scholarly journals Location and Extent of A1, A2 Release and Its Impact on Tendon Subluxation and Bowstringing—A Cadaveric Study

2019 ◽  
Vol 52 (03) ◽  
pp. 349-354
Author(s):  
Laxminarayan Bhandari ◽  
Alireza Hamidian Jahromi ◽  
Aden Gunnar Miller ◽  
Huey Tien
Keyword(s):  
Surgical Treatment ◽  
Upper Extremity ◽  
Traction Force ◽  
Cadaveric Study ◽  
Trigger Finger ◽  
Flexor Tendons ◽  
Safe Limit ◽  
A2 Pulley ◽  
A1 Pulley

AbstractSurgical treatment of trigger finger involves release of A1 pulley. Some authors have theorized that the loss of A1 pulley can lead to ulnar subluxation of flexor tendons, which can be prevented by release of A1 pulley radially, even in a nonrheumatoid hand. However, there is no evidence in literature to either support or oppose this hypothesis. Occasionally, difficulty is encountered to precisely identify where A1 ends and A2 begins. While incomplete release of A1 can cause relapse of triggering, release of substantial A2 can cause bowstringing. Knowledge of the safe limit of concomitant A2 release is beneficial. The study was conducted in 12 cadaver upper extremity specimens. A1 pulleys of 48 fingers were divided at the radial (24 fingers) or ulnar (24 fingers) attachment. A 20lb traction force was applied on the flexor tendons. Any subluxation or bowstringing was noted. The experiment was repeated following serial release of the A2—initially 25%, followed by 50% and 100%. No bowstringing or subluxation was noted when A1 pulley was opened, either by radial or ulnar incision. The same was true for A1 + 25% A2 release. When A1 + 50% A2 pulley were released, bowstringing was observed in 3/48 fingers. When A1 + 100% of the A2 pulley were released, bowstringing occurred in all cases. The location of incision for release of the A1 pulley has no effect on bowstringing or tendon subluxation. Release of additional 25% of the A2 pulley can be performed safely, which corresponds to the level of palmar digital crease.

scholarly journals A Cadaveric Study of the Thread Trigger Finger Release: The First Annular Pulley Transection Through Thread Transecting Technique

Hand ◽  
2017 ◽  
Vol 13 (2) ◽  
pp. 170-175 ◽  
Author(s):  
Danqing Guo ◽  
Danzhu Guo ◽  
Joseph Guo ◽  
Logan C. McCool ◽  
Brionn Tonkin
Keyword(s):  
Clinical Study ◽  
Flexor Tendon ◽  
Carpal Tunnel Release ◽  
Cadaveric Study ◽  
Trigger Finger ◽  
Digital Nerve ◽  
Iatrogenic Injuries ◽  
A2 Pulley ◽  
Annular Pulley ◽  
A1 Pulley

Background: After the thread transecting technique was successfully applied for the thread carpal tunnel release, we researched using the same technique in the thread trigger finger release (TTFR). This study was designed to test the operational feasibility of the TTFR on cadavers and verify the limits of division on the first annular (A1) pulley to ensure a complete trigger finger release with minimal iatrogenic injuries. Methods: The procedure of TTFR was performed on 14 fingers and 4 thumbs of 4 unembalmed cadaveric hands. After the procedures, all fingers and thumbs were dissected and visually assessed. Results: All of the digits and thumbs demonstrated a complete A1 pulley release. There was no injury to the neurovascular bundle (radial digital nerve in case of thumb), flexor tendon, or A2 pulley for each case. Conclusions: The cadaveric study showed that the technique of TTFR was safe and effective, and the future clinical study is necessary to verify the findings of this study.

scholarly journals A cadaveric assessment of percutaneous trigger finger release with 15° stab knife: its effectiveness and complications

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Abbas Abdoli ◽  
Majid Asadian ◽  
Seyed Houssein Saeed Banadaky ◽  
Rabeah Sarram
Keyword(s):  
Success Rate ◽  
Tendon Injury ◽  
Trigger Finger ◽  
Safe Alternative ◽  
Flexor Tendons ◽  
Flexor Tendon Injury ◽  
Percutaneous Release ◽  
Significant Difference ◽  
A2 Pulley ◽  
A1 Pulley

