scholarly journals Pediatric Trigger Finger due to Osteochondroma

Hand ◽  
2016 ◽  
Vol 12 (1) ◽  
pp. 99-105 ◽  
Author(s):  
Ricardo Kaempf de Oliveira ◽  
Pedro J. Delgado ◽  
João Guilherme Brochado Geist
Keyword(s):  
Proximal Phalanx ◽  
Tumor Resection ◽  
Surgical Techniques ◽  
Trigger Finger ◽  
Initial Visit ◽  
Initial Portion ◽  
A2 Pulley ◽  
Finger Motion ◽  
Bone Tumor Resection ◽  
A1 Pulley

Background: The trigger finger is characterized by the painful blocking of finger flexor tendons of the hand, while crossing the A1 pulley. It is a rare disease in children and, when present, is usually located in the thumb, and does not have any defined cause. Methods: We report 2 pediatric trigger finger cases affecting the long digits of the hand that were caused by an osteochondroma located at the proximal phalanx. Both children held the diagnosis of juvenile multiple osteochondromatosis. They had presented at the initial visit with a painful finger blocking. Surgical approach was decided with wide regional exposure, as compared with the trigger finger traditional surgical techniques, with the opening of the A1 pulley and the initial portion of the A2 pulley, along with bone tumor resection. Results: Patients evolved uneventfully, and recovered the affected finger motion. Conclusion: It is important to highlight that pediatric trigger finger is a distinct ailment from the adult trigger finger, and also in children is important to differentiate whenever the disease either affects the thumb or the long fingers. A secondary cause shall be sought whenever the long fingers are affected by a trigger finger.

scholarly journals A Cadaveric Study of the Thread Trigger Finger Release: The First Annular Pulley Transection Through Thread Transecting Technique

Hand ◽  
2017 ◽  
Vol 13 (2) ◽  
pp. 170-175 ◽  
Author(s):  
Danqing Guo ◽  
Danzhu Guo ◽  
Joseph Guo ◽  
Logan C. McCool ◽  
Brionn Tonkin
Keyword(s):  
Clinical Study ◽  
Flexor Tendon ◽  
Carpal Tunnel Release ◽  
Cadaveric Study ◽  
Trigger Finger ◽  
Digital Nerve ◽  
Iatrogenic Injuries ◽  
A2 Pulley ◽  
Annular Pulley ◽  
A1 Pulley

Background: After the thread transecting technique was successfully applied for the thread carpal tunnel release, we researched using the same technique in the thread trigger finger release (TTFR). This study was designed to test the operational feasibility of the TTFR on cadavers and verify the limits of division on the first annular (A1) pulley to ensure a complete trigger finger release with minimal iatrogenic injuries. Methods: The procedure of TTFR was performed on 14 fingers and 4 thumbs of 4 unembalmed cadaveric hands. After the procedures, all fingers and thumbs were dissected and visually assessed. Results: All of the digits and thumbs demonstrated a complete A1 pulley release. There was no injury to the neurovascular bundle (radial digital nerve in case of thumb), flexor tendon, or A2 pulley for each case. Conclusions: The cadaveric study showed that the technique of TTFR was safe and effective, and the future clinical study is necessary to verify the findings of this study.

scholarly journals A cadaveric assessment of percutaneous trigger finger release with 15° stab knife: its effectiveness and complications

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Abbas Abdoli ◽  
Majid Asadian ◽  
Seyed Houssein Saeed Banadaky ◽  
Rabeah Sarram
Keyword(s):  
Success Rate ◽  
Tendon Injury ◽  
Trigger Finger ◽  
Safe Alternative ◽  
Flexor Tendons ◽  
Flexor Tendon Injury ◽  
Percutaneous Release ◽  
Significant Difference ◽  
A2 Pulley ◽  
A1 Pulley

