Top

BMC Musculoskeletal Disorders

Published in:

Open Access 01-12-2021 | Flexor Tendon Sheath Infection | Research article

Evaluation of the first annular pulley stretch effect under isometric contraction of the flexor tendon in healthy volunteers and trigger finger patients using ultrasonography

Authors: Shinya Tanaka, Kosuke Uehara, Ryota Sugimura, Toshiki Miura, Takashi Ohe, Sakae Tanaka, Yutaka Morizaki

Published in: BMC Musculoskeletal Disorders | Issue 1/2021

Abstract

Background

Isometric exercises for a flexed finger have been reported to be effective for treating trigger finger as the flexor tendon widens the space under the first annular (A1) pulley towards the palmar destination during the exercise. This study aimed to evaluate the structural changes during the A1 pulley stretch in healthy volunteers and patients with trigger finger using ultrasonography.

Methods

We enrolled 25 male and 14 female patients (39 middle fingers). The thickness of the subcutaneous tissue (parameter a), A1 pulley (parameter b), and the flexor tendon (parameter c) and the distance between the dorsal surface of the flexor tendon and the palmar surface of the metacarpal head (parameter d) were measured using ultrasonography of the metacarpophalangeal joint of the middle finger flexed at 45° at rest (pattern A) and under isometric contraction of the flexor tendon against an extension force of the proximal interphalangeal joint (pattern B).

Results

The average differences between patterns A and B in the healthy volunteers were 0.29 mm (parameter a; P = 0.02), 0.017 mm (parameter b; P = 0.63), 0.16 (parameter c; P = 0.26), and 0.41 (parameter d; P = 0.004), and those in patients with trigger finger were 0.22 mm (parameter a; P = 0.23), 0.019 mm (parameter b; P = 0.85), 0.03 mm (parameter c; P = 0.82), and 0.78 mm (parameter d; P < 0.001). The distance between the dorsal side of the A1 pulley and the palmar surface of the metacarpal head was also significantly increased by 0.57 mm (8.2%) in healthy volunteers (P < 0.001) and 0.81 mm (11%) in patients with trigger finger (P < 0.001).

Conclusions

In this study, the space under the A1 pulley was expanded under isometric contraction of the flexor tendon. These findings support the effectiveness of pulley stretch exercises for the trigger finger condition.

Akhtar S, Bradley MJ, Quinton DN, Burke FD. Management and referral for trigger finger/thumb. BMJ. 2005;331(7507):30–3. https://doi.org/10.1136/bmj.331.7507.30.CrossRefPubMedPubMedCentral

Eastwood DM, Gupta KJ, Johnson DP. Percutaneous release of the trigger finger: an office procedure. J Hand Surg Am. 1992;17(1):114–7. https://doi.org/10.1016/0363-5023(92)90125-9.CrossRefPubMed

Fiorini HJ, Tamaoki MJ, Lenza M, Gomes Dos Santos JB, Faloppa F, Belloti JC. Surgery for trigger finger. Cochrane Database Syst Rev. 2018;2:CD009860.PubMed

Langer D, Luria S, Michailevich M, Maeir A. Long-term functional outcome of trigger finger. Disabil Rehabil. 2018;40(1):90–5. https://doi.org/10.1080/09638288.2016.1243161.CrossRefPubMed

Miyamoto H, Miura T, Isayama H, Masuzaki R, Koike K, Ohe T. Stiffness of the first annular pulley in normal and trigger fingers. J Hand Surg Am. 2011;36(9):1486–91. https://doi.org/10.1016/j.jhsa.2011.05.038.CrossRefPubMed

Uchihashi K, Tsuruta T, Mine H, Aoki S, Nishijima-Matsunobu A, Yamamoto M, et al. Histopathology of tenosynovium in trigger fingers. Pathol Int. 2014;64(6):276–82. https://doi.org/10.1111/pin.12168.CrossRefPubMed

Sato J, Ishii Y, Noguchi H, Takeda M. 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(10):2012–20. https://doi.org/10.1016/j.jhsa.2012.06.027.CrossRefPubMed

Giugale JM, Fowler JR. Trigger finger: adult and pediatric treatment strategies. Orthop Clin North Am. 2015;46(4):561–9. https://doi.org/10.1016/j.ocl.2015.06.014.CrossRefPubMed

Ryzewicz M, Wolf JM. Trigger digits: principles, management, and complications. J Hand Surg Am. 2006;31(1):135–46. https://doi.org/10.1016/j.jhsa.2005.10.013.CrossRefPubMed

10.

Drijkoningen T, van Berckel M, Becker SJE, Ring DC, Mudgal CS. Night splinting for idiopathic trigger digits. Hand (N Y). 2018;13(5):558–62. https://doi.org/10.1177/1558944717725374.CrossRef

11.

Kanchanathepsak T, Pichyangkul P, Suppaphol S, Watcharananan I, Tuntiyatorn P, Tawonsawatruk T. Efficacy comparison of hyaluronic acid and corticosteroid injection in treatment of trigger digits: a randomized controlled trial. J Hand Surg Asian Pac Vol. 2020;25(1):76–81. https://doi.org/10.1142/S2424835520500101.CrossRefPubMed

12.

Peters-Veluthamaningal C, van der Windt DA, Winters JC, Meyboom-de Jong B. Corticosteroid injection for trigger finger in adults. Cochrane Database Syst Rev. 2009;(1):CD005617. https://doi.org/10.1002/14651858.CD005617.pub2.

