{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T04:06:32Z","timestamp":1770696392671,"version":"3.49.0"},"reference-count":59,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,2,8]],"date-time":"2026-02-08T00:00:00Z","timestamp":1770508800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Background: The traditional A1-centric paradigm for trigger finger (TF) management does not fully capture heterogeneous pathology spanning isolated pulley stenosis, tendon degeneration, and impaired tendon\u2013sheath gliding. Methods: A comprehensive literature synthesis (2010\u20132025) integrating anatomy, biomechanics, and ultrasound-guided interventions was performed to develop a testable, phenotype-driven framework. Results: A continuum model is proposed emphasizing (i) origin-to-insertion assessment of the flexor apparatus, (ii) pragmatic ultrasound phenotyping into pulley-dominant, tendon-dominant, and mixed patterns, and (iii) a stepwise, phenotype-matched management pathway incorporating conservative care, ultrasound-guided injection, selected adjuncts (e.g., hydrodissection, prolotherapy, ESWT) for tendon-dominant or mixed presentations, and percutaneous or open release when an A1 bottleneck is confirmed. Conclusions: This framework is presented as a hypothesis to guide standardized reporting, reliability testing, and phenotype-stratified comparative trials, rather than as a validated clinical guideline. This article proposes a novel, phenotype-driven clinical framework to address this limitation. Contemporary evidence is integrated to construct a model emphasizing (i) a whole-length, origin-to-insertion assessment of the flexor apparatus, (ii) sonographic phenotyping into pulley-dominant, tendon-dominant, and mixed patterns, and (iii) a stepwise treatment algorithm integrating conservative care, ultrasound-guided injections, ultrasound-guided percutaneous release, and selected adjunctive approaches such as hydrodissection (HD), prolotherapy (Prolo), and extracorporeal shockwave therapy (ESWT). While evidence supports individual modalities, the framework\u2019s primary innovation lies in matching interventions to phenotype. This sonographic phenotyping system is presented not as a validated tool, but as a testable hypothesis designed to guide future validation studies. The proposed framework establishes research priorities, including standardized criteria, reliability testing, and comparative effectiveness research for phenotype-stratified management.<\/jats:p>","DOI":"10.3390\/life16020289","type":"journal-article","created":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T09:41:02Z","timestamp":1770630062000},"page":"289","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Toward a Phenotype-Driven Continuum Model in Trigger Finger: Proposing a Sonographic Framework for Personalized Management"],"prefix":"10.3390","volume":"16","author":[{"given":"Sang-Hyun","family":"Kim","sequence":"first","affiliation":[{"name":"College of Korean Medicine, Woosuk University, 443, Samnye-ro, Samnye-eup, Wanju_gun, Jeonju 55338, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9141-9856","authenticated-orcid":false,"given":"Jihyo","family":"Hwang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Gangnam Sacred Heart Hospital, Hallym University College of Medicine, 1 Singil-ro, Yeongdeungpo-gu, Seoul 07441, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8746-3718","authenticated-orcid":false,"given":"Yonghyun","family":"Yoon","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Gangnam Sacred Heart Hospital, Hallym University College of Medicine, 1 Singil-ro, Yeongdeungpo-gu, Seoul 07441, Republic of Korea"},{"name":"Incheon Terminal Orthopedic Surgery Clinic, Inha-ro 489beon-gil, Namdong-gu, Incheon 21574, Republic of Korea"},{"name":"International Academy of Regenerative Medicine, Inha-ro 489beon-gil, Namdong-gu, Incheon 21574, Republic of Korea"},{"name":"International Association of Musculoskeletal Medicine, Kowloon, Hong Kong, China"},{"name":"MSKUS, 1035 E. Vista Way #128, Vista, CA 92084, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jaeik","family":"Choi","sequence":"additional","affiliation":[{"name":"International Academy of Regenerative Medicine, Inha-ro 489beon-gil, Namdong-gu, Incheon 21574, Republic of Korea"},{"name":"Dr. Choi\u2019s Rehabilitation Clinic, Daelim Building 303, Kojandong, Ansansi, Kyengido, Seoul 15476, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gyungseog","family":"Ko","sequence":"additional","affiliation":[{"name":"International Academy of Regenerative Medicine, Inha-ro 489beon-gil, Namdong-gu, Incheon 21574, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hyeongjik","family":"Kim","sequence":"additional","affiliation":[{"name":"International Academy of Regenerative Medicine, Inha-ro 489beon-gil, Namdong-gu, Incheon 21574, Republic of Korea"},{"name":"Ahyeon Orthopedic Clinic, B270 Sinchon-ro, Mapo-gu, Seoul 04116, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dongyeun","family":"Sung","sequence":"additional","affiliation":[{"name":"International Academy of Regenerative Medicine, Inha-ro 489beon-gil, Namdong-gu, Incheon 21574, Republic of Korea"},{"name":"Himchannamu Neurosurgery Clinic, 439, Hakjeong-ro, Buk-gu, Daegu 41423, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rowook","family":"Park","sequence":"additional","affiliation":[{"name":"International Academy of Regenerative Medicine, Inha-ro 489beon-gil, Namdong-gu, Incheon 21574, Republic of Korea"},{"name":"Department of Rehabilitation Medicine, Sae Yonsei Rehabilitation Clinic, Seoul 03186, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jaehyun","family":"Shim","sequence":"additional","affiliation":[{"name":"International Academy of Regenerative Medicine, Inha-ro 489beon-gil, Namdong-gu, Incheon 21574, Republic of Korea"},{"name":"Department of Neurosurgery, Chungdammadi Neurosurgery Clinic, Seoul 03186, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonghyeok","family":"Lee","sequence":"additional","affiliation":[{"name":"International Academy of Regenerative Medicine, Inha-ro 489beon-gil, Namdong-gu, Incheon 21574, Republic of Korea"},{"name":"Bareun Neurosurgery Clinic, 39, Daenong-ro, Heungdeok-gu, Cheongju-si 28402, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seungbeom","family":"Kim","sequence":"additional","affiliation":[{"name":"International Academy of Regenerative Medicine, Inha-ro 489beon-gil, Namdong-gu, Incheon 21574, Republic of Korea"},{"name":"Miso Pain Clinic, 1569, Bongyeong-ro, Yeongtong-gu, Suwon-si 16703, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Youngmo","family":"Kim","sequence":"additional","affiliation":[{"name":"International Academy of Regenerative Medicine, Inha-ro 489beon-gil, Namdong-gu, Incheon 21574, Republic of Korea"},{"name":"Hongje Oneul Teun Teun Clinic, 442, Tongil-ro, Seodaemun-gu, Seoul 03629, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1392-829X","authenticated-orcid":false,"given":"King Hei Stanley","family":"Lam","sequence":"additional","affiliation":[{"name":"International Academy of Regenerative Medicine, Inha-ro 489beon-gil, Namdong-gu, Incheon 21574, Republic of Korea"},{"name":"Faculty of Medicine, The University of Hong Kong, Hong Kong, China"},{"name":"Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China"},{"name":"The Department of Clinical Research, The International Association of Musculoskeletal Medicine, Hong Kong, China"},{"name":"The Department of Clinical Research, The Hong Kong Institute of Musculoskeletal Medicine, Hong Kong, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,8]]},"reference":[{"key":"ref_1","unstructured":"Jeanmonod, R., Tiwari, V., and Waseem, M. 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