Ultrasound Guided Corticosteroid Injection at A1 Pulley in Comparison to Percutaneous A1 Pulley Release as a Treatment for Idiopathic Trigger Finger

Overview

Objectives: To compare the efficacy of ultrasonography guided corticosteroid injection at A1 pulley and percutaneous A1 pulley release as a treatment for trigger finger. Methods: 75 patients with idiopathic trigger finger were enrolled in our prospective study. Patients with diabetes mellitus, previous history of open release for trigger finger, different inflammatory arthritis and multiple trigger fingers affections were excluded. Group A 40 patients: Underwent ultrasound guided methyl prednisolone acetate injection, between A1 pulley and tendons .Group B 35 patients :Underwent ultrasonography-guided percutaneous A1 pulley needle release .All patients were subjected to the following before and after intervention by 1 and 3 months , DASH, trigger finger classification grade \& VAS

Trigger finger ( TF) is a pathologic problem of the finger leads to a painful tendon snap or click on flexion and extension, and/or locking of the metacarpophalangealor proximal interphalngeal joint (1) . Entrapment of the affected tendon at the first annular (A1) pulley occurs because of a differencein the diameter of the flexor tendon and its sheath as a result of thickening of the sheath and or localized tendon thickening.(1) . Most cases of trigger fingers are idiopathic and the incidence is around 28 cases per 100 000 population per year, or a lifetime risk of 2.6% in the general population and about 10% of patients are diabetics (1). Women are usually more affected than men, usually in the fifth and sixth decades(2) it is more common in women than in men, usually in the dominant hand, and most often in the thumb or ring fingers followed . (2) The diagnosis of trigger finger is based mainly on the medical history and clinical examination. The most important characteristic clinical sign is the mechanical blocking of the finger when flexed with painful snapping extended. (3). Management includes many options such as conservative treatment in the form of splinting, physical therapy, non-steroidal anti-inflammatory drugs, and local steroid injections, and surgical pulley release