Abstract Percutaneous release of the A1 pulley has been introduced as a therapeutic approach for trigger fingers and is suggested as an effective and safe alternative, where conservative treatments fail. The aim of the current study was to determine if percutaneous release with a 15° stab knife can effectively result in acceptable efficacy and lower complication rate. Methods In the present study, the percutaneous release of the A1 pulley was evaluated by percutaneous release using a 15° stab knife in 20 fresh-frozen cadaver hands (10 cadavers). One hundred fingers were finally included in the present study. The success rate of A1 pulley release as well as the complications of this method including digital vascular injury, A2 pulley injury, and superficial flexor tendon injury was evaluated, and finally, the data were analyzed by the SPSS software. Results The results showed a success rate of 75% for A1 pulley release in four fingers, followed by eleven fingers (90%) and eighty-five fingers (100%). Therefore, the A1 pulley was found to be completely released in eighty-five fingers (100%). Overall, the mean of A1 pulley release for these fingers was determined as 97.9%, indicating that percutaneous trigger finger release can be an effective technique using a 15° stab knife. Furthermore, our findings revealed no significant difference in the amount of A1 pulley release in each of the fingers in the right and left hands. Additionally, 17 fingers developed superficial scrape in flexor tendons, while 83 fingers showed no flexor tendons injuries and no other injuries (i.e., vascular, digital nerve, and A2 pulley injuries). Conclusions Percutaneous release of the A1 pulley using a 15° stab knife was contributed to acceptable efficacy and a relatively good safety in the cadaveric model.

scholarly journals Comparison of the Thickness of Pulley and Flexor Tendon Between in Neutral and in Flexed Positions of Trigger Finger

2016 ◽  
Vol 10 (1) ◽  
pp. 36-40 ◽  
Author(s):  
Junko Sato ◽  
Yoshinori Ishii ◽  
Hideo Noguchi
Keyword(s):  
Flexor Tendon ◽  
Tendon Sheath ◽  
Trigger Finger ◽  
Neutral Position ◽  
Flexor Tendons ◽  
Flexor Tendon Sheath ◽  
Posterior Direction ◽  
Flexor Digitorum ◽  
A1 Pulley ◽  
Anterior Posterior

Objective: This study aims to compare the morphology of the A1 pulley and flexor tendons in idiopathic trigger finger of digits other than the thumb between in neutral position and in the position with the interphalangeal joints full flexed and with the metacarpophalangeal (MP) joint 0° extended (hook grip position). Method: A total of 48 affected digits and 48 contralateral normal digits from 48 patients who initially diagnosed with idiopathic trigger finger were studied sonographically. Sonographic analysis was focused on the A1 pulley and flexor tendons at the level of the MP joint in the transverse plane. We measured the anterior-posterior thickness of A1 pulley and the sum of the flexor digitorum superficialis and profundus tendons, and also measured the maximum radialulnar width of the flexor tendon in neutral and hook grip positions, respectively. Each measurement was compared between in neutral and in hook grip positions, and also between the affected and contralateral normal digits in each position. Results: In all the digits, the anterior-posterior thickness of flexor tendons significantly increased in hook grip position as compared with in neutral position, whereas radial-ulnar width significantly decreased. Both the A1 pulley and flexor tendons were thicker in the affected digits as compared with contralateral normal digits. Conclusion: The thickness of flexor tendons was significantly increased anteroposteriorly in hook grip position as compared with in neutral position. In trigger finger, A1 pulley and flexor tendon were thickened, and mismatch between the volume of the flexor tendon sheath and the tendons, especially in anterior-posterior direction, might be a cause of repetitive triggering.

scholarly journals Transverse Carpal Ligament and Forearm Fascia Release for the Treatment of Carpal Tunnel Syndrome Change the Entrance Angle of Flexor Tendons to the A1 Pulley: The Relationship between Carpal Tunnel Surgery and Trigger Finger Occurence

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Nazım Karalezli ◽  
Harun Kütahya ◽  
Ali Güleç ◽  
Serdar Toker ◽  
Hakan Karabörk ◽  
...  
Keyword(s):  
Carpal Tunnel ◽  
Trigger Finger ◽  
Distal Forearm ◽  
Transverse Carpal Ligament ◽  
Predisposing Factor ◽  
Maximal Increase ◽  
Entrance Angle ◽  
Flexor Tendons ◽  
Carpal Tunnel Surgery ◽  
A1 Pulley

