The Effect of Trigger Finger Injection Site on Injection-Related Pain

Background: Stenosing tenosynovitis, or trigger digit, is a common condition for which patients often seek relief. Corticosteroid injections have been shown to provide relief in many cases, and several different approaches for delivering the injection have been described in the literature. We compared patients’ perception of pain following each of 3 accepted injection methods, namely, palmar proximal, palmar distal, and webspace approaches. Methods: We prospectively followed 38 patients with 39 symptomatic digits in this trial, with varying severities of trigger finger as graded by the Patel and Moradia classification. The patients were divided into 3 groups representing the 3 approaches without randomization, based upon the treating surgeons’ preference. Disabilities of the Arm, Shoulder and Hand and visual analog scale (VAS) pain scores were calculated pre-injection and at 4-week and 8-week follow-up visits. Results: No statistically significant differences in age, sex, affected extremity, grade, or duration of symptoms were observed among the 3 approaches. No statistically significant differences in VAS score were found between the palmar proximal (mean = 6.6, SD = 2.6), palmar distal (mean = 6.0, SD = 2.8), and webspace (mean = 6.8, SD = 1.8) approaches. Conclusion: Our data suggest that injection approach does not affect patient pain perception scores or outcomes. We recommend that the technique that is most comfortable to the surgeon be utilized, with the understanding that one injection alone has a low likelihood of relieving symptoms.

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Results of percutaneous release of stenosing tenosynovitis (trigger finger) using hypodermic needle

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20192228 ◽

2019 ◽

Vol 5 (4) ◽

pp. 578

Author(s):

Shiv Kumar ◽

Khalid Muzzafar ◽

Irfan Tasaduq ◽

Arpan Bijyal

Keyword(s):

Hand Function ◽

Trigger Finger ◽

Hypodermic Needle ◽

Common Condition ◽

Open Release ◽

Percutaneous Release ◽

Stenosing Tenosynovitis ◽

Level Hospital ◽

A1 Pulley

Background: Stenosing tenosynovitis or trigger finger is a common condition affecting finger function, which can lead to disability in hand function. Treatment in form of conservative can be helpful in early stages, however later stages and chronic triggering needs release of A1 pulley either by open or percutaneous methods. The aim of this study was to find the results of percutaneous release of trigger finger with 18 guage needle.Methods: 43 digits in 36 patients were enrolled for this prospective study in a district level hospital over a 2 year period. Release was done under local anaesthesia using 18 guage needle percutaneously. Follow up was done upto 6 months. Final scoring was done at 6 months using Quinell’s criteria.Results: We had 81.39% (35 out of 43) excellent to good results. 19.61% (8) needed open release. We had no neurovascular injury or infection in our series.Conclusions: Percutaneous release by 18 guage needle is safe and effective treatment for trigger finger without much complication.

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Ultrasonography-guided sialolithotomy and stricture dilations of the major salivary glands: a preliminary study

Journal of Ultrasonography ◽

10.15557/jou.2021.0038. ◽

2021 ◽

Vol 21 (86) ◽

pp. e237-e243

Author(s):

Kaan Orhan ◽

◽

Poyzan Bozkurt ◽

Zeynep Serap Berktaş ◽

Mehmet Hakan Kurt ◽

...

Keyword(s):

Patient Satisfaction ◽

Positive Outcomes ◽

Case Description ◽

Analog Scale ◽

Pain Scores ◽

Different Types ◽

Preliminary Study ◽

Duct Stricture ◽

Ultrasonography Guidance

Aim of the study: The present preliminary study aims to evaluate the possible positive outcomes of ultrasonography-guided sialolithotomies and duct stricture dilations utilizing stone retrieval baskets and guide wires. Case description: A total of 6 cases in an ongoing study (4 cases of sialolithiasis and 2 cases of duct strictures with intraluminal adhesion) were analyzed. All sialoliths were <5 mm in diameter. Stone removals and duct dilations were performed under ultrasonography guidance with two different types of linear probes. Edema measurements were carried out, and the area of edema was evaluated via the echogenicity changes. Patient satisfaction was also evaluated by the patients themselves using a Visual Analog Scale questionnaire on postoperative day 0, and on days 1, 2, and 3. Conclusions: There were no postoperative complications, and mouth openings returned to normal at 7-day follow-up. The pain scores decreased after 6 hours, and pain subsided completely after 12 hours in all the patients. Edema also resolved gradually after the operation. The patient satisfaction levels were high.

