Tendinosis in Trigger Finger

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Lundin, Anna-CarinLinköpings universitet,Avdelningen för Kirurgi, Ortopedi och Onkologi,Medicinska fakulteten (author)

Tendinosis in Trigger Finger

BookEnglish2017

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Linköping :Linköping University Electronic Press,2017
61 s.
electronicrdacarrier

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LIBRIS-ID:oai:DiVA.org:liu-136784
ISBN:9789176855355
https://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-136784URI
https://doi.org/10.3384/diss.diva-136784DOI

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Language:English
Summary in:English

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Subject category:vet swepub-contenttype
Subject category:dok swepub-publicationtype

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Linköping University Medical Dissertations,0345-0082 ;1573

Notes

Trigger finger is one of the most common hand conditions, with a prevalence of almost 3%. The aetiology remains unclear even though many causes have been suggested. The prevailing paradigm is that the pathogenesis of trigger finger is ascribed to primary changes in the first fibrous condensation of the tendon sheath (A1-pulley). Several studies have investigated pathology in the pulley, but few have investigated the tendon. The general aim of this thesis was to find out if there is pathology in the trigger finger tendon and to define it.We first looked at trigger finger tendon biopsies in a light microscope, and found that they were histologically different from healthy tendons. They showed signs of micro-ruptures, collagen degradation, increased amounts of ground substance, both hyper- and hypo-cellular areas, round active cell nuclei and absence of inflammatory cells, all similar to tendinosis. The histological picture was further assessed by using a scoring system for Achilles tendinosis. The trigger finger tendons scored high, suggesting a similar histopathology.Next, we performed a quantitative real-time polymerase chain reaction (qPCR) on trigger finger tendons. We assessed the mRNA expression of 10 genes, which have been described to be differently expressed in Achilles tendinosis (collagen 1 and 3, versican, decorin, biglycan, aggrecan, MMP-2, MMP-3, ADAMTS-5, and TIMP-3). The overall expression pattern agreed with previous studies on Achilles tendinosis, suggesting that the cellular function in trigger finger tendons is disturbed in a similar way as in Achilles tendinosis.Recent experimental and observational research has suggested potential side effects of statin treatment on tendons, but firm evidence was lacking. We performed an epidemiological study on two large population-based cohorts. Statin use was found to increase the risk of both trigger finger and tendinosis in the shoulder and Achilles tendons, especially among men. This suggests a similar pathology in trigger finger and tendinosis.We have also studied the time to treatment effect after a single injection of glucocorticoid in trigger finger. Our results suggest that 60-80% of patients can expect resolution of the triggering within 14 days, and half of them within seven days. This result allows correct information to be given to the patient and proper planning of follow-ups.In conclusion, the pathology in trigger finger tendons is similar to tendinosis in other tendons.

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Aspenberg, Per,Professor emeritiusLinköpings universitet,Avdelningen för Kirurgi, Ortopedi och Onkologi,Medicinska fakulteten,Region Östergötland, Ortopedkliniken i Linköping(Swepub:liu)peras36 (thesis advisor)
Eliasson T., Pernilla,DrLinköpings universitet,Avdelningen för Kirurgi, Ortopedi och Onkologi,Medicinska fakulteten(Swepub:liu)perel67 (thesis advisor)
Zdolsek, Johann,Dr.Linköpings universitet,Kirurgi,Medicinska fakulteten,Region Östergötland, Hand- och plastikkirurgiska kliniken US(Swepub:liu)johzd58 (thesis advisor)
Nylander, Göran,Dr.Linköpings universitet,Avdelningen för kliniska vetenskaper,Medicinska fakulteten,Region Östergötland, Hand- och plastikkirurgiska kliniken US(Swepub:liu)gorny98 (thesis advisor)
Dahlin, Lars,ProfessorInstitutionen för translationell medicin-handkirurgi, Lunds Universitet, Skånes universitetssjukhus, Malmö, Sverige. (opponent)
Linköpings universitetAvdelningen för Kirurgi, Ortopedi och Onkologi (creator_code:org_t)

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