering factors, there is no consensus on the true cause in the literature, and its true etiology remains unknown. The diagnosis is purely clinical most of the time. It depends solely on the existence of finger locking during active bending movement. Trigger finger treatment usually begins with nonsurgical interventions that are instituted for at least 3 months. In patients with initial presentation with flexion deformity or inability to flex the finger, there may be earlier indication of surgical treatment due to pain intensity and functional disability. In the present review article, we will present the modalities and our algorithm for the treatment of trigger finger.

Resumo O dedo em gatilho é uma afecção frequente. Não obstante a tenossinovite e a alteração da polia A1 serem identificados como fatores desencadeantes, não há consenso sobre a verdadeira causa na literatura, sendo que a sua verdadeira etiologia permanece desconhecida. O diagnóstico é puramente clínico na maior parte das vezes. Ele depende unicamente da existência do travamento do dedo no decorrer da movimentação flexão ativa. O tratamento do dedo em gatilho geralmente se inicia com intervenções não cirúrgicas que são instituídas por pelo menos 3 meses. Nos pacientes em quem haja apresentação inicial com deformidade em flexão ou incapacidade de flexão do dedo, pode haver indicação mais precoce do tratamento cirúrgico em razão da intensidade do quadro álgico e da incapacidade funcional do paciente. No presente artigo de revisão, apresentaremos as modalidades e o nosso algoritmo para o tratamento do dedo em gatilho.

Common Hand Conditions: A Review.

Importance: Carpal tunnel syndrome, trigger finger, de Quervain tenosynovitis, and basilar (carpometacarpal) joint arthritis of the thumb can be associated with significant disability. Observations: Carpal tunnel syndrome is characterized by numbness and tingling in the thumb and the index, middle, and radial ring fingers and by weakness of thumb opposition when severe. It is more common in women and people who are obese, have diabetes, and work in occupations involving use of keyboards, computer mouse, heavy machinery, or vibrating manual tools. The Durkan physical examination maneuver, consisting of firm digital pressure across the carpal tunnel to reproduce symptoms, is 64% sensitive and 83% specific for carpal tunnel syndrome. People with suspected proximal compression or other compressive neuropathies should undergo electrodiagnostic testing, which is approximately more than 80% sensitive and 95% specific for carpal tunnel syndrome. Splinting or steroid injection may temporarily relieve symptoms. Patients who do not respond to conservative therapies may undergo open or endoscopic carpal tunnel release for definitive treatment. Trigger finger, which involves abnormal resistance to smooth flexion and extension ("triggering") of the affected finger, affects up to 20% of adults with diabetes and approximately 2% of the general population. Steroid injection is the first-line therapy but is less efficacious in people with insulin-dependent diabetes. People with diabetes and those with recurrent symptoms may benefit from early surgical release. de Quervain tenosynovitis, consisting of swelling of the extensor tendons at the wrist, is more common in women than in men. People with frequent mobile phone use are at increased risk. The median age of onset is 40 to 59 years. Steroid injections relieve symptoms in approximately 72% of patients, particularly when combined with immobilization. People with recurrent symptoms may be considered for surgical release of the first dorsal extensor compartment. Thumb carpometacarpal joint arthritis affects approximately 33% of postmenopausal women, according to radiographic evidence of carpometacarpal arthritis. Approximately 20% of patients require treatment for pain and disability. Nonsurgical interventions (immobilization, steroid injection, and pain medication) relieve pain but do not alter disease progression. Surgery may be appropriate for patients unresponsive to conservative treatments. Conclusions and Relevance: Carpal tunnel syndrome, trigger finger, de Quervain tenosynovitis, and thumb carpometacarpal joint arthritis can be associated with significant disability. First-line treatment for each condition consists of steroid injection, immobilization, or both. For patients who do not respond to noninvasive therapy or for progressive disease despite conservative therapy, surgical treatment is safe and effective.

A New Test for Trigger Finger: The Lenox Independent Flexion Test.

