The thickness of the A2 pulley and the flexor tendon are related to the severity of trigger finger: results of a prospective study using high-resolution ultrasonography

Abstract

We aimed to investigate the relationship between the pulley-tendon complexes and the severity of trigger finger. The thickness of the A1 and A2 pulleys, and the cross-sectional area of the flexor tendon under the pulleys, were prospectively assessed using 17 MHz high-resolution ultrasonography, in 20 patients with trigger finger (31 fingers). A control group comprised 15 asymptomatic fingers. The thickness of the A1 pulley and the proximal part of the A2 pulley, and the cross-sectional area of the flexor tendon under the A2 pulley, were significantly increased in the patient group. Clinical grade was significantly correlated with the thickness of the A1 pulley, the thickness of the proximal part of the A2 pulley, and the cross-sectional area of the flexor tendon under the proximal part of the A2 pulley. This study confirmed that the thickness of the A2 pulley and flexor tendon under the A2 pulley seems to be related to the severity of trigger finger.

Level of evidences: Level III

Keywords

Trigger finger A2 pulley cross-sectional area of the flexor tendon high-resolution ultrasonography

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References

Al-Qattan

. Trigger fingers requiring simultaneous division of the A1 pulley and the proximal part of the A2 pulley. J Hand Surg Eur. 2007, 32: 521–3.

Boutry

Titecat

Demondion

Glaude

Fontaine

Cotten

. High-frequency ultrasonographic examination of the finger pulley system. J Ultrasound Med. 2005, 24: 1333–9.

Burman

. Stenosing tendovaginitis of the dorsal and volar compartments of the wrist. Arch Surg. 1952, 65: 752–62.

Drossos

Remmelink

Nagy

de Maertelaer

Pasteels

Schuind

. Correlations between clinical presentations of adult trigger digits and histologic aspects of the A1 pulley. J Hand Surg Am. 2009, 34: 1429–35.

Fahey

Bollinger

. Trigger-finger in adults and children. J Bone Joint Surg Am. 1954, 36: 1200–18.

Ferree

Neuhaus

Becker

Jupiter

Mudgal

Ring

. Risk factors for return with a second trigger digit. J Hand Surg Eur. 2014, 39: 704–7.

Froimson

. Tenosynovitis and tennis elbow, 4th Edn. Philadelphia, Churchill Livingstone, 1999.

Hirata

Fujisawa

Sasaki

Morita

Matsumoto

. Congenital triggering of the index finger at the A2 pulley. J Hand Surg Am. 1996, 21: 609–11.

Hirschmann

Konala

Amsler

Iranpour

Friederich

Cobb

. The position and orientation of total knee replacement components: a comparison of conventional radiographs, transverse 2D-CT slices and 3D-CT reconstruction. J Bone Joint Surg Br. 2011, 93: 629–33.

10.

Ikeda

Osamura

. Trigger finger at the A2 pulley in children—two case reports. J Plast Reconstr Aesthet Surg. 2010, 63: e635–6.

11.

Landis

Koch

. The measurement of observer agreement for categorical data. Biometrics. 1977, 33: 159–74.

12.

Lee

Bae

Choy

. The relationship of trigger finger and flexor tendon volar migration after carpal tunnel release. J Hand Surg Eur. 2014, 39: 694–8.

13.

Lundin

Aspenberg

Eliasson

. Trigger finger, tendinosis, and intratendinous gene expression. Scand J Med Sci Spor. 2014, 24: 363–8.

14.

Makkouk

Oetgen

Swigart

Dodds

. Trigger finger: etiology, evaluation, and treatment. Curr Rev Musculoskelet Med. 2008, 1: 92–6.

15.

Miyamoto

Miura

Isayama

Masuzaki

Koike

Ohe

. Stiffness of the first annular pulley in normal and trigger fingers. J Hand Surg Am. 2011, 36: 1486–91.

16.

Nagaoka

Yamaguchi

Nagao

. Triggering at the distal A2 pulley. J Hand Surg Eur. 2007, 32: 210–3.

17.

Ryzewicz

Wolf

. Trigger digits: principles, management, and complications. J Hand Surg Am. 2006, 31: 135–46.

18.

Sato

Ishii

Noguchi

Takeda

. Sonographic appearance of the flexor tendon, volar plate, and A1 pulley with respect to the severity of trigger finger. J Hand Surg Am. 2012, 37: 2012–20.

19.

Sato

Ishii

Noguchi

Takeda

. Sonographic analyses of pulley and flexor tendon in idiopathic trigger finger with interphalangeal joint contracture. Ultrasound Med Biol. 2014, 40: 1146–53.

20.

Seradge

Kleinert

. Reduction flexor tenoplasty. Treatment of stenosing flexor tenosynovitis distal to the first pulley. J Hand Surg Am. 1981, 6: 543–4.

21.

Uchihashi

Tsuruta

Mine

. Histopathology of tenosynovium in trigger fingers. Pathol Int. 2014, 64: 276–82.