Abstract Percutaneous release of the A1 pulley has been introduced as a therapeutic approach for trigger fingers and is suggested as an effective and safe alternative, where conservative treatments fail. The aim of the current study was to determine if percutaneous release with a 15° stab knife can effectively result in acceptable efficacy and lower complication rate. Methods In the present study, the percutaneous release of the A1 pulley was evaluated by percutaneous release using a 15° stab knife in 20 fresh-frozen cadaver hands (10 cadavers). One hundred fingers were finally included in the present study. The success rate of A1 pulley release as well as the complications of this method including digital vascular injury, A2 pulley injury, and superficial flexor tendon injury was evaluated, and finally, the data were analyzed by the SPSS software. Results The results showed a success rate of 75% for A1 pulley release in four fingers, followed by eleven fingers (90%) and eighty-five fingers (100%). Therefore, the A1 pulley was found to be completely released in eighty-five fingers (100%). Overall, the mean of A1 pulley release for these fingers was determined as 97.9%, indicating that percutaneous trigger finger release can be an effective technique using a 15° stab knife. Furthermore, our findings revealed no significant difference in the amount of A1 pulley release in each of the fingers in the right and left hands. Additionally, 17 fingers developed superficial scrape in flexor tendons, while 83 fingers showed no flexor tendons injuries and no other injuries (i.e., vascular, digital nerve, and A2 pulley injuries). Conclusions Percutaneous release of the A1 pulley using a 15° stab knife was contributed to acceptable efficacy and a relatively good safety in the cadaveric model.

scholarly journals Location and Extent of A1, A2 Release and Its Impact on Tendon Subluxation and Bowstringing—A Cadaveric Study

2019 ◽  
Vol 52 (03) ◽  
pp. 349-354
Author(s):  
Laxminarayan Bhandari ◽  
Alireza Hamidian Jahromi ◽  
Aden Gunnar Miller ◽  
Huey Tien
Keyword(s):  
Surgical Treatment ◽  
Upper Extremity ◽  
Traction Force ◽  
Cadaveric Study ◽  
Trigger Finger ◽  
Flexor Tendons ◽  
Safe Limit ◽  
A2 Pulley ◽  
A1 Pulley

AbstractSurgical treatment of trigger finger involves release of A1 pulley. Some authors have theorized that the loss of A1 pulley can lead to ulnar subluxation of flexor tendons, which can be prevented by release of A1 pulley radially, even in a nonrheumatoid hand. However, there is no evidence in literature to either support or oppose this hypothesis. Occasionally, difficulty is encountered to precisely identify where A1 ends and A2 begins. While incomplete release of A1 can cause relapse of triggering, release of substantial A2 can cause bowstringing. Knowledge of the safe limit of concomitant A2 release is beneficial. The study was conducted in 12 cadaver upper extremity specimens. A1 pulleys of 48 fingers were divided at the radial (24 fingers) or ulnar (24 fingers) attachment. A 20lb traction force was applied on the flexor tendons. Any subluxation or bowstringing was noted. The experiment was repeated following serial release of the A2—initially 25%, followed by 50% and 100%. No bowstringing or subluxation was noted when A1 pulley was opened, either by radial or ulnar incision. The same was true for A1 + 25% A2 release. When A1 + 50% A2 pulley were released, bowstringing was observed in 3/48 fingers. When A1 + 100% of the A2 pulley were released, bowstringing occurred in all cases. The location of incision for release of the A1 pulley has no effect on bowstringing or tendon subluxation. Release of additional 25% of the A2 pulley can be performed safely, which corresponds to the level of palmar digital crease.

The thickness of the A2 pulley and the flexor tendon are related to the severity of trigger finger: results of a prospective study using high-resolution ultrasonography

2015 ◽  
Vol 41 (2) ◽  
pp. 204-211 ◽  
Author(s):  
S.-J. Kim ◽  
C.-H. Lee ◽  
W.-S. Choi ◽  
B.-G. Lee ◽  
J.-H. Kim ◽  
...  
Keyword(s):  
Flexor Tendon ◽  
Proximal Part ◽  
Cross Sectional Area ◽  
Trigger Finger ◽  
Sectional Area ◽  
Cross Sectional ◽  
A2 Pulley ◽  
The Cross ◽  
High Resolution Ultrasonography ◽  
A1 Pulley