Background: The diagnosis of trigger finger (TF) in patients who do not demonstrate triggering at presentation can be challenging. We have been using a new test for TF - the Lenox Independent Flexion Test (LIFT). The aim of this study is to determine the sensitivity of LIFT in diagnosing TF. We hypothesise that LIFT will be more sensitive compared to the classic physical exam finding of triggering or locking with active range of motion (AROM). Methods: This is a prospective study of consecutive patients with TF over a 5-month period. Patients with the onset of trigger following trauma and trigger of the thumb were excluded. Patients were examined for tenderness over the first annular (A1) pulley, triggering or locking with AROM, and the LIFT was performed. A two-proportion test was used to determine whether the LIFT was more sensitive than triggering with AROM. Results: The study included 85 patients with 118 TFs. The average age of patients was 63 years and the study included 49 women. There were 69, 49, 0 and 0 grade I, II, III and IV TF, respectively. 108 fingers (92%) had a history of catching or locking of the affected digit, 110 (93%) had tenderness over the A1 pulley, 49 (44%) had triggering or locking with AROM and 102 (91%) had a positive LIFT. The LIFT was found to be more sensitive when compared to triggering with AROM (p < .001). Conclusion: The LIFT is more sensitive than triggering with AROM in the diagnosis of trigger digits. This test is especially useful in the diagnosis of TF in patients who do not have triggering at presentation. Level of Evidence: Level III (Diagnostic).

Pediatric Trigger Digits.

Pediatric trigger thumb (PTT) and finger (PTF) are upper extremity deformities that frequently go unrecognized by providers. Early recognition by pediatricians and caregivers is vital because PTT is successfully treated nonoperatively in more than 95% of patients if diagnosed early. Similarly, PTF can be successfully treated nonoperatively in 67% of patients. Although PTT is typically benign and 10 times more common, PTF may be associated with underlying concurrent medical conditions, such as juvenile rheumatoid arthritis, diabetes, mucopolysaccharide and lysosomal disorders, and trisomy 18. Routine examinations consisting of full hand range of motion should be performed in all children. Clinicians should be aware of the importance of conservative treatment options for PTT and PTF and the value of screening for underlying medical conditions associated with PTF.

[Carpal tunnel compression syndrome and third finger in trigger secondary to an encapsulated fibrolipoma of the wrist: a case report]. / Síndrome de compresión del túnel del carpo y tercer dedo en gatillo secundarios a un fibrolipoma encapsulado de la muñeca: reporte de un caso.

INTRODUCTION: the association of carpal tunnel syndrome with stenosing tenosynovitis of the hand is very rare, even more, if it is generated by a fibrolipoma at the carpal tunnel. The imaging study useful to detect this type of hand injuries are X-ray screening for carpal tunnel, computed tomography and magnetic resonance imaging. But these are not commonly used for the study of protocolized carpal tunnel syndrome and much less trigger finger. OBJECTIVE: the aim of this work is to report a case of a middle-aged female with carpal tunnel syndrome characteristic symptoms, associated with the third trigger finger; she was handled with the release of the median nerve by a minimally invasive approach, in addition to the A1 pulley release. CLINICAL CASE: the patient persists with both problems and at a secondary surgical review, we detected wrist locking sensation. The patient was reoperated finding an ovoid encapsulated tumor, measuring 3.0 × 2.0 × 1.0 cm, with smooth outer surface, whitish appearance, and soft rubbery consistency. The biopsy pathology outlines identified an encapsulated fibrolipoma, causing nerve compression and locking flexor tendon. CONCLUSION: the importance of this writing is in adding tumors to the etiological repertoire, which can cause compression of the median nerve and even less frequent as a cause of the flexor tendons of the hand snagging.

