Percutaneous Release Research Articles

PERCUTANEOUS RELEASE OF THE MEDIAL COLLATERAL LIGAMENT DURING KNEE ARTHROSCOPY

The complete visualisation of the internal joint space is crucial for effective knee arthroscopy. However, limited access to certain areas can lead to complications, including cartilage damage. Percutaneous partial release of the medial collateral ligament has been shown to effectively widen the medial compartment of the joint. Objective. This study aimed to determine the effect of percutaneous release of the medial collateral ligament on the postoperative period and restoration of knee joint function. Methods. The patients were divided into two groups: the study group (n = 32) and the comparison group (n = 36). T he study group underwent partial resection of the medial meniscus in combination with percutaneous partial release of the medial collateral ligament, while the comparison group underwent only partial removal of the medial meniscus without widening the medial joint gap. The assessment included pain, functional recovery according to the Tegner Lisholm scale, and the possibility of developing medial instability. Results. The analysis of VAS scores showed a significant reduction in pain in both groups over time. However, there was no significant difference in pain intensity between the two groups during the study. According to the Tegner Lysholm scale, there was a statistically significant improvement in the functional status of patients 6 months after surgery compared to preoperative values in both the study group (p = 0.0034) and the control group (p = 0.0071). However, there was no statistically significant difference between the groups on t he s ame s cale ( p = 0 .871). The study g roup s howed a s light increase in valgus deviation of the tibia (no more than 5o) in 14 (43.75%) patients during the valgus stress test performed on days 7–10 postoperatively. However, after 6 weeks, none of the patients reported any subjective instability or weakness of the knee joint. Therefore, it can be concluded that the procedure was successful. Conclusion. Percutaneous release of the medial collateral ligament to widen the medial aspect during knee arthroscopy has no effect on the postoperative period or the results of partial removal of the medial meniscus.

Ultrasound-guided vs. non-guided trigger finger release: a systematic review and meta-analysis.

Trigger finger (TF) is a common hand condition that can be treated with surgery. We conducted a systematic review and meta-analysis to assess whether ultrasound-guided (US-guided) percutaneous surgery is superior to other conventional surgical methods. We conducted a comprehensive search in Medline, Embase, and the Cochrane Library to identify relevant studies. We included randomized clinical trials (RCTs) and observational studies comparing US-guided TF release with blind percutaneous or open approaches. We combined Risk Ratios (RR) and Mean Differences (MD) with 95% Confidence Intervals (CI) across studies. Data processing and analysis were conducted using R software, version 4.3.1. Our analysis included eight RCTs and two observational studies with 555 patients. US-guided surgery significantly reduced postoperative DASH scores (MD -3.75 points; 95% CI = -7.48, -0.02; p < 0.01), shortened time to resume activities (MD -11.52 days; 95% CI = -16.13, -6.91; p < 0.01), hastened discontinuation of oral analgesics (MD -4.44 days; 95% CI = -8.01, -0.87; p < 0.01), and improved patient satisfaction scores (RR 1.13; 95% CI = 1.04, 1.23; p = 0.75). There were no significant differences in VAS scores, time to movement recovery, or surgical success rate. Ultrasound-guided percutaneous release is a safe, effective, and superior alternative for treating TF compared to other methods, leading to improved DASH scores, quicker recovery, faster cessation of oral analgesics, and enhanced patient satisfaction.

Open Versus Percutaneous Fixation of Trigger Finger: Meta-Analysis of Clinical Outcomes

With variable and conflicting results to date, it remains unclear whether the percutaneous or open surgical A1 pulley release technique is superior regarding safety and efficacy. The goal of this meta-analysis was to compare the two techniques. PubMed, Cochrane, and Google Scholar (pages 1-20) were searched through August 2023. Eight randomized controlled trials met the inclusion criteria and were included in this meta-analysis. Of the eight included studies and 548 total patients, there were 278 subjects in the percutaneous release group and 270 subjects in the open release group. There was no significant difference between the two surgical techniques in postoperative rates of revision, complications, or pain. This meta-analysis found no significant difference between open and percutaneous techniques regarding the need for revision procedures, complications, or postoperative pain. Therefore, both open and percutaneous releases are appropriate. Therapeutic I.

