Maintaining intraoperative haemostasis is crucial when conducting wide-awake hand surgeries, this is particularly to improve visibility which will improve patient\'s outcome. There are various methods that could achieve the aforementioned, some of which is wide awake local anaesthesia without tourniquet (WALANT) or Tourniquet alongside sedation. Each method has its own benefits and drawbacks. This study primarily focuses on Carpal Tunnel Syndrome and Trigger Finger release. A comprehensive literature review was conducted through PUBMED, Scopus, google scholar, and web of science. A total of 45 articles were included in the study. We aimed to assess whether the literature supports the use of a tourniquet alongside sedation, or only local anesthesia and epinephrine in wide awake hand surgeries. Moreover, we aimed to highlight the benefits and drawbacks of using a tourniquet, and determine the patient population most likely to benefit from tourniquet application.

OBJECTIVE: Updated retrospective review of the sonographic appearance of palmar fibromatosis (PF) with evaluation of the utility of the Comb Sign previously described in plantar fibromas. Additional evaluation was conducted on the location relative to the flexor tendon, anatomic proximity of palmar fibromas to the A1 pulley and evaluate any potential association with trigger finger.
METHODS: Medical record and imaging review was performed from 2017 to 2023, for patients with a new onset ultrasound or clinical diagnosis of PF. Clinical associations and imaging morphology were reviewed including presence of the Comb Sign, fibroma association with the A1 pulley, and fibroma association with trigger finger.
RESULTS: Exactly 87 total fibromas in 53 patients were evaluated. The Comb Sign was present in 39% of fibromas, usually seen in transverse plane, more prevalent in multifocal disease and larger fibromas. Most (72%) palmar fibromas were within 1 cm of, contacted, or covered the A1 pulley (P < .001). Lateral extension beyond the flexor tendon axis can be seen (44%). Trigger finger and tenosynovitis were rare. However, volume and SI dimension of fibromas were associated with tenosynovitis (P < .0001) and all nine patients with concomitant trigger finger had fibromas within 1 cm from the A1 pulley.
CONCLUSIONS: The Comb Sign can aid in sonographic diagnosis of PF. Lateral extension of fibromas can occur. Most palmar fibromas have a significant intimate association with the A1 pulley, and presence of trigger finger with adjacent palmar fibroma can exist and is important for hand surgeons to know preoperatively.

Trigger finger (TF) is a disorder characterized by snapping or locking a finger. It has a prevalence of greater than 3% in the general population; however, this estimate could be increased to 5% up to 20% in diabetic patients. Some unreal ambiguity about definition, pathophysiology, site of lesion, and etiology are found among researchers and clinicians, leading to a lack of understanding of all aspects of the disease and improper management as many clinicians proceed to anti-inflammatory medications or steroids injection without in-depth patient evaluation. Original articles cited up to 2022, found through a Google search using the specified keywords, have been used in this review. Close-access articles were accessed through our researcher account with the Egyptian Knowledge Bank. In this review, we will focus on pathophysiology to present all possible findings and etiology to represent all risk factors and associated diseases to assess and confirm a diagnosis and the exact location of pathology hence better treatment modalities and reducing the recurrence of the pathology.

OBJECTIVE: Trigger finger (TF) is a common hand condition that can be treated with surgery. We conducted a systematic review and meta-analysis to assess whether ultrasound-guided (US-guided) percutaneous surgery is superior to other conventional surgical methods.
METHODS: We conducted a comprehensive search in Medline, Embase, and the Cochrane Library to identify relevant studies. We included randomized clinical trials (RCTs) and observational studies comparing US-guided TF release with blind percutaneous or open approaches. We combined Risk Ratios (RR) and Mean Differences (MD) with 95% Confidence Intervals (CI) across studies. Data processing and analysis were conducted using R software, version 4.3.1.
RESULTS: Our analysis included eight RCTs and two observational studies with 555 patients. US-guided surgery significantly reduced postoperative DASH scores (MD -3.75 points; 95% CI = -7.48, -0.02; p < 0.01), shortened time to resume activities (MD -11.52 days; 95% CI = -16.13, -6.91; p < 0.01), hastened discontinuation of oral analgesics (MD -4.44 days; 95% CI = -8.01, -0.87; p < 0.01), and improved patient satisfaction scores (RR 1.13; 95% CI = 1.04, 1.23; p = 0.75). There were no significant differences in VAS scores, time to movement recovery, or surgical success rate.
CONCLUSIONS: Ultrasound-guided percutaneous release is a safe, effective, and superior alternative for treating TF compared to other methods, leading to improved DASH scores, quicker recovery, faster cessation of oral analgesics, and enhanced patient satisfaction.