INTRODUCCIÓN: la asociación del síndrome del túnel del carpo con tenosinovitis estenosante de la mano es muy rara, aún más, si es generada por un fibrolipoma a nivel del túnel del carpo. El estudio de imagen para detectar este tipo de lesiones en la mano incluye: desde una radiografía con proyección para el túnel del carpo, tomografía axial computarizada y resonancia magnética nuclear; pero éstos no se utilizan habitualmente para el estudio protocolizado del síndrome del túnel del carpo y mucho menos para los dedos en gatillo. OBJETIVO: el objetivo de este trabajo es reportar un caso en el cual se presenta la sintomatología característica de un síndrome de túnel del carpo, asociada a tercer dedo en gatillo, el cual se maneja con la liberación del nervio mediano por medio de un abordaje de mínima invasión, además de la polea A1. CASO CLÍNICO: la paciente persistió con ambas alteraciones y en la revisión secundaria se detectó bloqueo a nivel de la muñeca. Se intervino nuevamente a la paciente y se encontró una tumoración encapsulada, que midió 3.0 × 2.0 × 1.0 cm, con superficie externa lisa, blanquecina, de aspecto ovoide y consistencia blanda "ahulada". El estudio anatomopatológico la identificó como un fibrolipoma encapsulado que ocasionó la compresión nerviosa y el bloqueo del tendón flexor. CONCLUSIÓN: la importancia de este reporte de caso radica en agregar los tumores al repertorio etiológico, que además pueden provocar una compresión del nervio mediano y en que sean aún menos frecuentes como causa de atrapamiento de los tendones flexores de la mano.

Splinting for the treatment of pediatric trigger thumbs: a pilot study.

Controversy still exists whether conservative treatment may be a useful option for the treatment of pediatric trigger thumbs. We reviewed a random sample patient cohort with regard to success rates depending on whether flexible or fixed trigger thumbs were present. We performed a pilot study of 13 children (15 thumbs), who received a standardized treatment protocol including a custom-made thermoplastic splint for use during sleeping hours for a minimum of 3 months. Splinting was of only minor value for moderate and severe cases was but was beneficial for the majority of patients showing triggering symptoms only. It may thus be a reasonable option to delay surgery in infants with mild/flexible cases.

Presentation and aetiology of paediatric trigger finger: a systematic review.

Paediatric trigger finger is a rare condition distinct from paediatric trigger thumb and adult trigger digits. We performed a systematic review of paediatric trigger finger presentation and aetiology in order to guide workup and management. Fifty-one studies with 193 patients and 398 trigger fingers were included. Most patients had a single, unilateral trigger finger (54%). Fifty-five patients (29%) had an underlying condition, such as mucopolysaccharidosis; these cases appeared to be associated with multiple or bilateral trigger fingers or with carpal tunnel syndrome. All patients with mucopolysaccharidosis were treated surgically. Conservative management was reported in 33% of all patients, and two-thirds of these did not need further intervention. Patients undergoing surgical release infrequently had recurrence of triggering (6%). We propose an algorithmic approach for patients presenting with paediatric trigger finger. Presence of bilateral or multiple trigger digits or concomitant carpal tunnel syndrome should raise suspicion for an atypical underlying pathology.

Recognizing and treating trigger finger.

This inflammatory condition can leave your patient in pain and with impaired function. Here's what you need to know about the diagnosis and Tx options to provide relief.

Pediatric Trigger Digit Presenting in the Setting of Trauma.

