Assessment of short-term response and review of technique of ultrasound-guided percutaneous A1 pulley release for the treatment of trigger finger.

Abstract

Ultrasound-guided percutaneous first annular pulley (A1) release is a non-surgical management for the treatment of trigger finger, also known as stenosing tenosynovitis. Trigger finger occurs secondary to inflammation and retinacular sheath hypertrophy with subsequent restriction of the flexor tendons. Trigger finger can have a marked functional impact, with current conservative measures including steroids and/or splinting, and surgical therapy involving open release. A population of 20 adult patients with ultrasound proven trigger finger underwent percutaneous release with refined technique. Patients with additional ultrasound proven tenosynovitis received steroid injection. Of the 20 cases, 18 cases involved the fingers, 2 cases involved the thumb and 14 cases had additional tenosynovitis. All procedures involving the fingers were well tolerated with initial symptomatic and functional relief. At 1-week post-intervention, 2 finger cases without concurrent steroid injection represented with pain but not triggering. Cases which did not receive concurrent steroid injection described post-procedural pain requiring oral analgesia. One case involving the thumb was complicated by no relief with a mild radial digital nerve neuropraxia, with near complete resolution at 6 weeks. The second thumb case reported only partial relief of triggering. US-guided percutaneous release of the A1 pulley is an effective procedure in achieving at least short-term resolution of trigger finger. It is best reserved for fingers due to the challenging anatomy of the thumb.