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Anterior versus posterior surgical approach for lumbosacral tuberculosis

Journal of International Medical Research ◽

10.1177/0300060518764933 ◽

2018 ◽

Vol 46 (7) ◽

pp. 2569-2577 ◽

Cited By ~ 3

Author(s):

Bolong Zheng ◽

Dingjun Hao ◽

Hua Guo ◽

Baorong He

Keyword(s):

Cobb Angle ◽

Anterior Approach ◽

Posterior Approach ◽

Operation Time ◽

Analog Scale ◽

Loss Of Correction ◽

Pain Scores ◽

Angle Correction ◽

Before And After

Objective To compare two different approaches for the treatment of lumbosacral tuberculosis. Patients and Methods In total, 115 patients who were surgically treated in our department from July 2010 to July 2014 were included in this retrospective study. They were divided into the anterior and posterior approach groups. Intraoperative hemorrhage; the surgery time; the Cobb angle preoperatively, postoperatively, and at the follow-up visit (2 years postoperatively); visual analog scale (VAS) pain scores before and after surgery; and Oswestry Disability Index (ODI) scores before and after surgery were compared between the two groups. Results The Cobb angle and VAS and ODI scores were significantly improved in both groups after surgery. Significant differences were found in the operation time, intraoperative hemorrhage, Cobb angle correction, and loss of correction at the last follow-up. No significant differences were found in the VAS and ODI scores between the groups. Conclusions The posterior approach is superior to the anterior approach with respect to the surgery time, intraoperative hemorrhage, and Cobb angle postoperatively and at the last follow-up. When both approaches can be carried out for a patient with lumbosacral tuberculosis, the posterior approach should be favored over the anterior approach.

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Significant pain reduction in chronic pain patients after detoxification from high-dose opioids

Journal of Opioid Management ◽

10.5055/jom.2006.0041 ◽

2006 ◽

Vol 2 (5) ◽

pp. 277 ◽

Cited By ~ 59

Author(s):

Michael J. Baron, MD, MPH ◽

Paul W. McDonald, PhD

Keyword(s):

Chronic Pain ◽

High Dose ◽

Pain Condition ◽

Opioid Dose ◽

Pain Scores ◽

Patient Pain ◽

Opioid Induced Hyperalgesia ◽

Pain Sensitization ◽

Pain Patients

Opioid tolerance is a well-established phenomenon that often occurs in patients taking opioids for the treatment of chronic pain. Typically, doctors need to periodically elevate patients’ opioid doses in an attempt to manage their underlying pain conditions, resulting in escalating opioid levels with only moderate to negligible improvement in pain relief. Recently, opioid-induced hyperalgesia has been recognized as a potential form of central sensitization in which a patient’s pain level increases in parallel with elevation of his or her opioid dose. Here, we report a retrospective study of patients undergoing detoxification from high-dose opioids prescribed to treat an underlying chronic pain condition which had not resolved in the year prior. All patients were converted to ibuprofen to manage pain, with a subgroup treated with buprenorphine during detoxification. Selfreports for pain scores were taken at first evaluation, follow-up visits, and termination. Twenty-one of 23 patients reported a significant decrease in pain after detoxification, suggesting that high-dose opioids may contribute to pain sensitization via opioid-induced hyperalgesia, decreasing patient pain threshold and potentially masking resolution of the preexisting pain condition.