Duplication of the flexor digitorum profundus (FDP) tendon is an extremely uncommon anatomical anomaly found within the flexor digitorum superficialis (FDS) muscle, with minimal documentation in the current literature. We present the case of a 45-year-old female manual laborer who exhibited symptoms suggestive of trigger finger in her right middle finger. Surgical exploration uncovered a duplicated FDP tendon, a previously unreported anatomical anomaly in this context. Despite attempting conservative treatment initially, surgical intervention involving release of the A1 pulley, excision of the A1 pulley, and identification of the duplicated tendon was performed. The unusual nature of this anatomical variation highlights the need for additional research into its clinical significance and treatment options. This case highlights the significance of conducting comprehensive anatomical assessments to diagnose and treat uncommon variations within the FDS muscle. It underscores the continued need for collaborative research to enhance treatment approaches, especially in instances where trigger finger symptoms are present.

Percutaneous first annular pulley (A1 pulley) release, which has been increasingly used to treat trigger fingers, has been widely established as a safe and simple procedure. Multiple studies have reported positive results of percutaneous A1 pulley release. In this study, however, we report cases of patients who developed complications after undergoing percutaneous A1 pulley release at local clinics. A total of six patients visited our hospital for infectious complications after percutaneous A1 pulley release. Various sequelae such as damage to normal structures, insufficient procedure, and tissue necrosis were observed during the exploration. A retrospective study was conducted to identify the cause and trend of the observed complications by instruments (HAKI knife or needle). In the HAKI knife group, there was a tendency for damage to normal structures, while in the needle group, an insufficient release or serious soft tissue necrosis was observed. Based on these cases, our findings confirm the existence and characteristics of infectious complications following the percutaneous A1 pulley release. We further identify that the type of instrument used predicts the nature of complications. Thus, reliable and skilled performance of the procedure by experts is essential for safe treatment.

BACKGROUND: Although corticosteroid injections are an effective treatment for musculoskeletal pathologies, they may not be suitable for all patients. The purpose of this systematic review was to compare clinical outcomes between patients who received NSAID and corticosteroid injections for various orthopedic conditions.
METHODS: Medline, Embase, Web of Science, and Cochrane Central Register of Controlled Trials were searched, and meta-analyses were performed using a random-effects model for outcomes presented in three or more studies. Other studies were qualitatively analyzed.
RESULTS: A total of 28 articles with 2113 patients were included. A meta-analysis of five studies in patients with shoulder impingement syndrome demonstrated that there was no significant difference in the pain visual analogue scale (VAS) between subacromial NSAID injections and corticosteroid injections at 1 month [weighted mean difference (WMD) -0.244; 95% CI, -1.232 to 0.745; I2, 94.5%]. For patients with knee osteoarthritis, a meta-analysis of three studies demonstrated that there was no significant difference between intraarticular NSAID injections and corticosteroid injections in pain VAS at 1 month (WMD 0.754; 95% CI, -0.413 to 1.921; I2, 90.2%) and 3 months (WMD-0.089; 95% CI, -0.345 to 0.166; I2, 0%). A review of the studies assessing pain outcomes for hip osteoarthritis, adhesive capsulitis, and plantar fasciitis showed no significant differences between the NSAID and corticosteroid groups.
CONCLUSIONS: NSAID injections may be safe and effective alternatives to steroid injections, especially in shoulder impingement syndrome and knee osteoarthritis.

Diabetes mellitus is a metabolic disease that results in long-term hyperglycemia. Among the many long-term complications associated with diabetes, manifestations in the hand include Dupuytren\'s contracture, trigger finger, compressive neuropathies, and infections. These conditions can have a profound impact on a patient\'s quality of life, highlighting the importance of timely recognition and treatment of these manifestations. This review aims to provide updated information regarding the incidence and outcomes of these clinical manifestations in the diabetic versus nondiabetic population. A systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was performed. The literature search included the use of PubMed and Ovid databases to find relevant articles that were then selected based on an inclusion criterion that required level 4 evidence. Diabetes mellitus results in an increased incidence of Dupuytren\'s contracture, trigger finger, carpal tunnel syndrome, cubital tunnel syndrome, and hand infections. Dupuytren\'s, trigger finger, and carpal tunnel syndrome all had similar outcomes, while diabetic patients had worse outcomes related to infections. There was a lack of data regarding the effect of diabetes on cubital tunnel syndrome. Future studies should be performed to analyze the effects of diabetes mellitus on hand manifestations, particularly regarding the outcomes of diabetic patients with cubital tunnel syndrome.

