Predictive Factors Associated With Proximal Interphalangeal Joint Contracture In Trigger Finger
Junko Sato, MD, PhD1; Yoshinori Ishii, MD, PhD2; Hideo Noguchi, MD2; Ikuko Takahashi, MD3
1Ishii Orthopaedic & Rehabilitation Clinic, Gyoda, Japan; 2Ishii Orthopaedic & Rehabilitation Clinic, Gyoda, Saitama, Japan; 3Ishii orthopedic & Rehabilitation Clinic, Gyoda, Japan
Introduction Proximal interphalangeal (PIP) joint contracture associated with trigger finger is resistant to treatment. We report the results of a comparison of background factors in trigger finger patients with and without PIP joint contracture, focusing on patients who have never had treatment.
Materials & Methods Consecutive patients diagnosed with trigger finger, excluding the thumb, during a 6-year period in our clinic were studied. At their initial visit, we judged the presence or absence of PIP joint contracture as defined by more than 5 degrees loss of active extension. Characteristics compared included gender, age, body mass index (BMI), hand dominance, previous other trigger fingers, simultaneous occurrence in multiple digits, previous occurrence of carpal tunnel syndrome (CTS) and/or De Quervain‘s syndrome, previous heavy manual work, diabetes mellitus, clinical grade and duration of triggering. The duration of triggering was categorized from the patients’ history. Previous heavy manual work was deemed to have occurred whether from the patients’ job, hobbies or activities of daily life. For all characteristics, we recorded one set of data for each affected digit at the time of the initial diagnosis. Statistical comparisons were performed respectively (p<0.05).
Results In total, one hundred and twenty-six digits with trigger finger in 116 patients were included in this study (45 men and 71 women; mean age 60 years, range 15–80). Thirty-seven of 126 trigger digits (29%) had PIP joint contracture. Eight patients had more than one digit included in this study. Flexion contracture of the PIP joint was significantly associated with older age, previous CTS or De Quervain’s syndrome, and more severe clinical grade. Although the mean age of the patients with the PIP joint contracture was significantly higher than those without the contracture, the difference was only 4 years.
Conclusions Physicians should be encouraged to consider the clinical severity and previous hand disorders, including CTS and De Quervain’s syndrome, when monitoring the progress of PIP joint contracture in trigger finger. If the patients have these factors, intervention such as A1 pulley release and/or flexor digitorum superficialis resection may be indicated at an early stage regardless of the duration of triggering.
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