Ultrasound-Guided Percutaneous Release of A1 Pulley by Using a Needle Knife: A Prospective Study of 41 Cases.

Zhiqi Fan,Min Pan,Hong Yang,Shuya Sheng,Fei Yan,Zhansen E,Hao Lu

doi:10.3389/fphar.2019.00267

Abstract

Objective: The purpose of this study was to evaluate the efficacy of ultrasonography-guided percutaneous A1 pulley release with the needle knife for trigger finger.Methods: The prospective study included 21 patients (21 fingers) who underwent blind release with the needle knife and 20 patients (20 fingers) who underwent ultrasonography-guided release with the needle knife. The thickness and width of A1 pulley, clinical grade before and after release, complications, and operation time were compared between the groups.Results: The results showed that the ultrasonography-guided group had significantly better grade postoperatively and reached to 100% complete release in one time compared to the blind group (p < 0.05). Moreover, no any complications had been happened in the ultrasonography-guided group. A relatively longer operation time of the ultrasonography-guided group was observed compared to the time of the blind group.Conclusions: The needle knife is a very good tool for release of triggering fingers. Ultrasound provides a direct and precise visualization of the thickness, width and location of A1 pulley lesion. The combined use of ultrasound and the needle knife can achieve the best result for trigger finger. Moreover, the combination changes the traditional opinion and operator-dependent mode that were once widely adopted in the hospital of Chinese Medicine.

Highlights

Stenosing tenosynovitis, called trigger finger (TF), is the snapping and locking of the finger, related mainly to an imbalance between the size of the flexor tendons and that of the tendon sheath (Yin and Guo, 2016; Nikolaou et al, 2017)
The exclusion criteria were a previous history of open release for trigger finger, rheumatoid arthritis, a concomitant pathologic condition in hand at the first visit to the rehabilitation doctor, and A1 pulley thickness more than one finger
Mean follow-up, involvement of digit, and the thickness and width of A1 pulley were evaluated as demographic factors

Summary

Introduction

Called trigger finger (TF), is the snapping and locking of the finger, related mainly to an imbalance between the size of the flexor tendons and that of the tendon sheath (Yin and Guo, 2016; Nikolaou et al, 2017). Blind percutaneous A1 pulley release was first described by Lorthior in 1958 (Paulius and Maguina, 2009). This operation can be done without any special preparation and can obtain the effect equal to that of an open procedure. This procedure has many advantages, including shorter recovery time, avoidance of scar tenderness, and application in the outpatient setting (Rajeswaran et al, 2009; Rojo-Manaute et al, 2010, 2012a,b; Smith et al, 2010). It is difficult to confirm whether the release is complete or not during operation because of invisualization directly (Lee et al, 2018)

Methods

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Discussion

Conclusion