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.

scholarly journals Features of minimally invasive ligamentotomy of the thumb A1 pulley (our experience)

2021 ◽  
Vol 24 (2) ◽  
pp. 64-73
Author(s):  
A. V. Zhigalo ◽  
V. V. Pochtenko ◽  
V. V. Morozov ◽  
P. A. Berezin ◽  
M. A. Zhogina ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Average Length ◽  
Outpatient Setting ◽  
Trigger Finger ◽  
Safe Procedure ◽  
Results Of Treatment ◽  
Orthopedic Surgeons ◽  
Lower Treatment ◽  
Stenosing Tenosynovitis ◽  
A1 Pulley

Objective. Stenosing tenosynovitis (Nott’s disease, "trigger finger") is one of the most common pathologies of the hand which hand surgeons and orthopedic surgeons have to deal with. A variety of conservative methods are used to treat “trigger finger", including individual splinting and corticosteroid injections. Surgical treatment consists of dissection of the A1 pulley. Traditionally, the operation starts with a small incision. However, in recent years, a number of articles have appeared that report that percutaneous ligamentotomy on II-V fingers is a safe and effective alternative to an open surgery. Due to anatomical features, some authors do not recommend performing a percutaneous ligamentotomy on the thumb, fearing the damage it can cause to the digital nerves.The purpose of this research is to show that the minimally invasive needle ligamentotomy of the thumb A1 pulley is a safe procedure and to conduct the approbation of the offered method.Material and methods. The research consisted of two parts - anatomical and clinical. In the anatomical part of the research (8 upper extremities of 4 unfixed corpses), we proposed the safe accesses in order to conduct percutaneous ligamentotomy of the thumb A1 pulley.In the clinical part of the study we tested a minimally invasive ligamentotomy and analysed the results of treatment in 109 patients with stenosing tenosynovitis of the thumb II-IV stage by Green aged from 28 to 80. All patients received minimally invasive ligamentotomy of the A1 pulley with 18g needle under local anaesthesia (120 surgeries). Average length of the operation was several minutes. All procedures were performed outpatiently. Evaluation of the results of treatment was performed using the Visual Analog Scale (VAS) and Gilberts questionnaire. The observation period was from 12 months up to 24 months.The results. In most cases both clinical and esthetical results were excellent. It was possible to eliminate the “trigger” of the finger intraoperatively for all patients. However, 6 (5.5%) patients complained about the presence of residual clicks due to incomplete dissection of the ligament at the control examination a week later. Percutaneous ligamentotomy was conducted again on all patients with successful outcomes. No recurrence of the disease was noted. 17% of patients tend to complain about pain in the A1 pulley localization during the first week after the operation.Conclusion. The empirical findings prove the efficiency and safety of percutaneous ligamentotomy of the thumb A1 pulley. One of the merits of this technique is a lower risk of postoperative complications and lower treatment expenses. This technique can be successfully used in the practice of hand surgeons in the outpatient setting that have the experience with the conduction of open operations.

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.

scholarly journals Results of percutaneous release of stenosing tenosynovitis (trigger finger) using hypodermic needle

2019 ◽  
Vol 5 (4) ◽  
pp. 578
Author(s):  
Shiv Kumar ◽  
Khalid Muzzafar ◽  
Irfan Tasaduq ◽  
Arpan Bijyal
Keyword(s):  
Hand Function ◽  
Trigger Finger ◽  
Hypodermic Needle ◽  
Common Condition ◽  
Open Release ◽  
Percutaneous Release ◽  
Stenosing Tenosynovitis ◽  
Level Hospital ◽  
A1 Pulley

<p class="abstract"><strong>Background:</strong> Stenosing tenosynovitis or trigger finger is a common condition affecting finger function, which can lead to disability in hand function. Treatment in form of conservative can be helpful in early stages, however later stages and chronic triggering needs release of A1 pulley either by open or percutaneous methods. The aim of this study was to find the results of percutaneous release of trigger finger with 18 guage needle.</p><p class="abstract"><strong>Methods:</strong> 43 digits in 36 patients were enrolled for this prospective study in a district level hospital over a 2 year period. Release was done under local anaesthesia using 18 guage needle percutaneously. Follow up was done upto 6 months. Final scoring was done at 6 months using Quinell’s criteria.<strong></strong></p><p class="abstract"><strong>Results:</strong> We had 81.39% (35 out of 43) excellent to good results. 19.61% (8) needed open release. We had no neurovascular injury or infection in our series.</p><p class="abstract"><strong>Conclusions:</strong> Percutaneous release by 18 guage needle is safe and effective treatment for trigger finger without much complication.</p>

Mini Fronto-Orbital Approach: “Window Opening” Towards the Superomedial Orbit – A Virtual Reality-Planned Anatomic Study

2020 ◽  
Vol 19 (3) ◽  
pp. 330-340 ◽  
Author(s):  
Carmine Antonio Donofrio ◽  
Jody Filippo Capitanio ◽  
Lucia Riccio ◽  
Aalap Herur-Raman ◽  
Anthony J Caputy ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Minimally Invasive ◽  
Three Dimensional ◽  
Skin Incision ◽  
Surgical Approaches ◽  
Target Area ◽  
Minimally Invasive Approach ◽  
Invasive Approach ◽  
Window Opening ◽  
Dissection Technique