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Total subaxial reconstruction

Journal of Neurosurgery Spine ◽

10.3171/2010.4.spine09923 ◽

2010 ◽

Vol 13 (4) ◽

pp. 424-434 ◽

Cited By ~ 6

Author(s):

Vincent C. Traynelis

Keyword(s):

Cervical Spine ◽

Visual Analog Scale ◽

Anterior Decompression ◽

Analog Scale ◽

Excellent Outcome ◽

Arm Pain ◽

Subaxial Cervical Spine ◽

Pain Scores ◽

The Mean

Object Certain cervical spinal conditions require decompression and reconstruction of the entire subaxial cervical spine. There are limited data concerning the clinical details and outcomes of patients treated in this manner. The object of this study was to describe the specific technique employed to perform a total subaxial reconstruction and review the postoperative outcomes following surgery. Methods The author performed a review of data prospectively collected in 27 consecutive patients undergoing complete anterior decompression and reconstruction of the anterior cervical spine and followed by posterior instrumented arthrodesis with or without decompression. Results There were 16 men and 11 women whose mean age was 59 years (range 35–86 years). The minimum follow-up was 12 months and the mean follow-up period for all patients was 26 months. One patient underwent C2–7 surgery, and in all others the procedure crossed the cervicothoracic junction. Following surgery patients remained intubated for an average of 3.3 days (range 1–22 days). The mean hospital length of stay was 11 days (range 3–45 days). One patient died 6 weeks following an uneventful surgery. Pneumonia developed in 5 patients, 1 patient experienced a minor pulmonary embolism, and 2 patients had posterior wound infections. No patient was neurologically worse following surgery. A single patient presented with a C-8 radiculopathy 6 weeks after surgery. At final follow-up no patient complained of dysphagia when specifically questioned about this potential problem. In all patients solid fusions developed at each treated levels. Preoperatively the mean sagittal Cobb angle was 15.4° (kyphosis) and the postoperative mean angle was −10.9° (lordosis) representing a total average correction of over 25° (p < 0.0001). The mean preoperative Neck Disability Index was 27.6; this score decreased to 15.5 (p = 0.0008) postoperatively. The mean pre- and postoperative visual analog scale neck pain scores were 6.0 and 2.1, respectively (p = 0.0004), and mean visual analog scale arm pain scores decreased by 3.7 following surgery (p = 0.001). Based on Odom criteria, the author found that 8 patients had an excellent outcome and 14 patients a good outcome. There were 4 patients in whom the outcome was judged to be fair and the single death was recorded as a poor outcome. The mean preoperative Nurick score was 2.68. Postoperatively the group improved to an average score of 1.5; the difference between the 2 was statistically significant (p = 0.002). Conclusions Segmental anterior decompression and reconstruction of the entire subaxial cervical spine, combined with an instrumented posterolateral fusion, can be performed with acceptable morbidity and is of significant benefit in selected patients.

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Trigger Finger Corticosteroid Injection With and Without Local Anesthetic: A Randomized, Double-Blind Controlled Trial

Hand ◽

10.1177/1558944719884663 ◽

2019 ◽

pp. 155894471988466

Author(s):

J. Randall Patrinely ◽

Shepard P. Johnson ◽

Brian C. Drolet

Keyword(s):

Local Anesthetic ◽

Corticosteroid Injection ◽

Controlled Trial ◽

Treatment Method ◽

Trigger Finger ◽

Injection Pain ◽

Double Blind ◽

Pain Scores ◽

Injection Methods ◽

To Receive

Background: The first-line treatment for trigger finger is a corticosteroid injection. Although the injectable solution is often prepared with a local anesthetic, we hypothesize that patients receiving an injection with anesthetic will experience more pain at the time of injection. Methods: C Patients with trigger finger were prospectively randomized into 2 cohorts to receive triamcinolone (1 mL, 40 mg) plus 1% lidocaine with epinephrine (1 mL) or triamcinolone (1 mL, 40 mg) plus normal saline (1 mL, placebo). Both patient and surgeon were blinded to the treatment arm. The primary outcome was pain measured using a (VAS) immediately following the injection. Results: Seventy-three patients with a total of 110 trigger fingers were enrolled (57 lidocaine with epinephrine and 53 placebo). Immediate postinjection pain scores were significantly higher for injections containing lidocaine with epinephrine compared with placebo (VAS 3.5 vs 2.0). Conclusions: In the treatment of trigger finger, corticosteroid injections are effective and have relatively little associated pain. This study shows there is more injection-associated pain when lidocaine with epinephrine is included with the corticosteroid. Therefore, surgeons looking to decrease injection pain should exclude the anesthetic, but they should discuss the trade-off of foregoing short-term anesthesia with patients. Using only a single drug (ie, corticosteroid alone) is not only less painful but is also more simple, efficient, and safe; this has therefore become our preferred treatment method.

