Journal of Korean Society of Medical Ultrasound 2003;22(2): 73-78.
Ultrasonography of the Trigger Fingers: Emphasis on Findings of Annular Pulley.
Hye Won Chung
1Department of Radiology, Seoul Municipal Boramae Hospital, Korea.
2Department of Radiology, Seoul National University College of Medicine, Korea.
  Published online: June 1, 2003.
PURPOSE: To analyze the sonographic findings of clinically diagnosed trigger fingers by comparing those of normal fingers with a special emphasis on findings of the annular pulleys that has not been demonstrated previously . MATERIALS AND METHODS: Forty-four fingers of 38 patients with clinically diagnosed trigger fingers and 31 asymptomatic contralateral fingers from 29 patients as the normal control group were included in this study. The mean age of the subjects with trigger fingers was 39 years (age range, 7-74 years; female: male = 32: 6) while that of the normal control group, 49 years (age range, 7-74 years; female: male = 24: 5). Longitudinal and axial images of the flexor digitorum tendons (FDTs) and adjacent soft tissue were obtained with a careful examination of the annular pulleys including A1 pulley. Two radiologists conducted a retrospective analysis of sonographic findings with an emphasis on the visualization and thickness of annular pulleys, thickness and echo pattern of FDTs, distension of tendon sheath , and presence of ganglion. Statistical significances for the difference of thickness of the annular pulleys and FDTs between patients and normal control group were determined with independent sample t-test. The probability value less than .05 was considered statistically significant. RESULTS: Twenty-six of 44 fingers (59%) showed thickened annular pulleys (A1 in 20 and A3 in 6 cases). The thickness of annular pulleys of control and patient groups was 0.27+/-.40 mm and 0.77+/-.85 mm, respectively. The average thickness of FDTs of the control and patient groups were 3.35+/-.77 mm and 3.6+/-.9 mm, respectively. The annular pulleys were thickened in the patient group with a statistical significance (p<0.05) whereas the thickness of FDTs did not. The echo pattern of FDTs was normal in 38 fingers of 44 patients (86%) while only six remaining fingers (14%) showed decreased echo and loss of the normal fibrillary pattern within the tendon. Three fingers showed distension of tendon sheath; one finger showed ganglion attached to the tendon sheath. CONCLUSION: Sonography can clearly demonstrated the presence or absence and the severity of thickening of the annular pulleys in patients with trigger fingers as well as any change of FDTs and other associated findings.
Keywords: Fingers and toes, abnormalities; Tendons, injuries; Tendons, US
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