Abstract BACKGROUND Surgical approaches to the orbit are challenging and require combined multispecialist skills. Considering its increasing relevance in neurosurgical practice, keyhole surgery could be also applied to this field. However, mastering a minimally invasive approach necessitates an extended learning curve. For this reason, virtual reality (VR) can be effectively used for planning and training in this demanding surgical technique. OBJECTIVE To validate the mini fronto-orbital (mFO) approach to the superomedial orbit, using VR planning and specimen dissections, conjugating the principles of skull base and keyhole neurosurgery. METHODS Three-dimensional measurements were performed thanks to Surgical Theater (Surgical Theater© LLC), and then, simulated craniotomies were implemented on cadaver specimens. RESULTS The mFO approach affords optimal exposure and operability in the target area and reduced risks of surrounding normal tissue injuries. The eyebrow skin incision, the minimal soft-tissue retraction, the limited temporalis muscle dissection and the single-piece craniotomy, as planned with VR, are the key elements of this minimally invasive approach. Furthermore, the “window-opening” cotton-tip intraorbital dissection technique, based on widening surgical corridors between neuromuscular bundles, provides a safe orientation and a deep access inside the orbit, thereby significantly limiting the risk of jeopardizing neurovascular structures. CONCLUSION The mFO approach associated to the window-opening dissection technique can be considered safe, effective, suitable, and convenient for treating lesions located in the superomedial orbital aspect, up to the orbital apex.

Current Image-Guided Interventions in Pediatric Surgery

2020 ◽  
Vol 30 (02) ◽  
pp. 164-171
Author(s):  
Nathan S. Rubalcava ◽  
Marcus D. Jarboe
Keyword(s):  
Image Quality ◽  
Surgical Technique ◽  
Minimally Invasive ◽  
Pediatric Surgery ◽  
Image Guidance ◽  
Surgical Intervention ◽  
Surgical Approaches ◽  
Current Image ◽  
Image Guided ◽  
Invasive Management

AbstractTraditionally, surgical technique has not included imaging modalities. Image guidance had largely been left to radiology specialties. However, in recent years, tremendous advances in imaging have taken place with improvements in image quality, portability, and accessibility. With these advances, surgeons have begun to realize the benefits of fusing image guidance with traditional surgical approaches. Subsequently, many novel surgical approaches utilizing image guidance have been developed that allow for precise, safe, and minimally invasive management of conditions that previously required open surgical intervention.

Minimally invasive video-assisted cervical ventral slot in dogs

2011 ◽  
Vol 24 (01) ◽  
pp. 50-56 ◽  
Author(s):  
M. Manassero ◽  
S. Blot ◽  
J. L. Thibaud ◽  
V. Viateau ◽  
D. Leperlier
Keyword(s):  
Minimally Invasive ◽  
Skin Incision ◽  
Surgical Approaches ◽  
Safe Procedure ◽  
Clinical Experiences ◽  
Technical Problems ◽  
Video Assisted ◽  
Iatrogenic Damage ◽  
Recorded Data ◽  
Potential Damage

Summary Objectives: To investigate the feasibility of a minimally invasive video-assisted (MIVA) cervical ventral slot (VS) in dogs without the use of fluoroscopy, and to report our initial clinical experiences in dogs. Methods: Two surgical approaches to an inter-vertebral disk space (IVDS) were performed in eight intact canine cadavers to determine the feasibility of MIVA-VS using the Destandau Endospine™ Device a (DED) without fluoroscopic guidance. In a subsequent clinical study, 10 client-owned dogs admitted for a Hansen type 1 disk extrusion underwent a MIVA-VS. Recorded data in both studies included: incision lengths, correct targeting of the IVDS, technical problems encountered during the procedure, and potential damage to major anatomical structures. In the 10 clinical cases, duration of the procedure and clinical outcome at five and 12 days, and after a minimum of three months were also recorded. Results: Correct exposure of the targeted IVDS was achieved in all cases. There was no major iatrogenic damage. Mean skin incision length was 39 mm and mean surgery time was 52 minutes. The technique provided increased illumination and magnification of the surgical field. Recovery was uneventful in all cases. Clincial relevance: The present study provided evidence that MIVA-VS using the DED was feasible and a relatively fast and safe procedure for the treatment of cervical disk herniation. Advantages of the technique seemed to include shorter incisions, less dissection and improved visibility.

scholarly journals The Management of Trigger Finger: A 5-Year Retrospective Review

2021 ◽  
Vol 4 (2) ◽  
Keyword(s):  
General Population ◽  
Retrospective Review ◽  
Flexor Tendon ◽  
Age Of Onset ◽  
Ring Finger ◽  
Trigger Finger ◽  
Dominant Hand ◽  
Increased Risk ◽  
Stenosing Tenosynovitis ◽  
A1 Pulley

Stenosing tenosynovitis, generally known as Trigger Finger (TF), is a common hand disorder characterized by pain and locking of the affected digit, which is often found on the dominant hand [1- 3]. This locking occurs when swelling or thickening of the flexor tendon restricts its ability to glide through the A1 pulley during flexion or extension [4, 5]. The general population has a two percent lifetime risk of developing trigger finger, with an average age of onset of 50 years [6, 7]. Women are affected up to six times more than men and diabetics have an increased risk of 10% [8, 9]. Although all digits are susceptible, evidence has shown the ring finger and thumb to be the most affected [10].

An Ultrasound-guided Percutaneous Surgical Technique for Trigger Finger Release Using a Minimally Invasive Surgical Knife

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Michiel Cromheecke ◽  
Vincent Haignère ◽  
Olivier Mares ◽  
Pieter-Bastiaan De Keyzer ◽  
Pascal Louis ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Minimally Invasive ◽  
Trigger Finger ◽  
Ultrasound Guided ◽  
Minimally Invasive Surgical

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.

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