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Comparative study of ultrasonography-guided percutaneous A1 pulley release versus blinded percutaneous A1 pulley release

Journal of Orthopaedic Surgery ◽

10.1177/2309499018772368 ◽

2018 ◽

Vol 26 (2) ◽

pp. 230949901877236 ◽

Cited By ~ 4

Author(s):

Sung Hyun Lee ◽

Young Chae Choi ◽

Hong Je Kang

Keyword(s):

Patient Satisfaction ◽

Postoperative Pain ◽

Prospective Study ◽

Proximal Interphalangeal Joint ◽

Interphalangeal Joint ◽

Trigger Finger ◽

Analog Scale ◽

Vas Score ◽

A1 Pulley

Purpose: The purpose of this study was to compare the results of blind versus ultrasonography-guided percutaneous A1 pulley release for treatment of trigger finger. Methods: This prospective study included 21 patients (25 fingers) who underwent blind release and 20 patients (23 fingers) who underwent ultrasonography-guided release. The visual analog scale (VAS) score, proximal interphalangeal joint contracture, complications, and patient satisfaction were compared between the groups. Results: At the final follow-up, triggering had disappeared in all patients who underwent ultrasonography-guided release, whereas three patients who underwent blind release required revision surgery for postoperative triggering. No complications were observed. VAS score was significantly different between groups at 2 and 4 weeks postoperatively. All patients who underwent ultrasonography-guided release were satisfied, whereas three patients who underwent blind release were not satisfied. Conclusion: Ultrasonography-guided percutaneous A1 pulley release for treatment of trigger finger reduces postoperative pain and complications, such as incomplete release, compared with a blind procedure.

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Comparative Analysis of Periodontal Pain Using Two Different Orthodontic Techniques, Fixed Multibrackets and Removable Aligners: A Longitudinal Clinical Study with Monthly Follow-Ups for 12 Months

Applied Sciences ◽

10.3390/app112412013 ◽

2021 ◽

Vol 11 (24) ◽

pp. 12013

Author(s):

Silvia Alcón ◽

Adrián Curto ◽

Mario Alvarado ◽

Alberto Albaladejo ◽

Daniele Garcovich ◽

...

Keyword(s):

Clinical Study ◽

Visual Analog Scale ◽

Study Groups ◽

Analog Scale ◽

Pain Scores ◽

Patient Reported ◽

Maximum Pain ◽

Conventional Brackets ◽

Longitudinal Clinical Study

The aim of this study was to evaluate the perception of periodontal pain in patients treated with either fixed multibrackets or removable alignment systems with a monthly follow-up over a period of twelve months. Materials and Methods: This longitudinal clinical study comprised a sample of 140 patients (72 women; 68 men) divided into two groups of 70 patients each: the bracket group (BG) with conventional fixed brackets using the MBT technique with a 0.022″ slot and the Invisalign group (IG) with aligners (Invisalign). The visual analog scale (VAS) was used to quantify patient-reported pain. Pain analysis was conducted monthly at 4 (T1), 8 (T2), and 24 h (T3) post-follow-up as well as at 2 (T4), 3 (T5), 4 (T6), 5 (T7), 6 (T8), and 7 days (T9) post-follow-up during the first twelve months after starting orthodontic treatment. Results: Statistically significant differences (p < 0.05) were observed between both study groups in the mean pain scores on the visual analog scale (VAS) during the twelve-month follow-up period, except for during the eighth month of treatment. In the first month, the group with conventional brackets reported higher pain scores. From the second month onwards, we observed that patients with aligners described a higher level of pain compared to the group of patients with conventional brackets. In both experimental groups, though at different evaluation periods, we found that the peak of maximum pain occurred between 24 and 48 h (T3–T4) after monthly follow-up appointments; from this point, the pain decreased until reaching minimum values from the fifth day onwards (T7). Conclusions: In the first month of treatment, the patients with conventional fixed multibrackets reported the highest levels of pain compared to those with removable aligners. From the second month on, this trend changed. The patients with removable aligners reported the highest levels of pain. Therefore, the orthodontic system used influenced the perception of pain in patients.

