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.MethodsIn 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.ResultsThe 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).ConclusionsPercutaneous release of the A1 pulley using a 15° stab knife was contributed to acceptable efficacy and a relatively good safety in the cadaveric model.
Highlights
The trigger finger (TF) or stenosing tenosynovitis has been defined as a condition caused by thickening of the flexor tendon sheath or its nodular thickening, resulting in a difference between flexor tendon diameters/retinacular sheath of flexor and the A1 pulley, contributing to the delayed and painful extension of the digit, pain, and disability [1, 2].This implicates the A1 pulley sheath, A2 or A3 [3,4,5]; the primary pathology has been described to be thickened A1 pulley, which is associated with entrapment of the flexor tendon, leading to triggering sensation [6]
There are studies that indicated a lower success rate of conservative treatment including steroid injection in diabetic patients, splinting, and other non-operative modalities [15, 16], while percutaneous release has been introduced as a safe alternative, where conservative treatment fails because trigger digit was found to be effectively managed by percutaneous release [15]
In the present study, the success rate of A1 pulley release was determined from 100 fingers of 10 cadavers including nine males and one female
Summary
The trigger finger (TF) or stenosing tenosynovitis has been defined as a condition caused by thickening of the flexor tendon sheath or its nodular thickening, resulting in a difference between flexor tendon diameters/retinacular sheath of flexor and the A1 pulley, contributing to the delayed and painful extension of the digit, pain, and disability [1, 2] This implicates the A1 pulley sheath, A2 or A3 [3,4,5]; the primary pathology has been described to be thickened A1 pulley, which is associated with entrapment of the flexor tendon, leading to triggering sensation [6]. Success rates of finger release have been reported to be between 84 and 100% by the mid-term follow-up [17,18,19]
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