Ultrasonography-Guided Corticosteroid Injection Combined with Versus Without Needle Knife Release of A1 Pulley for Trigger Finger

The full text of this preprint has been withdrawn by the authors due to author disagreement with the posting of the preprint. Therefore, the authors do not wish this work to be cited as a reference. Questions should be directed to the corresponding author.

Efficacy Analysis of Day Surgery A1 Pulley Release for Pediatric Trigger Thumb

Objective: To investigate clinical application of day surgery A1 pulley release for pediatric trigger thumb.Methods: We retrospectively analyzed the clinical data of 1,642 children with trigger thumb who were treated with day surgery A1 pulley release at our hospital, including satisfaction surveys, functional recovery, and complications.Results: The operative time for unilateral and bilateral tenolysis was 4.8 ± 3.1 and 9.2 ± 3.8 min, respectively. Three children had postoperative fever and were discharged on the 2nd day after surgery. The rest of the children were discharged on the day of surgery. All incisions healed primarily, and no complications of vascular and nerve injury were reported. The patients' degree of satisfaction with the medical treatment process, diagnosis and treatment workflow, treatment effectiveness, length of hospital stay and hospitalization cost, and discharge guidance were 97.9, 96.1, 99.3, 91.1, and 98.5%, respectively. The follow-up period was between 5 months and 3 years and 1 month. Four children experienced symptom relapse after the operation, and re-tenolysis was performed in one of them. At the final follow-up, the appearance and function of the thumb had recovered well in all cases.Conclusion: Day surgery A1 pulley release can effectively release tendon sheaths and has a short operative time, no complications of vascular and nerve injury, and good recovery of thumb function. It is a safe and reliable procedure with high patient satisfaction, and it is worthy of clinical promotion.

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

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.

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

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.

Ultrasonography-Guided Corticosteroid Injection Combined with Versus Without Needle Knife Release of A1 Pulley for Trigger Finger

Background: Although corticosteroid injection remains a common first-line treatment of trigger finger, but not all cases of trigger finger respond the same. This study aims to compare the clinical effectiveness of ultrasonography-guided corticosteroid injection with and without needle knife release of A1 pulley in treating trigger finger. Methods: 49 patients with trigger fingers (55 fingers, thumb) were included in this study. 28 fingers underwent ultrasonography-guided corticosteroid injection plus needle knife release of A1 pulley (combination group), and 27 fingers underwent only ultrasonography-guided needle knife release of A1 pulley (monotherapy group). Visual analogue scale (VAS), Froimson scale, postoperative recurrence rate, and thickness of A1 pulley in pre-operation and follow-up period were recorded. Results: Higher clinical amelioration and clinical cure rate were observed in combination group at 2 weeks after treatment among patients with Froimson scale Grade III and IV (p<0.05). Among Grade IV patients, combination group had narrower thickness of A1 pulley and better pain relief at 2 weeks postoperatively (all p<0.05). There was no significant difference regarding the values of clinical amelioration rate, clinical cure rate, thickness of the A1 pulley, pain relief and recurrence rate between the two groups at 12 week and 6 months postoperatively (all p>0.05). Conclusion: Ultrasonography-guided corticosteroid injection combined with needle knife release of A1 pulley had superiority in early-stage pain relief and narrowing the thickness of A1 pulley than single needle knife release, but its medium and long-term effects were not obvious.

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

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].