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Identifying the Risk Factors and Characterizing the Survival of SuperTrigger Finger (STF) Patients: Defining the "Super-Triggerers"
Nicholas Bank, MD
1,2, Alexander D Jeffs, M.D.
3, Sarah Conlon, M.D.
3, Stephen M Himmelberg, MD
4, Stephen Perle, BS
5, Reid W Draeger, M.D.
6; J. Megan M. Patterson, MD
7(1)University of North Carolina Hospitals, Chapel Hill, NC, (2)Case Western Reserve University, Cleveland, OH, (3)The University of North Carolina School of Medicine, Chapel Hill, NC, (4)University of North Carolina, Chapel Hill, NC, (5)University of North Carolina School of Medicine, Chapel Hill, NC, (6)Department of Orthopaedics, The University of North Carolina School of Medicine, Chapel Hill, NC, (7)Department of Orthopaedics, University of North Carolina, Chapel Hill, NC
Introduction: Trigger finger (TF) and recurrence after trigger finger release (TFR) are commonly associated with diabetes mellitus, carpal tunnel syndrome (CTS), increasing age, and female sex. However, less is known about patients with multiple TFs and those who develop additional TFs in more rapid succession than the typical population, defined as super trigger finger (STF) patients. This study aimed to analyze risk and survival timelines to subsequent TFR and identify independent risk factors associated with STF.
Methods: The TriNetX database was queried for patients 18 years and older who underwent between 2-10 TFRs. TFR was identified using CPT code 26055 and ICD-10-PCS codes 0LN7/0LN8. Cohorts were stratified by number of TFRs. Kaplan-Meier (KM) survival analyses were performed to determine risk/hazard of subsequent TFR within 1 year from prior TFR. Median survival times were assessed to identify cohorts experiencing subsequent TFR<30 days after prior TFR (STF patients). STF cohorts were pooled for comparative multivariate analysis to determine independent risk factors for this outcome. Statistical significance was determined using HRs with 95% confidence intervals (95%CI).
Results: 24,966 patients met criteria. Significant differences in 1-year survival were observed in the 5-9 TFR cohorts. Except for the 3 TFR cohort, 1-year survival probability decreased, median survival time decreased, and HRs increased with each successive TFR. The 7-10 TFR cohorts all demonstrated median survival between 1-7 days from prior TFR (
Figure 1).
Multivariate analysis of pooled STF cohorts compared with pooled non-STF cohorts determined significantly higher HR of subsequent TFR (HR 6.357;95%CI 5.949-6.794). Risk factors associated with STF included male sex (HR 1.072;95%CI 1.042-1.103), HbA1c<5.7% (HR 1.188;95%CI 1.143-1.234) or >10% (HR 1.09;95%CI 1.022-1.163), hypothyroidism (HR 1.053, 95%CI 1.012-1.094), rheumatoid arthritis (HR 1.129;95%CI 1.042-1.224), Dupuytren's disease (HR 1.1;95%CI 1.025-1.18), CTS (HR 1.175;95%CI 1.143-1.209), tobacco use (HR 1.249;95%CI 1.159-1.348), hormonal contraceptive use (HR 1.106;95%CI 1.018-1.203), and hormone replacement therapy (HR 1.42;95%CI 1.289-1.564).
Conclusions: This study identified significantly more rapid succession of subsequent TFR after the 6
th TFR, providing the first characterization of STF patients alongside condition-specific risk factors. These results suggest that when counseling STF patients, consider a lower threshold to offer TFR for other digits, even with mild symptoms. Additional research is warranted to further characterize STF risk factors and potential for alternative treatment algorithms in these patients.
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