MANAGEMENT OF CONGENITAL TALIPES EQUINOVARUS WITH PONSETI TECHNIQUE IN CHILDREN UNDER 2 YEARS OF AGE

ABSTRACT: BACKGROUND AND OBJECTIVES: CTEV is a complex congenital deformity of the foot and occurs due to the confluence of genetic &amp; environmental factors. If it is not treated promptly and accordingly, it limits patient mobility and results in a painful foot. In most cases, it is treated conservatively using the Ponseti technique. This method was developed by a Japanese orthopedic surgeon Ignatio Ponseti who successfully treated CTEV in infants without extensive surgery. It is a manipulative technique with percutaneous release of tendoachilles that allows the ankle to obtain correction. This study was conducted to assess the functional outcomes of CTEV management by Ponseti method. METHODS: Ethical approval was obtained from the Ethical Review Board Of Services Hospital Lahore. This descriptive study was conducted at the department of orthopedic surgery from December 2018 to December 2020. A total number of 120 patients having CTEV deformity of the foot, aged less than 2 years, were included in the study. From these, 70 children had bilateral foot involvement. It was treated with 5-7 casts with each cast applied for 07 days according to the Ponseti method. In the final cast, a percutaneous Achilles Tenotomy was performed, where the deformity was restricted to 10 degrees from the neutral. After completion of casts, each patient was braced with Foot Abduction Brace. RESULTS: We used Pirani Score for pre- and post-operative assessment of correction of deformity via Ponseti method. There were 91% excellent results achieved through this method, whilst 6% of patients had good results and 3% had poor results. CONCLUSION: Ponseti technique has got good functional &amp; cosmetic results. It is economical and easy to apply. KEY WORDS: Club foot, Pirani Shafique score, Ponseti technique, CTEV

Prospective evaluation of a novel device for ultrasound-guided percutaneous treatment of carpal tunnel and trigger finger disease. Efficacy and safety of sono-instruments®.

To evaluate the safety and effectiveness of percutaneous release procedures under sonography using Sono-Instruments® in the treatment of carpal tunnel syndrome (CTS) and trigger finger (TF). Prospective study involving 30 patients, divided into two groups (15 CTS, and 15 TF). The primary outcomes were surgical performance-related outcomes (visibility, ease of use, satisfaction, duration) using Sono-Instruments® and patient-related outcomes (pain, activity limitations, time to return to work, functional scores). Secondary outcomes included complications. Patients were followed for two months post-operatively. In the CTS group, the average age of the patients was 58.7years. The percutaneous release of the transverse carpal ligament was effectively completed in all cases, with excellent device performance and no adverse events. At one week, all patients could wash their hands, 80% could perform activities of daily living, and 80% of those working had returned to their activities. At two months, all patients had resumed all activities. Pillar pain was still present in 53.3%. In the TF group, the patients had an average age of 57.9years. The percutaneous release of the A1 annular pulley was successful in all cases, with excellent device performance and no adverse events. At one week, all patients could wash their hands, 93.3% could do all activities of daily living, and 75% of those working were back to their professional activities. At two months, all patients were back to all activities of daily living and work. The DASH score was significantly improved at two months, compared to preoperative, for both groups (p < 0.001). Percutaneous sono-guided release using Sono-Instruments® is safe and efficient, and associated with quick functional recovery. II.

O24: Triggering Change: Evaluating Minimally Invasive Techniques in the Pandemic-Era Hand Surgery in Malaysia

Abstract Aims This study aimed to compare outcomes of open surgical release versus ultrasound-guided and anatomical landmark-guided percutaneous release techniques for trigger finger treatment during the COVID-19 pandemic (year 2020-2022) at a single centre in Malaysia. Methods A retrospective review was conducted for 44 patients (94 digits) who underwent open surgical release (OS, n=52 digits), ultrasound-guided percutaneous release (UPR, n=30 digits), or anatomical landmark-guided percutaneous release (APR, n=12 digits) for trigger finger from 2020-2022. Outcomes assessed included post-operative pain, triggering recurrence, time to return to work/activities, patient satisfaction, and complications. Results Patients undergoing percutaneous release had expedited return to work/activities (3 days) compared to open surgery (20 days) (p&amp;lt;0.0001). No UPR/APR patients reported persistent pain at 3 months versus 13.5% of OS patients. Recurrence rates were comparable between modalities (1.9% vs 2.4%). Patient satisfaction was similar across OS/UPR/APR groups (4.4 vs 4.3 vs 4.4). Complication risks were lower with percutaneous techniques. Conclusions During the COVID-19 pandemic, percutaneous trigger finger release facilitated swifter rehabilitation and reduced hospital visits versus open surgery. The percutaneous approaches demonstrated clear benefits especially relevant for strained healthcare systems, including neater post-operative recovery, diminished long-term discomfort, and lower complication risks. Percutaneous release has considerable advantages and merits wider embrace.