We aimed to investigate the relationship between the pulley-tendon complexes and the severity of trigger finger. The thickness of the A1 and A2 pulleys, and the cross-sectional area of the flexor tendon under the pulleys, were prospectively assessed using 17 MHz high-resolution ultrasonography, in 20 patients with trigger finger (31 fingers). A control group comprised 15 asymptomatic fingers. The thickness of the A1 pulley and the proximal part of the A2 pulley, and the cross-sectional area of the flexor tendon under the A2 pulley, were significantly increased in the patient group. Clinical grade was significantly correlated with the thickness of the A1 pulley, the thickness of the proximal part of the A2 pulley, and the cross-sectional area of the flexor tendon under the proximal part of the A2 pulley. This study confirmed that the thickness of the A2 pulley and flexor tendon under the A2 pulley seems to be related to the severity of trigger finger. Level of evidences: Level III

scholarly journals Trigger finger due to phalangeal osteochondroma of an adult: A case report

2020 ◽  
Vol 28 (3) ◽  
pp. 230949902096999
Author(s):  
Hoi Young Kwon ◽  
Hong Je Kang
Keyword(s):  
Pediatric Patients ◽  
Proximal Phalanx ◽  
Middle Finger ◽  
Trigger Finger ◽  
X Rays ◽  
Solitary Osteochondroma ◽  
Stenosing Tenosynovitis ◽  
Left Middle ◽  
A1 Pulley ◽  
Rule Out

Trigger finger is stenosing tenosynovitis that occurs in A1 pulley. It usually occurs idiopathically in patients’ 40s and 50s. On the other hand, pediatric trigger finger usually occurs before 8 years old in pediatric patients. Even though being rare, a tumor occurred in the soft tissue or bone near flexor tendons can cause a trigger finger. Trigger finger due to osteochondroma is very rare. Furthermore, most cases of trigger finger due to osteochondroma occur in pediatric patients with hereditary multiple osteochondromatosis (HMO). The authors report this case of a trigger finger caused by a solitary osteochondroma that occurred in the proximal portion of the proximal phalanx of the left middle finger, of a 21-year-old patient. The symptoms were relieved after excision of the osteochondroma. If a patient with unusual demographics visits, the cause of trigger finger may not be idiopathic. Evaluation methods such as x-rays and ultrasonography can be helpful to rule out other causes, such as tumors.

Solutions to Two Difficult Surgical Problems in Musicians: Modified Surgical Techniques for Basal Thumb Arthritis and Trigger Finger

2008 ◽  
Vol 23 (1) ◽  
pp. 16-19
Author(s):  
R Ragoowansi ◽  
I Winspur
Keyword(s):  
General Population ◽  
Functional Outcome ◽  
Surgical Procedures ◽  
Surgical Techniques ◽  
Trigger Finger ◽  
Thumb Carpometacarpal ◽  
Joint Arthritis ◽  
Cmc Joint ◽  
A1 Pulley ◽  
Population Yield

Basal thumb joint arthritis and trigger finger are problems encountered in musicians. Routine surgical procedures to treat these disorders in the general population yield predictable results with good functional outcome. However, in piano players, routine arthroplasty of the thumb carpometacarpal (CMC) joint cannot meet the specific demands of full opposition/rotation and extension/span. In guitar players and string players, standard release of the A1 pulley for trigger finger can compromise fine distal control of the fingertip in extreme flexion. In this paper, we describe modifications of these procedures tailored to meet the functional demands of pianists, violinists, and guitarists.

Trigger Fingers Requiring Simultaneous Division of the A1 Pulley and the Proximal Part of the A2 Pulley

2007 ◽  
Vol 32 (5) ◽  
pp. 521-523 ◽  
Author(s):  
M. M. AL-QATTAN
Keyword(s):  
Prospective Study ◽  
Range Of Motion ◽  
Full Range ◽  
Proximal Part ◽  
Adult Patients ◽  
Trigger Finger ◽  
A2 Pulley ◽  
A Prospective Study ◽  
A1 Pulley

In a prospective study of 50 adult patients with primary idiopathic trigger finger, four patients (8%) required simultaneous division of the proximal 3 to 4 mm of the A2 pulley as well as the A1 pulley in order to completely resolve the triggering. At final follow up at 6 to 12 months, all patients were symptom-free with a full range of motion of the fingers. This entity is discussed.