13.

Dala-Ali BM, Nakhdjevani A, Lloyd MA, Schreuder FB. The efficacy of steroid injection in the treatment of trigger finger. Clin Orthop Surg. 2012;4(4):263–8. https://doi.org/10.4055/cios.2012.4.4.263.CrossRefPubMedPubMedCentral

14.

Matthews A, Smith K, Read L, Nicholas J, Schmidt E. Trigger finger: an overview of the treatment options. JAAPA. 2019;32(1):17–21. https://doi.org/10.1097/01.JAA.0000550281.42592.97.CrossRefPubMed

15.

Huisstede BM, Hoogvliet P, Coert JH, Friden J, European HG. Multidisciplinary consensus guideline for managing trigger finger: results from the European HANDGUIDE study. Phys Ther. 2014;94(10):1421–33. https://doi.org/10.2522/ptj.20130135.CrossRefPubMed

16.

Colbourn J, Heath N, Manary S, Pacifico D. Effectiveness of splinting for the treatment of trigger finger. J Hand Ther. 2008;21(4):336–43. https://doi.org/10.1197/j.jht.2008.05.001.CrossRefPubMed

17.

Rosenbaum YA, Benvenuti N, Yang J, Ruff ME, Awan HM, Samora JB. The effect of trigger finger injection site on injection-related pain. Hand (N Y). 2018;13(2):164–9. https://doi.org/10.1177/1558944717703134.CrossRef

18.

Strigelli V, Mingarelli L, Fioravanti G, Merendi G, Merolli A, Fanfani F, et al. Open surgery for trigger finger required combined a1-a2 pulley release. A retrospective study on 1305 case. Tech Hand Up Extrem Surg. 2019;23(3):115–21. https://doi.org/10.1097/BTH.0000000000000231.CrossRefPubMed

19.

Yamazaki A, Matsuura Y, Kuniyoshi K, Suzuki T, Akasaka T, Ozone E, et al. A1 pulley stretching treats trigger finger: A1 pulley luminal region under digital flexor tendon traction. Clin Biomech (Bristol, Avon). 2020;72:136–40.CrossRef

20.

Quinnell RC. Conservative management of trigger finger. Practitioner. 1980;224(1340):187–90.PubMed

21.

Abrahams M. Mechanical behaviour of tendon in vitro. A preliminary report. Med Biol Eng. 1967;5(5):433–43. https://doi.org/10.1007/BF02479137.CrossRefPubMed

22.

Sarver DC, Kharaz YA, Sugg KB, Gumucio JP, Comerford E, Mendias CL. Sex differences in tendon structure and function. J Orthop Res. 2017;35(10):2117–26. https://doi.org/10.1002/jor.23516.CrossRefPubMedPubMedCentral

23.

Treme G, Diduch DR, Billante MJ, Miller MD, Hart JM. Hamstring graft size prediction: a prospective clinical evaluation. Am J Sports Med. 2008;36(11):2204–9. https://doi.org/10.1177/0363546508319901.CrossRefPubMed

24.

Kuczmarski AS, Harris AP, Gil JA, Weiss AC. Management of diabetic trigger finger. J Hand Surg Am. 2019;44(2):150–3. https://doi.org/10.1016/j.jhsa.2018.03.045.CrossRefPubMed

25.

Wojahn RD, Foeger NC, Gelberman RH, Calfee RP. Long-term outcomes following a single corticosteroid injection for trigger finger. J Bone Joint Surg Am. 2014;96(22):1849–54. https://doi.org/10.2106/JBJS.N.00004.CrossRefPubMedPubMedCentral

26.

Catalano LW 3rd, Glickel SZ, Barron OA, Harrison R, Marshall A, Purcelli-Lafer M. Effect of local corticosteroid injection of the hand and wrist on blood glucose in patients with diabetes mellitus. Orthopedics. 2012;35(12):e1754–8. https://doi.org/10.3928/01477447-20121120-20.CrossRefPubMed

Title: Evaluation of the first annular pulley stretch effect under isometric contraction of the flexor tendon in healthy volunteers and trigger finger patients using ultrasonography
Authors: Shinya Tanaka
Kosuke Uehara
Ryota Sugimura
Toshiki Miura
Takashi Ohe
Sakae Tanaka
Yutaka Morizaki
Publication date: 01-12-2021
Publisher: BioMed Central
Keyword: Flexor Tendon Sheath Infection
Published in: BMC Musculoskeletal Disorders / Issue 1/2021
Electronic ISSN: 1471-2474
DOI: https://doi.org/10.1186/s12891-021-04299-1

At a glance: The STEP trials

Springer Medicine

Evaluation of the first annular pulley stretch effect under isometric contraction of the flexor tendon in healthy volunteers and trigger finger patients using ultrasonography

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2021

Effect of real-time ultrasound imaging for biofeedback on trunk muscle contraction in healthy subjects: a preliminary study

Temporary hemiepiphysiodesis using an eight‐plate implant for coronal angular deformity around the knee in children aged less than 10 years: efficacy, complications, occurrence of rebound and risk factors

Bone defects are repaired by enhanced osteogenic activity of the induced membrane: a case report and literature review

Cervical sagittal alignment after Prestige LP cervical disc replacement: radiological results and clinical impacts from a single-center experience

Result of cementless total hip arthroplasty in a patient with osteopoikilosis, hip dysplasia and advanced osteoarthritis: a case report

Is early full weight bearing safe following locking plate ORIF of distal fibula fractures?