Percutaneous release of trigger finger and its functional outcome

Background: An overview of percutaneous release for trigger finger and its functional outcomes. Methods: The present prospective controlled analytical study was conducted after taking approval from center human ethical committee. A written and informed consent was obtained. There were 50 patients who reported to outpatient department (OPD) with symptoms suggestive of trigger thumb/ finger, were subjected to the study. Results: Most of the patients belonged to the age group of 41-50 years. Majority of patients were females (56%) and males were (44%). Most of the patients had the right 1st digit involved (32%), followed by left 1st and right 3rd digit (18% each). Before the release of affected digit, 56% were grade 3, 26% were grade 4 and only 18% were grade 1. Complete resolution immediately after the procedure was seen in 82% cases. Pre procedure, mean VAS of 8.4 reduced to mean VAS of 6.2 immediate post procedure. At 48 hours post procedure, mean VAS of 3.06 and mean VAS of 1.12 was seen at 1-month post procedure period. At 3 months post procedure, mean VAS of 0.42. 94% cases had no complications. Conclusions: Percutaneous release of trigger finger is a safe and effective procedure associated with favorable functional outcomes. It provides an alternative treatment option for patients who have failed conservative management or prefer a minimally invasive approach.

Retrograde Percutaneous Release of Trigger Finger or Thumb Using Sono-Instruments®: Detailed Technique, Pearls, and Pitfalls.

Percutaneous release is a common treatment option for trigger finger stenosing tenosynovitis. While surgical and conservative treatments are available, percutaneous techniques offer several advantages, including faster recovery time, reduced complications, and simultaneous treatment of multiple trigger fingers. The sono-instrument is a minimally invasive device designed for surgical release of the A1 pulley in adults. The device is efficient and safe, and in addition, several design features enhance the visibility of the instrument under ultrasound imaging. The technique is truly percutaneous, as the whole operation is done through a single needle puncture. This minimizes postoperative discomfort and allows an immediate return to daily living and professional activities. The technique can be performed in an outpatient clinic under local anesthesia. The learning curve is quick; however, surgeons must acquire experience in hand sonography to master this new form of surgery. The aim of this article is to provide an in-depth exposition of the technical nuances, pearls, and pitfalls of this novel retrograde percutaneous release method. To our knowledge, this is the first retrograde truly percutaneous release technique yet described, facilitated by the novel Sono-Instruments®.

Does Surgical Experience Affect the Outcomes During Percutaneous Release of the Trigger Finger?

Background Trigger finger is a condition characterized by clicking or locking during finger movement, sometimes resulting in the freezing of a finger in flexion or extension. The aim of our retrospective study was to determine the effect of the surgeon's learning curve on clinical outcomes in percutaneous release of the trigger finger. In addition, we evaluated the effects of diabetes and local steroid injections on clinical outcomes. Methodology A total of 954 trigger fingers in 678 patients were reviewed from 2012 to 2022. All percutaneous release procedures were performed by a single surgeon in our institute under local anesthesia. The main outcome measures were recurrence and patient satisfaction. In addition, all patients were evaluated in terms of re-operation and complications. The mean follow-up period was 54.87 months. Results There was complete relief of symptoms in 636 (93.81%) patients, and 22 (3.24%) patients had mild pain but were satisfied. We found that the success rateincreased over time. The success rate was 91.4% in the first three years and increased to 98.25% in the next seven years (p = 0.001). There was no statistically significant difference between the diabetic and non-diabetic groups in terms of recurrence, satisfaction rate, and complications (p > 0.05). There was no statistically significant difference in terms of recurrence, satisfaction rate, and complications between the groups that received and did not receive steroid injections (p > 0.05). Conclusions Percutaneous release is a safe and reliable procedure in the treatment of trigger fingers, and the success rate increases as the experience increases. Moreover, diabetes mellitus and steroid injections did not affect the clinical results.

