Morphological alterations of the tendon and pulley on ultrasound after intrasynovial injection of betamethasone for trigger digit

Mitsuhiko Takahashi, Ryosuke Sato, Kenji Kondo, Koichi Sairyo, Mitsuhiko Takahashi, Ryosuke Sato, Kenji Kondo, Koichi Sairyo

Abstract

Purpose: The aim of this study was to elucidate whether intrasynovial corticosteroid injections for trigger digit reduced the volume of the tendon and pulley on high-resolution ultrasonography.

Methods: Twenty-three digits of 20 patients with trigger digit were included. Each affected finger was graded clinically according to the following classification: grade I for pre-triggering, grade II for active triggering, grade III for passive triggering, and grade IV for presence of contracture. Axial ultrasound examinations were performed before an intrasynovial corticosteroid injection and at an average of 31 days after the injection. The transverse diameter, thickness, and cross-sectional area of the tendon and the thickness of the pulley were measured by two independent, blinded researchers.

Results: At least 1 grade of improvement was achieved in this study group by the time of the second examination. The transverse diameter and cross-sectional area of the tendon and the thickness of the pulley significantly decreased (P<0.05).

Conclusion: The injection of a single dose of betamethasone improved clinical symptoms by reducing the volume of both the tendon and pulley, which may be related to the fact that tendon and pulley ruptures are delayed by corticosteroid injections.

Keywords: Adrenal cortex hormones; Tendons; Trigger finger disorder; Ultrasound.

Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1.. A 70-year-old man with grade…
Fig. 1.. A 70-year-old man with grade III trigger finger at the left 4th finger.
A. Longitudinal view on ultrasonography over the palmar aspect of the affected metacarpophalangeal joint refers the positional relation of the axial images. Dotted lines indicate the corresponding axial planes shown in C and D. Scale bar=10 mm. B. The same view with A shows the A1 and A2 pulleys (shaded area) over the tendon (T), volar plate (V), metacarpal head (M) and proximal phalanx (P). C, D. Consecutive axial images show the distal, less thick pulley (C) and the thickest pulley (D). Hypoechoic fluid distension was maximal at the level of D, E. Ultrasonography at the same level as D conducted 26 days after the injection shows decreased thickness of the tendon (from 3.78 to 3.41 mm), cross-sectional area of the tendon (from 18.52 to 16.15 mm2), and thickness of the pulley (from 0.922 to 0.533 mm), but no decrease in the transverse diameter of the tendon (from 5.59 to 5.81 mm) in this case.
Fig. 2.. Axial view for the measurements.
Fig. 2.. Axial view for the measurements.
A-D. An axial view on ultrasonography is used in this study to measure four parameters: the transverse diameter of the tendon (A, dotted line), the thickness of the tendon (B, dotted line), the cross-sectional area of the tendon (C, dotted line), and the thickness of the pulley (D, arrows). The tendon shows a hyperechoic fibrillar pattern, while hypoechoic fluid distension is maximal.

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