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Dorsal proximal interphalangeal joint tenderness is associated with prolonged postoperative pain after A1 pulley
Yuwarat Monteerarat1, Pimolpan Misen1, Panai Laohaprasitiporn1
1Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Insights
Dorsal proximal interphalangeal (PIP) joint tenderness is common in trigger finger patients, affecting nearly half. This tenderness is linked to prolonged postoperative pain after A1 pulley release surgery.
Area of Science:
- Orthopedics
- Hand Surgery
- Musculoskeletal Conditions
Background:
- Dorsal proximal interphalangeal (PIP) joint tenderness is an underrecognized condition in trigger finger patients.
- The prevalence, etiology, and impact on surgical outcomes remain unclear.
- This study addresses the knowledge gap regarding PIP joint tenderness in trigger finger surgery.
Purpose of the Study:
- Determine the prevalence and risk factors for dorsal PIP joint tenderness in trigger finger patients.
- Compare postoperative outcomes for trigger fingers with and without PIP joint tenderness.
- Inform surgical management and patient expectations.
Main Methods:
- Prospective cohort study of 190 patients undergoing open A1 pulley release for trigger finger.
- Investigated incidence, demographics, and surgical outcomes of dorsal PIP tenderness.
- Analyzed risk factors (occupation, symptoms, injections, diabetes) and evaluated pain, function, and range of motion pre- and post-surgery.
Main Results:
- Nearly half (46.8%) of patients exhibited dorsal PIP joint tenderness.
- Joint tenderness was associated with significantly higher and prolonged postoperative pain up to 3 months.
- No significant differences were observed in functional scales or range of motion between groups.
Conclusions:
- Dorsal PIP joint tenderness is more prevalent in trigger fingers than previously assumed.
- Pre-existing PIP tenderness correlates with increased and extended postoperative pain following A1 pulley release.
- Patients with PIP tenderness should be counseled on potential for residual pain post-surgery.
Background:
In some trigger finger patients, tenderness is found in the dorsal proximal interphalangeal (PIP) joint. The etiology and prevalence of this condition are unclear. Furthermore, surgical outcomes for trigger fingers with coexisting dorsal PIP tenderness have not been reported. This study (1) determined the prevalence and risk factors for PIP joint tenderness in trigger fingers and (2) compared postoperative outcomes for trigger fingers with and without joint tenderness.
Methods:
This prospective cohort study was conducted between August 2018 and March 2020. We enrolled 190 patients diagnosed with single-digit trigger fingers undergoing open A1 pulley release. The incidence, demographic data, and surgical outcomes of patients with dorsal PIP tenderness were investigated. Factors associated with tenderness were analyzed, including patient occupation, finger involvement, trigger finger grading, duration of symptoms, previous corticosteroid injections, and presence of diabetes mellitus. A numeric pain scale, a patient-specific functional scale, and the range of motion were evaluated preoperatively and 1, 2, and 6 weeks after surgery, with telephone follow-ups at 3 and 6 months.
Results:
Of 190 patients, 46.8% had tenderness of the dorsal PIP joint. Patients with joint tenderness had significantly more overall postoperative pain for up to 6 weeks and reported residual minor pain for up to 3 months. The functional scale and range of motion of the 2 groups did not differ during follow-up. The only risk factor observed was the occupation of the patients.
Conclusion:
Dorsal PIP tenderness is more common in trigger fingers than previously thought. It is also associated with higher and prolonged levels of postoperative pain after A1 pulley release. Therefore, patients with pre-existing PIP tenderness should be informed about the possibility of sustaining residual minor pain for up to 3 months after surgery.
Level Of Evidence:
II.
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