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The Prevalence of Intrinsic Tightness in Patients with Trigger Finger
Samara Moll, BA
1, Grace Kim, MD
1, Emily Davidovic-Katz, BA
1, Liana J Tedesco, MD
2, Matthew L Duenes, MD
1, Sallie Yassin, MS
1, Jonah Dewing, BS
1; S. Steven Yang, MD, MPH
1(1)NYU Langone Health, New York, NY, (2)New York University Langone Orthopedic Hospital, New York, NY
Introduction Trigger finger (TF) is a common condition with generally favorable outcomes following nonsurgical and surgical treatment. However, some patients experience prolonged symptoms, including stiffness and discomfort. We hypothesize that certain patients with TF develop concurrent intrinsic tightness (IT), which may contribute to more severe and persistent symptoms following treatment.
Materials and methods 216 trigger fingers were evaluated for triggering severity (classified on an established 1-3 scale), duration of triggering, presence of IT (assessed using the Bunnell test), and IT severity. Comorbidities, demographic information, and the need for further treatment such as therapy or intrinsic release surgery were evaluated.
Comparisons of categorical variables (IT presence across comorbidities, response to cortisone injections, and need for further treatment following triggering resolution) were assessed using either a chi-square test or Fisher's exact test, depending on expected cell counts.
Continuous variables including age were tested for normality using the Shapiro-Wilk test. Depending on the distribution, independent t-tests or Mann-Whitney U tests were used. Statistical tests were two-tailed and set at the p<0.05 level.
Results IT was significantly associated with TF severity (p = 0.049). The prevalence of IT increased with increasing TF severity: 10.0% of patients with grade 1 triggering had IT, compared to 30.8% with grade 2 triggering. This prevalence remained relatively stable at the highest severity level, with 27.0% of patients with grade 3 triggering exhibiting IT. Age, smoking status, and a history of pain disorder were significantly associated with the severity of IT (p = 0.030, p = 0.010, and p = 0.031, respectively).
Cortisone injections were successful in 36.0% of patients with concomitant TF and IT, compared to 71.1% of patients without IT (p<0.001). Following the resolution of their TF, 39.1% of patients with concomitant TF and IT required additional treatment, whereas only 3.3% of non-IT TF patients required further treatment (p<0.001).
Conclusion There is a significant prevalence of IT in patients with TF, especially among those with more severe TF. Patients who are older, with a smoking history, or with a pain disorder should be closely monitored. Additionally, patients with concomitant IT are less responsive to cortisone injection alone and more likely to require further interventions. Providers need to consider this in establishing prognosis and managing patient expectations.
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