Diagnosis and Treatment of Trigger Finger in Brazil - A Cross-Sectional Study

This is a cross-sectional study with a population composed of participants from the 2018 Brazilian Congress on Orthopedics and Traumatology (CBOT-2018, in the Portuguese acronym), who answered a questionnaire about the conduct adopted for trigger finger diagnosis and treatment.

Results

A total of 243 participants were analyzed, with an average age of 37.46 years old; most participants were male (88%), with at least 1 year of experience (55.6%) and from Southeast Brazil (68.3%). Questionnaire analysis revealed a consensus on the following issues: diagnosis based on physical examination alone (73.3%), use of the Quinnell classification modified by Green (58.4%), initial nonsurgical treatment (91.4%), infiltration of steroids combined with an anesthetic agent (61.7%), nonsurgical treatment time ranging from 1 to 3 months (52.3%), surgical treatment using the open approach (84.4%), mainly the transverse open approach (51%), triggering recurrence as the main nonsurgical complication (58%), and open surgery success in > 90% of the cases (63%), with healing intercurrences (54%) as the main complication. There was no consensus on the remaining variables. Orthopedists with different practicing times disagree on treatment duration (p = 0.013) and on the complication rate of open surgery (p = 0.010).

Conclusions

Brazilian orthopedists prefer to diagnose trigger finger with physical examination alone, to classify it according to the Quinnell method modified by Green, to institute an initial nonsurgical treatment, to perform infiltrations with steroids and local anesthetic agents, to sustain the nonsurgical treatment for 1 to 3 months, and to perform the surgical treatment using a transverse open approach; in addition, they state that the main nonsurgical complication was triggering recurrence, and report open surgery success in > 90% of the cases, with healing intercurrences as the main complication.

Keywords
trigger finger; questionnaire; cross-sectional study; stenosing tenosynovitis

Variables	N	%
Gender
Female	29	12.0
Male	212	88.0
Unknown	2
Brazilian region
Southeast	155	63.8
Northeast	28	11.5
South	28	11.5
Central-West	18	7.4
North	14	5.8
Practicing time
Resident	98	40.3
Up to 1 year	10	4.1
1-5 years	35	14.4
5-10 years	26	10.7
> 10 years	74	30.5
Specialty
Orthopedics Residence	91	37.4
Trauma	48	19.8
Knee	24	9.9
Hand	17	7
Hand Surgery Residence	12	4.9
Shoulder/Elbow	11	4.5
Spine	10	4.1
Pediatrics	8	3.3
Foot/Ankle	7	2.9
External Fixation	5	2.1
Hip	5	2.1
Bone Tumor	4	1.6
Sports Trauma	1	0.4
Mean age (years old) 37.46 ± 11.01	Minimum 24.00	Maximum 79.00

	Practicing Time
	Resident ( n= 98)		≤ 5 years ( n= 45)		> 5 years ( n= 100)
Variable	Resident ( n= 98)		≤ 5 years ( n= 45)		> 5 years ( n= 100)		p-value
Age
Mean	29.65 ± 3.58		32.60 ± 3.17		47.30 ± 10.50		< 0.0001**
Gender	n	%	n	%	n	%
Male	77	78.6	39	88.6	96	97.0	< 0.001*
Female	21	21.4	5	11.4	3	3.0
Unknown	2
Region
Southeast	68	69.39	25	55.56	62	62.0	0.227**
Central-West	9	8.82	1	2.22	8	8.0
Northeast	9	8.82	9	20.00	10	10.0
North	4	3.92	2	4.44	8	8.0
South	8	7.84	8	17.78	12	12.0

	Practicing Time
Variable	Resident (n= 98)	≤ 5 years (n= 45)	> 5 years (n= 100)	p-value
Diagnosis
Physical examination alone (locking)	68 (69.4%)	34 (75.6%)	76 (76.0%)	0.146**
Physical examination and ultrasonography	30 (30.6%)	9 (20.0%)	23 (23.0%)
Physical examination and magnetic resonance imaging	0 (0%)	2 (4.4%)	1 (1.0%)
Classification
Green	50 (51.0%)	28 (62.2%)	64 (64.0%)	0.375*
I do not use a classification system to treat	27 (27.6%)	10 (22.2%)	18 (18.0%)
Quinell	21 (21.4%)	7 (15.6%)	18 (18.0%)
Initial treatment
Physical therapy	43 (43.9%)	17 (37.8%)	53 (53.0%)	0.672**
A1 Pulley infiltration	34 (34.7%)	17 (37.8%)	26 (26.0%)
Surgical treatment	9 (9.2%)	5 (11.1%)	7 (7.0%)
NSAIDs, PO	7 (7.1%)	2 (4.4%)	5 (5.0%)
Steroid, IM	2 (2.0%)	2 (4.4%)	5 (5.0%)
Immobilization	2 (2.0%)	1 (2.2%)	4 (4.0%)
Rest	1 (1.0%)	1 (2.2%)	0 (0%)
Drug used for infiltration
Steroid with anesthetic agent	62 (63.3%)	29 (64.4%)	59 (59.0%)	0.626**
I do not perform infiltrations	21 (21.4%)	8 (17.8%)	20 (20.0%)
Steroids	15 (15.3%)	8 (17.8%)	19 (19.0%)
Hyaluronic acid	0 (0%)	0 (0%)	2 (2.0%)
Number of Infiltrations
None	19 (19.4%)	10 (22.2%)	20 (20.0%)	0.274**
1	41 (41.8%)	10 (22.2%)	32 (32.0%)
2	34 (34.7%)	20 (44.5%)	43 (43.0%)
≥ 3	4 (4.1%)00	5 (11.1%)	5 (5.0%)
Treatment Duration
< 1 month	7 (7.1%)	8 (17.8%)	11 (11.0%)	0.013**
1-3 months	46 (46.9%)	29 (64.4%)	52 (52.0%)
3-6 months	37 (37.8%)	8 (17.8%)	34 (34.0%)
> 6 months	8 (8.2%)	0 (0%)	3 (3.0%)
Nonsurgical Treatment Complications
Triggering recurrence	55 (56.1%)	27 (60.0%)	58 (58.0%)
Persistent local pain	27 (27.6%)	8 (17.8%)	21 (21.0%)	0.805**
Limited finger ROM	14 (14.3%)	9 (20.0%)	17 (17.0%)
Tendon rupture	2 (2.0%)	1 (2.2%)	4 (4.0%)
Nonsurgical Treatment Success Rate
0-30%	25 (25.5%)	9 (20.0%)	30 (30.0%)	0.616**
30-60%	47 (48.0%)	22 (48.9%)	43 (43.0%)
60-90%	24 (24.5%)	11 (24.4%)	21 (21.0%)
> 90%	2 (2.0%)	3 (6.7%)	6 (6.0%)