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Methylprednisolone Acetate Versus Dexamethasone Injection for Trigger Finger: A Double-blind Randomized Controlled Trial

Journal of Health Science and Medical Research ◽

10.31584/jhsmr.2021794 ◽

2021 ◽

Author(s):

Porames Suwanno ◽

Chaiwat Chuaychoosakoon

Keyword(s):

Randomized Controlled Trial ◽

Controlled Trial ◽

Trigger Finger ◽

Methylprednisolone Acetate ◽

Analog Scale ◽

Short Term ◽

Double Blind ◽

Randomized Controlled ◽

Prospective Randomized Controlled Trial

Objective: The study investigated the resolution of triggering by either a soluble methylprednisolone acetate or dexamethasone injection for idiopathic trigger finger at 24-week after injection.Material and Methods: One hundred and six patients were enrolled in a prospective randomized controlled trial (53 methylprednisolone acetate arms, 53 dexamethasone arms). The outcome was evaluated at 2, 6, 12 and 24-week follow-up.Results: The absence of triggering was documented in 32 of 43, 36 of 41 patients in the methylprednisolone cohort and in 20 of 43, 29 of 32 patients in the dexamethasone cohort at 6 and 24-week after injection. The methylprednisolone acetate cohort had significantly better satisfaction on a visual analog scale, tenderness, and locking at 2-week follow-up, and had significantly better satisfaction on resolution of triggering, tenderness, snapping, locking and the Disabilities of the Arm, Shoulder and Hand score at 6-week follow-up compared to those in the dexamethasone cohort.Conclusion: Methylprednisolone acetate is better in short term clinical outcomes than dexamethasone

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Chronic Tennis Elbow Treated by Platelet-Rich Plasma Versus Steroid Injections: A Comparative Study

AL-Kindy College Medical Journal ◽

10.47723/kcmj.v15i2.158 ◽

2020 ◽

Vol 15 (2) ◽

pp. 35-39

Author(s):

Mohammed Sh. Al-Edanni

Keyword(s):

Tennis Elbow ◽

Platelet Rich Plasma ◽

P Value ◽

First Line ◽

Analog Scale ◽

Lateral Epicondyle ◽

Pain Scores ◽

Group A ◽

Group B

Background: Painful elbow joint over the lateral epicondyle especially with resisted wrist extension are common signs of lateral epicondyle tendinopathy, also called tennis elbow. Objective: To evaluate the clinical outcome of local platelet rich plasma (PRP) injection in patients with chronic tennis elbow compared with a steroid (Depomedrol 40 mg) injection. Methods: A total of 88 patients with chronic tennis elbow were treated at Al-Kindy Teaching Hospital and private clinics. All patients had chronic pain for about 24 weeks or more and had failed first line treatment. The patients dividing into two groups, Group A injected with PRP (n = 44), and group B injected with depomedrol 40 mg (n = 44). A good clinical result was demarcated as 25% or more progress on the visual analog scale for pain. All patients followed for 6 months in both group for clinical successful result. Results: At three months (n = 44), in group A reported a perfection of 58.2% in their pain scores while 49.3% in the group B (N = 44). At 6 months follow up, the group A informed a perfection of 74.3% in their pain scores while 58.4 % in the group B. The local elbow tenderness recording at three months was 37.4% in the group A, while in the group B was 48.4%. At six months, 16.1% versus 30.2% recounted major elbow tenderness (P = .009) in groups (A and B) respectively. The clinical improvement rates at three months revealed no changes between both groups while it showed more significant clinically changes in group A ( 87.1%) than in group B (70.1 %) with P value = 0.008 after six months follow up. Conclusion: No important changes were found at 3 months in both groups, but at 6months, clinical significant perfections in patients treated with PRP group (group A)

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