BACKGROUND: Pediatric trigger digit is a relatively rare condition with incompletely understood etiology. In our practice, we noted a series of children presenting with pediatric trigger digit after an associated local trauma to the hand, which has not been previously described. The aim of this study was to analyze the nature of presentation of trigger digits, the accuracy of initial diagnosis, and the impact on treatment strategies used. METHODS: An institutional review board-approved retrospective review of our institution's experience with pediatric trigger finger from 2001 to 2015 was performed. RESULTS: Twenty-two patients with 26 affected digits were identified. Eighty-eight percent of patients were diagnosed with trigger thumb, whereas 3 patients (12%) had small finger triggering. Thirteen patients (59%) presented as outpatients, whereas 9 (41%) presented through the emergency department. All patients presenting to the emergency department were in the setting of recent minor trauma. Of this subset of patients, 67% had an incorrect initial diagnosis, leading to an average delay in treatment of 60 days. Ten patients (45% of total) were initially treated with immobilization versus surgical release of the A1 pulley. However, all but 2 of these patients required eventual A1 pulley release for persistent or recurrent triggering (88%). CONCLUSIONS: The cause of trigger digit in children remains incompletely understood and may be multifactorial. In this series, a traumatic component to presentation was found in a significant number of patients. This association with minor trauma may contribute to misdiagnosis and delay in definitive treatment. Although initial treatment with immobilization does not seem to impact surgical outcome, we found a high rate of failure with initial immobilization. Most patients required eventual surgical management, regardless of whether or not the initial presentation was associated with trauma. When performed, we found that A1 pulley release alone has safe, reliable results.

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.

Leiomyoma of digit of hand: Report of three cases with literature review.

Leiomyoma is a benign tumor of smooth muscle origin most common in areas of the body with abundant smooth muscle including the gynecologic, genitourinary, and gastrointestinal system. Leiomyoma outside of these locations is believed to arise from vascular smooth muscle and arrector pili muscles. Leiomyoma of an extremity is a rare diagnosis, especially when present in a digit of the hand due to the paucity of smooth muscle in this location. We report three cases of leiomyoma of a digit of the hand.

Trigger finger due to phalangeal osteochondroma of an adult: A case report.

Trigger finger is stenosing tenosynovitis that occurs in A1 pulley. It usually occurs idiopathically in patients' 40s and 50s. On the other hand, pediatric trigger finger usually occurs before 8 years old in pediatric patients. Even though being rare, a tumor occurred in the soft tissue or bone near flexor tendons can cause a trigger finger. Trigger finger due to osteochondroma is very rare. Furthermore, most cases of trigger finger due to osteochondroma occur in pediatric patients with hereditary multiple osteochondromatosis (HMO). The authors report this case of a trigger finger caused by a solitary osteochondroma that occurred in the proximal portion of the proximal phalanx of the left middle finger, of a 21-year-old patient. The symptoms were relieved after excision of the osteochondroma. If a patient with unusual demographics visits, the cause of trigger finger may not be idiopathic. Evaluation methods such as x-rays and ultrasonography can be helpful to rule out other causes, such as tumors.

Platelet-rich plasma versus corticosteroid injection for treatment of trigger finger: study protocol for a prospective randomized triple-blind placebo-controlled trial.

BACKGROUND: Trigger finger is a common hand disorder that limits finger range of motion and causes pain and snapping of the affected finger. Trigger finger is caused by an imbalance of the tendon sheath and the flexor tendon. The initial treatment is generally a local corticosteroid injection around the first annular (A1) pulley. However, it is not unusual that surgical release of the A1 pulley is required. Moreover, adverse events after local corticosteroid injection or operative treatment may occur. Platelet-rich plasma (PRP) has been shown to be safe and to reduce symptoms in different tendon pathologies, such as DeQuervain's disease. However, the effects of PRP on trigger finger have not been studied. The aim of this single-center triple-blind randomized controlled trial is to study whether PRP is non-inferior to corticosteroid injection in treating trigger finger. The secondary outcome is to assess the safety and efficacy of PRP in comparison to placebo. METHODS: The trial is designed as a randomized, controlled, patient-, investigator-, and outcome assessor-blinded, single-center, three-armed 1:1:1 non-inferiority trial. The patients with clinical symptoms of trigger finger will be randomly assigned to treatment with PRP, corticosteroid, or normal saline injection. The primary outcome is Patient-Rated Wrist Evaluation and symptom resolution. Secondary outcomes include Quick-Disabilities of the Arm, Shoulder and Hand; pain; grip strength; finger active range of motion; and complications. Appropriate statistical methods will be applied. DISCUSSION: We present a novel RCT study design on the use of PRP for the treatment of trigger finger compared to corticosteroid and normal saline injection. The results of the trial will indicate if PRP is appropriate for the treatment of trigger finger. TRIAL REGISTRATION: ClinicalTrials.gov NCT04167098 . Registered on November 18, 2019.

