Ultrasound examination was performed to eighteen trigger fingers of thirteen cases with rheumatoid arthritis (RA) and eighteen trigger fingers of fifteen cases with non-rheumatoid arthritis to evaluate pathophysiological features.
Thickness of flexor tendons and synovial tendon sheaths were measured by using a high frequency liner probe. The presence and absence of intra-articular abnormal vascular flow in RA cases were observed and recorded using Power Doppler Method, and then those cases were categorized into four groups with the presence of blood flow signals analyzed semi-quantitatively. The patient's pain was assessed by Visual Analog Scale (VAS).
As a result there was a significant difference (p<0.05) in thickness between the two groups: flexor tendons were thicker in none-RA cases than in RA cases, and there was no difference in Grade categorization between the two groups. On the other hand, there was no significant difference in thickness of synovial tendon sheaths between the two groups, but the higher the cases were graded, the thicker synovial tendon sheaths became. A significant difference in VAS values was observed in RA group as compared to non-RA group, namely, there was a tendency that VAS values increased as the cases were graded higher.
It was indicated that the cause of trigger fingers in non-RA cases was due to thickening of flexor tendons, whereas in RA group inflammation in addition to thickening of synovial tendon sheaths induced strong pain. In addition, Grade classification was correlated with the pain indicated by VAS, which led to assume that it could be an objective assessment method.
We conclude that ultrasound examination is a useful way to properly diagnose the cause of trigger fingers and consider appropriate treatment.

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Background: The systolic excursion of the tricuspid annular plane (TAPSE) reflects right ventricular (RV) ejection fraction. Since RV function may be an important determinant of cardiac output and exercise capacity in pulmonary arterial hypertension (PAH), we hypothesized that TAPSE would correlate with cardiac function and exercise tolerance in patients with PAH.
Methods: We retrospectively reviewed the data from 58 patients (age 52±16 years) with idiopathic PAH (mean pulmonary arterial pressure 51±20 mmHg) who underwent right heart catheterization within 48 hours of transthoracic echocardiography between January 2009 and August 2009, who were in sinus rhythm and had no more than moderate tricuspid regurgitation. We analyzed the relationships between TAPSE and the following parameters: cardiac index, pulmonary vascular resistance, and mean pulmonary arterial pressure assessed by cardiac catheterization, peak systolic tricuspid pressure gradient measured by echocardiography, 6-minute walking distance, plasma BNP level, and serum uric acid level.
Results: TAPSE (17±8 mm) significantly correlated with cardiac index (2.3±1.4 l/min/m²: r=0.48, p<0.05), 6-minute walking distance (447±139 m: r=0.58, p<0.01), pulmonary vascular resistance (1221±960 dynes/sec/m^-5: r=-0.57, p<0.01), and uric acid level (7.5±3.4 mg/dl: r=-0.24, p<0.05), but not correlated with BNP level (530±284 pg/ml), mean pulmonary arterial pressure (51±20 mmHg), and peak systolic tricuspid pressure gradient (76±39 mmHg).
Conclusion: In patients with PAH, RV function evaluated with TAPSE significantly correlates with cardiac output and exercise tolerance. Thus, TAPSE is a useful echocardiographic measure of RV function in patients with PAH.

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