Purpose. The appearance of trigger finger after decompression of the carpal tunnel without a preexisting symptom has been reported in a few articles. Although, the cause is not clear yet, the loss of pulley action of the transverse carpal ligament has been accused mostly. In this study, we planned a biomechanical approach to fresh cadavers.Methods. The study was performed on 10 fresh amputees of the arm. The angles were measured with (1) the transverse carpal ligament and the distal forearm fascia intact, (2) only the transverse carpal ligament incised, (3) the distal forearm fascia incised to the point 3 cm proximal from the most proximal part of the transverse carpal ligament in addition to the transverse carpal ligament. The changes between the angles produced at all three conditions were compared to each other.Results. We saw that the entrance angle increased in all of five fingers in an increasing manner from procedure 1 to 3, and it was seen that the maximal increase is detected in the middle finger from procedure 1 to procedure 2 and the minimal increase is detected in little finger.Discussion. Our results support that transverse carpal ligament and forearm fascia release may be a predisposing factor for the development of trigger finger by the effect of changing the enterance angle to the A1 pulley and consequently increase the friction in this anatomic area.Clinical Relevance. This study is a cadaveric study which is directly investigating the effect of a transverse carpal ligament release on the enterance angle of flexor tendons to A1 pulleys in the hand.

scholarly journals Pediatric Trigger Finger due to Osteochondroma

Hand ◽  
2016 ◽  
Vol 12 (1) ◽  
pp. 99-105 ◽  
Author(s):  
Ricardo Kaempf de Oliveira ◽  
Pedro J. Delgado ◽  
João Guilherme Brochado Geist
Keyword(s):  
Proximal Phalanx ◽  
Tumor Resection ◽  
Surgical Techniques ◽  
Trigger Finger ◽  
Initial Visit ◽  
Initial Portion ◽  
A2 Pulley ◽  
Finger Motion ◽  
Bone Tumor Resection ◽  
A1 Pulley

Background: The trigger finger is characterized by the painful blocking of finger flexor tendons of the hand, while crossing the A1 pulley. It is a rare disease in children and, when present, is usually located in the thumb, and does not have any defined cause. Methods: We report 2 pediatric trigger finger cases affecting the long digits of the hand that were caused by an osteochondroma located at the proximal phalanx. Both children held the diagnosis of juvenile multiple osteochondromatosis. They had presented at the initial visit with a painful finger blocking. Surgical approach was decided with wide regional exposure, as compared with the trigger finger traditional surgical techniques, with the opening of the A1 pulley and the initial portion of the A2 pulley, along with bone tumor resection. Results: Patients evolved uneventfully, and recovered the affected finger motion. Conclusion: It is important to highlight that pediatric trigger finger is a distinct ailment from the adult trigger finger, and also in children is important to differentiate whenever the disease either affects the thumb or the long fingers. A secondary cause shall be sought whenever the long fingers are affected by a trigger finger.

The thickness of the A2 pulley and the flexor tendon are related to the severity of trigger finger: results of a prospective study using high-resolution ultrasonography

2015 ◽  
Vol 41 (2) ◽  
pp. 204-211 ◽  
Author(s):  
S.-J. Kim ◽  
C.-H. Lee ◽  
W.-S. Choi ◽  
B.-G. Lee ◽  
J.-H. Kim ◽  
...  
Keyword(s):  
Flexor Tendon ◽  
Proximal Part ◽  
Cross Sectional Area ◽  
Trigger Finger ◽  
Sectional Area ◽  
Cross Sectional ◽  
A2 Pulley ◽  
The Cross ◽  
High Resolution Ultrasonography ◽  
A1 Pulley

We aimed to investigate the relationship between the pulley-tendon complexes and the severity of trigger finger. The thickness of the A1 and A2 pulleys, and the cross-sectional area of the flexor tendon under the pulleys, were prospectively assessed using 17 MHz high-resolution ultrasonography, in 20 patients with trigger finger (31 fingers). A control group comprised 15 asymptomatic fingers. The thickness of the A1 pulley and the proximal part of the A2 pulley, and the cross-sectional area of the flexor tendon under the A2 pulley, were significantly increased in the patient group. Clinical grade was significantly correlated with the thickness of the A1 pulley, the thickness of the proximal part of the A2 pulley, and the cross-sectional area of the flexor tendon under the proximal part of the A2 pulley. This study confirmed that the thickness of the A2 pulley and flexor tendon under the A2 pulley seems to be related to the severity of trigger finger. Level of evidences: Level III

Trigger Fingers Requiring Simultaneous Division of the A1 Pulley and the Proximal Part of the A2 Pulley

