Ultrasound-guided, percutaneous, needle technique, A1-pulley release for trigger finger

Abstract

Trigger finger is a common cause of hand pain and disability and an A1-pulley dividing, percutaneous release is a definitive treatment for advanced stage disease. High-resolution, musculoskeletal ultrasonography provides clear visualization of the A1-pulley and flexor tendon, however, the evidence to support ultrasonographic guidance of this procedure is scarce. This study aim to evaluate the results of ultrasound (US)-guided, percutaneous, needle technique, annular, A1-pulley release for trigger finger (TF); specifically identifying whether this minimally-invasive procedure had low complication rates and enables early functional recovery. Single center, prospective cohort study of consecutive patients who were > 20 years of age, had grade II TF or higher for at least 4 months, and were unresponsive to conservative treatment. Patients with chronic connective tissue disease, rheumatoid arthritis, previous TF surgery, pregnancy, or bleeding risks were excluded. The procedure was an US-guided percutaneous A1-pulley release using needle technique. Outcome measures at 1 week post-surgery included; recovery time, pain level and duration, use of analgesic medications, time to normal activity of affected TF, and subject satisfaction for cosmesis and overall results. Surgical complications were monitored for 6 months. Thirty-nine fingers from 33 patients who received US-guided, percutaneous, A1-pulley release using needle technique were included in the analysis. Mean operative time was 6.17 (SD = 1.70) minutes. Median postoperative pain duration, use of analgesic medications, and recovery time to normal activity were 1.0 (IQR = 0–2), 0.5 day (IQR = 0.5–1), and 2 days (IQR = 1–2), respectively. Mean subject satisfaction scores for wound appearance and overall treatment were 9.87 and 9.61, respectively. Only one patient had an incomplete release and no severe complication were observed. US-guided, percutaneous, A1-pulley release with needle technique was an effective treatment for TF, with high levels of overall satisfaction and no significant complications.