Toward a Phenotype-Driven Continuum Model in Trigger Finger: Proposing a Sonographic Framework for Personalized...

Area of Science:

• Orthopedics
• Musculoskeletal Imaging
• Regenerative Medicine

Background:

• The traditional A1 pulley-centric approach inadequately addresses the diverse pathologies in trigger finger (TF).
• Heterogeneous conditions include isolated pulley stenosis, tendon degeneration, and impaired tendon-sheath gliding.

Purpose of the Study:

• To develop a testable, phenotype-driven framework for trigger finger management.
• Integrate anatomy, biomechanics, and ultrasound interventions for a novel clinical model.

Main Methods:

• Comprehensive literature synthesis (2010-2025) on trigger finger pathology and treatments.
• Development of a continuum model based on origin-to-insertion assessment of the flexor apparatus.
• Pragmatic ultrasound phenotyping into pulley-dominant, tendon-dominant, and mixed patterns.

Main Results:

• A stepwise, phenotype-matched management pathway is proposed.
• Includes conservative care, ultrasound-guided injections, and adjuncts like hydrodissection, prolotherapy, and ESWT.
• Percutaneous or open release is indicated for confirmed A1 pulley stenosis.

Conclusions:

• The proposed framework is a testable hypothesis for standardized reporting and comparative trials.
• Emphasizes matching interventions to specific sonographic phenotypes (pulley-dominant, tendon-dominant, mixed).
• Guides research priorities for reliability testing and phenotype-stratified comparative effectiveness studies.