Digital Artery Pseudoaneurysm Following Percutaneous Trigger Thumb Release

Abstract

Stenosing flexor tenosynovitis, or trigger finger, is among the most commonly encountered clinical problems treated by hand surgeons. Corticosteroid injection is the most accepted first-line therapy, with successful resolution of symptoms occurring in 61% of patients1-5. Traditionally, trigger fingers unsuccessfully treated with corticosteroid injections have been managed with open surgical release of the A1 pulley2,3,6,7. Some surgeons have recommended percutaneous release of the A1 pulley1,8-10. Two randomized controlled trials comparing open surgical release with percutaneous release showed equivalent clinical outcomes, but the percutaneous release group had reduced recovery time, fewer wound complications, and lower costs7,11. To our knowledge, no neurovascular complications with the percutaneous release technique have been previously reported in the literature; we report the case of a patient with an iatrogenic pseudoaneurysm of the digital artery during percutaneous trigger finger release (PTFR) surgery. The patient was informed that data concerning his case would be submitted for publication. A sixty-year-old right-hand-dominant man presented with a persistent right thenar mass; this mass had been present for two months following PTFR of the right thumb. The patient, who was on chronic anticoagulation therapy with Coumadin (warfarin) because of a mechanical St. Jude aortic valve replacement, underwent a percutaneous release of the A1 pulley of the right thumb. During the first week following the PTFR, the patient noted substantial ecchymosis and minimal swelling on the dorsal part of the hand (Fig. 1-A). Over the next four weeks, he reported progressive thenar swelling (Fig. 1-B) as well as the onset of hypesthesia in the radial digital nerve distribution of the thumb. A hematoma or pseudoaneurysm was suspected on the basis of clinical examination. Magnetic resonance imaging (MRI) demonstrated a round lesion …