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

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Protocol publication

[…] All study procedures were conducted in accordance with the 1975 Declaration of Helsinki, as revised in 2008 [], and this study received approval from the Institutional Review Board. Informed consent to be included in this study was obtained from all patients. Consecutive patients clinically diagnosed with trigger digit at our institution between April 2011 and March 2015 were recruited, while patients with rheumatoid arthritis, a prior local corticosteroid injection, severe diabetes mellitus meaning that a local corticosteroid injection might be harmful, a history of infectious disease or major trauma in the same digit, or who were unwilling to participate in this study were excluded from this study. We used radiographs to confirm that none of the patients had a bony deformity, calcium deposition, or osteoarthritis in the digit. Twenty-three digits (five thumbs, one index, nine middle, and eight ring fingers) of 20 patients (seven males and 13 females; mean age, 64.0±9.7 years; range, 44 to 86 years) with trigger digit were ultimately included in this study after the exclusion of a patient who did not show clinical improvement after the treatment. Each affected finger was graded clinically according to signs of triggering: grade I (pretriggering) was defined by pain and a history of catching, but without demonstrable catching on the physical examination; grade II (active triggering) involved demonstrable catching, but the ability to actively extend the digit; grade III (passive triggering) was assigned to patients requiring passive extension or presenting an inability to engage in active flexion; and grade IV (contracture) was assigned to patients who showed fixed flexion contracture of the proximal interphalangeal joint [].All ultrasound examinations and patient management were performed by one author (M.T., 11 years of experience of hand surgery and >20 years of orthopaedic surgery). An axial view using high-resolution ultrasonography (EUB-7500 with a linear-array high-frequency transducer, Hitachi Medical Corp., Tokyo, Japan) was obtained from the volar aspect at the metacarpophalangeal (MP) joint with minimum pressure. The patient was relaxed in the supine position with the affected forearm positioned in supination, the wrist in neutral, and the MP joint in extension. The transducer was placed perpendicular to the tendon, such that the tendon was characterised by its hyperechoic fibrillar pattern and the surrounding fluid distension was maximal. After confirming thickening of the A1 pulley in comparison with that of the adjacent non-affected digit or that of the contralateral digit, 2.5 mg (0.5 mL) of an injectable suspension of betamethasone (Rinderon, Shionogi Co. Ltd., Osaka, Japan) with 10 mg (0.5 mL) of procaine was administered into the intrasynovial space beneath the affected pulley. The injection was made with a 27-gauge needle in a relief-of-resistance manner and with palpation of the distal tendon sheath to monitor ballooning during the injection. Patients were advised to exercise the affected digit after the injection. An ultrasound examination was repeated in the same manner as the initial examination at an average of 31 days (range, 26 to 39 days) after the injection. The axial images presenting maximal surrounding fluid distension both before and after the injection were chosen by the examiner (M.T.) for later measurements (). Two independent raters, both with >8 years of experience of orthopaedic surgery, who were blinded to all medical information about the patients, measured the selected parameters on the chosen image. The transverse diameter, thickness, and cross-sectional area of the tendon and the thickness of the pulley were measured (). The two raters measured these parameters on an independent computer with ImageJ software (ver. 1.46r, NIH, Bethesda, MD, USA) at almost the same time. Statistical analyses were performed using SPSS Statistics for Windows, ver. 22.0 (IBM Corp., Armonk, NY, USA). Linear regression was performed and intraclass correlation coefficients (ICCs) were calculated to quantify the level of agreement between the two raters. All data are averages from the two raters. Data are expressed as mean and standard error of the mean, unless otherwise mentioned. The paired t test was used to compare findings from the two ultrasound examinations. P-values <0.05 were considered to indicate statistical significance. […]

Pipeline specifications

Software tools ImageJ, SPSS
Applications Miscellaneous, Microscopic phenotype analysis
Organisms Homo sapiens
Diseases Rupture
Chemicals Betamethasone