	Practicing Time
Variable	Resident (n= 98)	≤ 5 years (n= 45)	> 5 years (n= 100)	p-value
Anesthesia type
Sedation with local anesthesia	35 (35.7%)	17 (37.8%)	42 (42.0%)	0.953**
Limb regional block^#	23 (23.5%)	12 (26.7%)	21 (21.0%)
Local anesthetic agent with no vasoconstrictor drug	21 (21.4%)	9 (20.0%)	16 (16.0%)
Brachial plexus regional block	10 (10.2%)	4 (8.9%)	8 (8.0%)
Local anesthetic agent with vasoconstrictor drug	7 (7.2%)	3 (6.6%)	9 (9.0%)
General anesthesia with laryngeal mask	2 (2.0%)	0 (0%)	4 (4.0%)
Surgical Treatment
Transversal open approach	48 (49.0%)	24 (53.3%)	52 (52.0%)
Oblique open approach	22 (22.4%)	6 (13.3%)	15 (15.0%)
Percutaneous release	18 (18.4%)	7 (15.6%)	13 (13.0%)	0.366*
Longitudinal open approach	10 (10.2%)	8 (17.8%)	20 (20.0%)
Percutaneous Surgery Complications
Triggering recurrence	44 (44.9%)	23 (51.1%)	50 (50.0%)
Persistent local pain	20 (20.4%)	12 (26.8%)	17 (17.0%)	0.806**
I do not perform percutaneous surgery	13 (13.2%)	5 (11.1%)	13 (13.0%)
Tendon rupture	8 (8.2%)	1 (2.2%)	11 (11.0%)
Operated finger ROM limitation	5 (5.1%)	1 (2.2%)	2 (2.0%)
Nerve injury	4 (4.1%)	1 (2.2%)	4 (4.0%)
Surgical wound complications	4 (4.1%)	2 (4.4%)	3 (3.0%)
Open Surgery Complications
Surgical wound complications	49 (50.0%)	26 (57.8%)	55 (55.0%)	0.010**
Persistent local pain	32 (32.6%)	10 (22.2%)	21 (21.0%)
Operated finger ROM limitation	8 (8.2%)	7 (15.6%)	3 (3.0%)
Triggering recurrence	8 (8.2%)	2 (4.4%)	16 (16.0%)
Nerve injury	1 (1.0%)	0 (0%)	5 (5.0%)
Percutaneous Surgery Success
0-30%	8 (8.2%)	3 (6.7%)	4 (4.0%)	0.858*
30-60%	18 (18.4%)	9 (20.0%)	20 (20.0%)
60-90%	46 (46.9%)	17 (37.8%)	41 (41.0%)
> 90%	14 (14.3%)	10 (22.2%)	20 (20.0%)
I do not perform percutaneous surgery	12 (12.2%)	6 (13.3%)	15 (15.0%)
Open Surgery Success
0-30%	0 (0%)	0 (0%)	1 (1%)	0.513*
30-60%	4 (4.1%)	2 (4.4%)	1 (1.0%)
60-90%	34 (34.7%)	12 (26.7%)	35 (35.0%)
> 90%	60 (61.2%)	31 (68.9%)	63 (63.0%)

Sociedade Brasileira de Ortopedia e Traumatologia Al. Lorena, 427 14º andar, 01424-000 São Paulo - SP - Brasil, Tel.: 55 11 2137-5400 - São Paulo - SP - Brazil
E-mail: rbo@sbot.org.br

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[1] Address for correspondence Paulo Henrique Jerônimo da Silva, Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Botucatu, 740 - Térreo – Protocolo, São Paulo, SP, 04023-900, Brazil (e-mail: pauloepm76@yahoo.com.br).

Brasil

Brasil

Diagnosis and Treatment of Trigger Finger in Brazil - A Cross-Sectional Study* * Study developed at the Orthopedics and Traumatology Department, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.

Abstract

Objective

Methods

Results

Conclusions

Diagnosis and Treatment of Trigger Finger in Brazil - A Cross-Sectional Study^* * Study developed at the Orthopedics and Traumatology Department, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.