Iranian Journal of Orthopedic Surgery

Abstract Abstract
Carpal Tunnel Syndrome (CTS) is the most common idiopathic neuropathic compression syndrome in the upper extremity, with a reported prevalence of 2.7% in the general population. Trigger Finger (TF) is a common upper limb disorder characterized by the painful locking of one or more fingers. A review of the literature, and personal experiences of the authors indicates that the occurrence of Trigger Finger after Carpal Tunnel Syndrome surgery is significantly higher in patients with CTS compared to those without CTS, though this increase in incidence has not definitively been linked to the surgery. In most studies, thumb has been the most commonly involved finger in association with CTS; however, in some cases, the third finger was more common. In contrast, when TF occurs alone, the fourth finger is typically the most frequently affected finger with triggering in the fourth one.

Abstract Background: Entrapment of flexor pollicis longus at the level of A1 pulley is the most common cause of snapping or painful thumb upon flexion and extension motion the so called which is called "Trigger Thumb". The aim of this study is to assess the efficacy of sonographically-guided intra tendon sheath corticosteroid injection in the management of trigger thumb. Methods: In a prospective study 104 patients (7 males, 97 females, 112 trigger thumbs) with the mean age of 52.11±7.63 who had trigger thumb underwent intra flexor sheath corticosteroid injection under the guide of ultrasound in a 2 year period in Rasht-Iran. Improvement was measured using the "Quinnell" grading system before and in intervals after 3 and 6 weeks 3, 6 and 12 months after injection. Results: From the 112 thumbs, 15 (13.4%) required reinjection and/or surgery. Twelve (80%) of these 15 thumbs were simply re-injected, 2 (13.3%) underwent surgery without re-injection but because of no improvement, underwent surgery. Reduction in Quinnell grade after the first injection was significant (p < .0001). One year after the first injection, 111 of 112 thumbs (99.1%) were symptom-free. Conclusion: Sonographically guided intra flexor sheath corticosteroid injectionis an effective method in the management of trigger thumb and would reduce the need for surgical release.