Percutaneous release of trigger finger

Abstract

BackgroundTrigger finger, stenosing tenosynovitis, is caused by nodular thickening of the flexor tendon, which catches on the proximal edge of the first A1 pulley; although the natural history indicates a self-limiting disease, prompt treatment is often required. Although a local steroid injection is simple and safe, it sometimes fails to relieve the triggering; then, open surgery is needed. To reduce the morbidity and cost of open release and also to enable outpatient surgery, percutaneous release was introduced.Patients and materialIn a prospective study, we report on 40 trigger fingers in 37 patients using either an 18 G needle or the sharp tip of scalpel No. 11. The age of the patients ranged from 23 to 56 years, with no age limit for the procedure; there were 28 women and 12 men, 20 thumb fingers, 15 ring fingers, four middle fingers, and one index finger.ResultsIn the first week, all the patients were seen; only one complained of pain and recurrent triggering, for whom we performed open release, and two patients had minor asymptomatic triggering and were satisfied. The other 37 patients were completely relieved with no pain and no more triggering. Those who reported complete relief were ranked as showing an excellent result and those with asymptomatic mild triggering as a good result, and there was one failure. Thus, we had 97% excellent and good results. There was no single case of digital nerve or tendon injury and no infection.ConclusionPercutaneous A1 pulley release is a safe method in patients with trigger finger, being advantageous in terms of ease of application, and it is an outpatient procedure with low complication rates and high patient satisfaction.