Current Concepts in the Management of Trigger Finger in Adults.

Trigger finger (TF) is one of the most common causes of hand disability. Immobilization of TF with a joint-blocking orthosis has been demonstrated to effectively relieve pain and improve function. The efficacy of steroid injections for TF varies based on the number of affected digits and the clinical severity of the condition. Up to three repeat steroid injections are effective in most patients. When conservative interventions are unsuccessful, open surgical release of the A1 pulley effectively alleviates the subjective and objective manifestations of TF and currently remains the benchmark procedure for addressing TF. Although several studies have emerged suggesting that a percutaneous approach may result in improved outcomes, this technique demands a learning curve that may predispose patients to higher risk of procedure-related complications. There is no role for preoperative antibiotics in patients who undergo elective soft-tissue procedures of the hand. WALANT anesthesia has gained popularity because it has been associated with improved patient outcomes and a clear cost savings; however, proper patient selection is critical. Similar to other soft-tissue hand procedures, TF surgery rarely necessitates a postoperative opioid prescription.

Pulling the Trigger: Recommendations for Surgical Care of the Pediatric Trigger Thumb.

BACKGROUND: Despite being a common pediatric hand condition, there are few clear guidelines regarding the optimal management of pediatric trigger thumb. Our primary aim was to help guide surgical management of this disorder by establishing a treatment algorithm on the basis of our institution's experience. METHODS: This is an institutional review board-approved retrospective study of all patients with idiopathic trigger thumbs from 2005 to 2015 at a single institution. Demographics and treatment course were recorded for all patients including duration of follow-up, observation, surgical intervention, and complications. All children were classified according to the Sugimoto classification. RESULTS: A total of 149 patients with 193 thumbs met inclusion and exclusion criteria. 16.5% of patients had stage II thumbs, 10.3% of patients with stage III, and 73% of patients with stage IV thumbs. Of all patients with stage IV thumbs, 3.5% were locked in extension for an overall incidence of 2.6%.In total, 46% of patients failed observation and underwent surgical treatment. Only 14% of stage IV trigger thumbs resolved when observed, compared with 53% of stage II and 25% of stage III trigger thumbs. Stage IV thumbs were 4.6 times more likely to fail conservative treatment and go on to surgery than stage II or III thumbs (odds ratio, 4.6; P=0.006).Thirty-two percent of patients underwent surgery without an observation period. Older children with bilateral stage 3 thumbs were the most likely to go straight to the odds ratio instead of being observed (P=0.002, r=0.17).Of the total amount of patients who underwent surgery (116), there were 4 complications for a rate of 3.4% with a recurrence rate of 1.7%. CONCLUSIONS: On the basis of the data in this study, the authors would recommend that stage IV thumbs undergo surgery without an observational period. Second, stage II and stage III thumbs can be safely observed for at least 1 year before surgery. Finally, our study concurs with the literature that surgery can be successful with low rates of complications and recurrence. LEVEL OF EVIDENCE: Level IV.

Proliferative fasciitis: A rare cause of disturbances in an adolescent hand.

We report a case of hand soft tissue tumor-proliferative fasciitis (PF)-in a 12-year-old patient that presented as a painful lump causing trigger finger. After meticulous diagnostic workup, a surgical excision led to immediate amelioration of symptoms. PF is a rare benign pseudosarcomatous lesion arising typically in the subcutaneous tissue and fascia in adults. It is very uncommon in the hand. To the best of our knowledge, this is the first report of a trigger finger being caused due to this pathology. In this report, the authors review PF lesions on hands, advice careful evaluation of magnetic resonance imaging features, and recommend surgical management.