Trigger finger release (TFR) is a common hand surgery, historically performed using a tourniquet. Recently, wide-awake local anesthesia no tourniquet (WALANT) has gained popularity due to ostensible advantages such as improved patient pain, satisfaction, lower rate of complications, and decreased cost. This systematic review compares outcomes of WALANT for TFR with local anesthesia with a tourniquet (LAWT). MEDLINE, Embase, CINAHL, Web of Science, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov were searched. All English-language peer-reviewed randomized and observational studies assessing TFR in adults were included. Quality of evidence was assessed with the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. Eleven studies (4 randomized controlled trials, 7 observational) including 1233 patients were identified. In the WALANT group, pain on injection was statistically nonsignificantly lower (mean difference [MD]: -1.69 points, 95% confidence interval [CI] = -4.14 to 0.76, P = .18) and postoperative pain was statistically lower in 2 studies. Patient and physician satisfaction were higher and analgesic use was lower in WALANT. There were no significant differences between groups for functional outcomes or rates of adverse events. Preoperative time was longer (MD: 26.43 minutes, 95% CI = 15.36 to 37.51, P < .01), operative time similar (MD: -0.59 minutes, 95% CI = -2.37 to 1.20, P = .52), postoperative time shorter (MD: -27.72 minutes, 95% CI = -36.95 to -18.48, P < .01), and cost lower (MD: -52.2%, 95% CI = -79.9% to -24.5%) in WALANT versus LAWT. The GRADE certainty of evidence of these results ranges from very low to low. This systematic review does not confirm superiority of WALANT over LAWT for TFR due to moderate to high risk of bias of included studies; further robust trials must be conducted.

BACKGROUND: Trigger finger (also known as stenosing tenosynovitis) is a chronic inflammatory disorder that affects the fingers and causes discomfort and functional impairment. It is estimated to affect 2-3.6% of the population and is more common in manual laborers and individuals engaged in repetitive hand activities. This study comprehensively compares the efficacy of ultrasound-guided release versus traditional open surgery in treating trigger fingers.
METHODS: We systematically searched PubMed, Scopus, EMBASE, and the Cochrane Library to identify relevant studies. Inclusion criteria were studies evaluating ultrasound-guided release of trigger finger (grade 2 and higher) compared with open surgical release. A meta-analysis was performed by Revman software 5.4.1 to assess efficacy, utilizing appropriate statistical methods to address heterogeneity. Primary outcome measures included \"Quick Disability of Arm, Shoulder, and Hand\" (QDASH) scores, Grip strength, and the Visual Analogue Scale (VAS). Secondary outcome measures included Days of stopping analgesia, full-digit flexion and extension, days to return to normal activities, pinch strength, Quinnell grading score, and bow strengthening.
RESULTS: Out of the initial pool of 820 studies, five met the inclusion criteria, including 275 patients with 283 trigger digits. The analysis revealed significant differences favoring the ultrasound-guided release group over the surgical group for improvement in Quick Disability of Arm, Shoulder, and Hand score in the first month (MD -0.48, 95% CI: 0.75 to -0.2, P = .0007, I2  = 20%). The difference was not statistically significant in the 3-month follow-up period (MD -2.25, 95% CI: -0.54 to 0.05, P = .1, I2  = 0%). Additionally, there is a significant difference in the days required for return to normal activities in favor of the ultrasound release approach (MD -13.78, 95% CI: -16.68 to 10.89, P = .00001, I2  = 68%). The data displayed heterogeneity, which was resolved through sensitivity analysis that also favored the ultrasound-guided group. In terms of grip strength, full-digit flexion and extension, VAS, and days of stopping analgesia no significant differences were observed.
CONCLUSIONS: Ultrasound-guided release showed advantages over open surgical release, resulting in improved QDASH score and quicker return to normal activities. This offers a minimally invasive, successful alternative to open surgery, reducing associated risks. Further studies with long-term follow-up are recommended.