Sonographic depiction of trigger fingers in acromegaly

Objective. The purpose of this study was to compare the prevalence of trigger fingers in patients with acromegaly versus an unaffected control group. Methods. This study was performed with Institutional Review Board approval, and informed written consent was obtained from each patient and control participant. The diagnosis was made by a combination of clinical symptoms and sonographically measured thickening of the first annular (A1) pulley. The A1 pulley thickness was measured in 40 patients and 40 control participants by means of a 17 - 5 MHz high-resolution transducer. Thickening of the A1 pulley and abnormalities of the underlying flexor tendons associated with the clinical sign were diagnostic for a trigger finger. The acromegalic patients were divided into groups according to disease activity and therapy. The study was performed at the baseline and at a follow-up after 1 year. Results. At the baseline, clinical and sonographic findings were consistent with trigger fingers in 25% of patients (6 at presentation and 4 with uncontrolled disease). After 1 year, the trigger fingers recovered in the patients who were not receiving any treatment at the beginning of the study. In patients with uncontrolled disease, the condition remained unchanged. The A1 pulley thickness was greater in the acromegalic patients than control participants (mean ± SD, 0.44 ± 0.19 versus 0.24 ± 0.05 mm; P <.05). In the patients treated for acromegaly, the trigger fingers disappeared, and a reduction in the A1 pulley thickness was noted (P <.05) at the follow-up. Conclusions. Trigger fingers were observed in 25% of the acromegalic patients but in none of the control participants. The A1 pulley was significantly thicker in the acromegalic patients and normalized after 1 year in some who were treated for the disease.