Reconstruction of the Mandibular Condyle

2021 ◽  
Author(s):  
Spencer R. Anderson ◽  
Kaitlynne Y. Pak ◽  
Aurora G. Vincent ◽  
Adrian Ong ◽  
Yadranko Ducic
Keyword(s):  
Gold Standard ◽  
Traumatic Injury ◽  
Tumor Resection ◽  
Surgical Techniques ◽  
Mandibular Condyle ◽  
Facial Aesthetics ◽  
Mandibular Growth ◽  
Alloplastic Materials ◽  
Technological Advances ◽  
Integral Structure

AbstractThe mandibular condyle is an integral structure in the temporomandibular joint (TMJ) serving not only as the hinge point for mandibular opening, but also facilitating mandibular growth and contributing to facial aesthetics. Significant compromise of the TMJ can be debilitating functionally, psychologically, and aesthetically. Reconstruction of the mandibular condyle is rarely straightforward. Multiple considerations must be accounted for when preparing for condylar reconstruction such as ensuring eradication of all chronically diseased or infected bone, proving clear oncologic margins following tumor resection, or achieving stability of the surrounding architecture in the setting of a traumatic injury. Today, there is not one single gold-standard reconstructive method or material; ongoing investigation and innovation continue to improve and transform condylar reconstruction. Herein, we review methods of condylar reconstruction focusing on autologous and alloplastic materials, surgical techniques, and recent technological advances.

scholarly journals Complex Bone Tumors of the Trunk—The Role of 3D Printing and Navigation in Tumor Orthopedics: A Case Series and Review of the Literature

2021 ◽  
Vol 11 (6) ◽  
pp. 517
Author(s):  
Martin Schulze ◽  
Georg Gosheger ◽  
Sebastian Bockholt ◽  
Marieke De Vaal ◽  
Tymo Budny ◽  
...  
Keyword(s):  
3D Printing ◽  
Tumor Resection ◽  
Case Series ◽  
Main Process ◽  
Patient Centered ◽  
Individual Care ◽  
Real Time Visualization ◽  
Bone Tumor Resection ◽  
Virtual Modeling

The combination of 3D printing and navigation promises improvements in surgical procedures and outcomes for complex bone tumor resection of the trunk, but its features have rarely been described in the literature. Five patients with trunk tumors were surgically treated in our institution using a combination of 3D printing and navigation. The main process includes segmentation, virtual modeling and build preparation, as well as quality assessment. Tumor resection was performed with navigated instruments. Preoperative planning supported clear margin multiplanar resections with intraoperatively adaptable real-time visualization of navigated instruments. The follow-up ranged from 2–15 months with a good functional result. The present results and the review of the current literature reflect the trend and the diverse applications of 3D printing in the medical field. 3D printing at hospital sites is often not standardized, but regulatory aspects may serve as disincentives. However, 3D printing has an increasing impact on precision medicine, and we are convinced that our process represents a valuable contribution in the context of patient-centered individual care.

Therapy and regeneration-combined bone cements for minimally invasive treatment of neoplastic bone defects

2021 ◽  
Author(s):  
Yu Qu ◽  
Hui Zhuang ◽  
Meng Zhang ◽  
Yufeng Wang ◽  
Dong Zhai ◽  
...  
Keyword(s):  
Calcium Phosphate ◽  
Minimally Invasive ◽  
Tumor Cells ◽  
Bone Tumor ◽  
Tumor Resection ◽  
Bone Defects ◽  
Bone Cements ◽  
Invasive Treatment ◽  
Calcium Phosphate Cements ◽  
Bone Tumor Resection

Although calcium phosphate cements (CPC) have been clinically used to repair bone defects caused by bone tumor resection, traditional CPC cannot kill the remaining tumor cells after surgery and prevent...

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