2007 ◽  
Vol 32 (5) ◽  
pp. 521-523 ◽  
Author(s):  
M. M. AL-QATTAN
Keyword(s):  
Prospective Study ◽  
Range Of Motion ◽  
Full Range ◽  
Proximal Part ◽  
Adult Patients ◽  
Trigger Finger ◽  
A2 Pulley ◽  
A Prospective Study ◽  
A1 Pulley

In a prospective study of 50 adult patients with primary idiopathic trigger finger, four patients (8%) required simultaneous division of the proximal 3 to 4 mm of the A2 pulley as well as the A1 pulley in order to completely resolve the triggering. At final follow up at 6 to 12 months, all patients were symptom-free with a full range of motion of the fingers. This entity is discussed.

scholarly journals Trigger Finger Appearing as Gradually Increasing Digital Nerve Disorder after Surgical Treatment

2013 ◽  
Vol 2013 ◽  
pp. 1-3
Author(s):  
Hiroyuki Tsuchie ◽  
Tomio Nishi ◽  
Hidekazu Abe ◽  
Masaaki Takeshima ◽  
Yoichi Shimada
Keyword(s):  
Surgical Treatment ◽  
Nerve Injury ◽  
Scar Tissue ◽  
Trigger Finger ◽  
Common Disease ◽  
Digital Nerve ◽  
Flexor Pollicis Longus ◽  
Open Release ◽  
Flexor Pollicis Longus Tendon ◽  
A1 Pulley

Trigger finger is a common disease, and operative treatments are often applied for it. Digital nerve injury is one of the complications of this surgical treatment, and paresthesia and sensory disturbance occur early after the operation. This paper presents a case of trigger finger appearing gradually as increasing digital nerve disorder after surgical treatment. In the second surgery, scar tissue covered the palmar MP joint where the A1 pulley had existed before, and palmar digital neurovascular tissue of the ulnar side was found on the inside of the scar. The ulnar digital nerve showed swelling like a neuroma, and bilateral digital nerves existed nearer to the center of the flexor pollicis longus tendon than normal digital nerves. Even when we operate on trigger finger by open release, we should create an appropriate surgical space for observation and be careful of digital nerve injury.

Endoscopic Trigger Finger Release: Surgical Technique

2018 ◽  
Vol 23 (01) ◽  
pp. 158-161
Author(s):  
Scott F.M. Duncan ◽  
Ryosuke Kakinoki ◽  
Ross Dunbar
Keyword(s):  
Surgical Technique ◽  
Minimally Invasive ◽  
Skin Incision ◽  
Endoscopic Technique ◽  
Trigger Finger ◽  
Surgical Approaches ◽  
Flexor Tendons ◽  
Stenosing Tenosynovitis ◽  
A1 Pulley

Numerous surgical approaches have been described for treating patients suffering with stenosing tenosynovitis. The usual surgical descriptions differ mainly by the type of skin incision utilized. The goal of surgery is to completely release the A1 pulley, thereby allowing unimpeded motion of the flexor tendons. We describe a minimally invasive endoscopic technique to address this condition in the fingers.

Management of Stenosing Tenosynovitis (trigger finger) with Ayurved- A case study

2020 ◽  
Vol 8 (01) ◽  
Author(s):  
Sunil D. Tagalpallewar
Keyword(s):  
Middle Finger ◽  
Tendon Sheath ◽  
Finger Joint ◽  
Trigger Finger ◽  
Complete Relief ◽  
Painful Condition ◽  
Flexor Tendons ◽  
Stenosing Tenosynovitis ◽  
Ayurvedic Treatment

Trigger finger is a painful condition that makes your fingers or thumb catch or lock when you bend them. It can affect any finger, or more than one. You might hear it called stenosing tenosynovitis. Most of the time, it comes from a repeated movement or forceful use of your finger or thumb. It can also happen due to inflammation. Local swelling from inflammation or scarring of the tendon sheath (tenosynovium) around the flexor tendons causes trigger finger. These tendons normally pull the affected digit inward toward the palm (flexion). When they are inflamed, they tend to catch where they normally slide through the tendon sheath. A 62 year old patient visited OPD. He was having symptoms on right hand middle finger and side finger.  He has difficulty in folding joint and if he fold finger joint he was unable to straight the joint. There was no relief aftermodern medicine. So he wishes to start Ayurvedic treatment. As per ayurved it is sandhi snayugat vata vikar. So considering this diagnosis, ksheerbala 101-  2 capsules tds were prescribed. Patient got complete relief after 3 months.

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