Long-term outcomes of percutaneous release technique or open for trigger finger in diabetic patients

Aims: Trigger finger is seen more often in diabetic patients and can lead to more serious postoperative complications compared to non-diabetic patients. The aim of this study was to compare the outcomes of open and percutaneous release techniques in diabetic patients.&#x0D; Methods: This retrospective study included 62 patients who met the study criteria. Of these patients, 32 underwent open release surgery and 30 underwent percutaneous release with an 18-gauge needle. The patients were evaluated retrospectively in respect of the data on first presentation preoperatively and at postoperative follow-up examinations at 3 weeks, 6 months and 1 year. A retrospective examination was made of the demographic data, Visual Analog Scale (VAS) scores preoperatively, at 6 and 12 months postoperatively, recurrence rates at the end of 6 months and 1 year, the Quinnell grading scale at the end of 1 year, wound site infection, tendon damage and neurovascular complications. VAS scores and the Quinnell grading scale were used for clinical evaluation. &#x0D; Results: The data of a total of 62 patients were statistically analyzed in the study, with 32 (51.6%) in the Open group and 30 (48.4%) in the Percutaneous group. The mean age of the patients was 58.97±7.51 (min-max: 45-72) years. The distributions of trigger finger and Quinnell grading system scores were statistically similar between the groups (P=0.974, P=0.279, respectively). The recurrent triggering rate at the 6th and 12th month was significantly higher in the Percutaneous group (P=0.049, P=0.049, respectively). The average return to work duration in the Percutaneous group (1.70±0.75) was significantly shorter than that in the Open group (3.88±1.21) (P

Comparison of Percutaneous A1 Pulley Release versus Steroid Injection in Terms of Mean Pain Score in Trigger Digits

Objective: To compare percutaneous A1 pulley release and steroid injection in terms of mean pain score in trigger digit. Study Design: Comparative cross- sectional study. Place and Duration of Study: Orthopedic Department Combined Military Hospital, Rawalpindi Pakistan, from Mar to Aug 2018. Methodology: Patients with trigger finger diagnosed clinically in Out Patient Department meeting inclusion and exclusion criteria were included in the study. Patients were randomly allocated to Group A &amp; B by lottery method. Group A had percutaneous release of A1 pulley using a surgical blade 11, after preparation of the skin and injection of 1ml 2% plain Lidocaine. Group B had injection with corticosteroid. Both procedures were carried out in Out Patient Department under strict aseptic measures. Visual analogue score at start and end of the study was recorded. Results: A total of 185 patients were included in this study, 122(66%) were males and females were 63(34%). The mean age of patient was 37.80±11.80 years with range from 15-60 years. Mean score of Group A was 39.16±12.22 years and the mean age Group B was 38.93±10.98 years. 56(30.3%) patient had mild visual analogue score, 96 (51.9%) had moderate visual analogue, 33(17.8%) had severe visual analogue. Conclusion: Percutaneous release was found better option for the treatment of the trigger digit with a high success rate. Surgery should be reserved only for cases refractory to steroid injection technique.

Ultrasound-Guided Percutaneous Release of Pulley in Trigger Finger: A Curved Needle Technique

Thickened A1 pulley is the most common cause of trigger finger. The patient complains of snapping and locking of finger like a trigger as the gliding of the flexor tendon become harder through the thickened pulley during flexion and superadded development of nodule on the surface of the tendon proximal to pulley. In severe cases or failed conservative/steroid injection cases, real-time percutaneous release of pulley under ultrasound (US) guidance can be considered. The percutaneous pulley release is a minimally invasive procedure compared to open surgical release and more accurate than blind percutaneous release with overall minimal complications. The US-guided percutaneous A1 pulley release has been described in the literature and done by knife, straight needles, and acutely bent needles with variable results. We describe the curved needle technique of percutaneous pulley release. The curved needle technique for US-guided A1 pulley release is novel and has the advantage of easy maneuverability over acutely bent needle and minimal chances of complications. The cutting edge of the curved needle scores through the thickened pulley with effective release and easy maneuverability.

A retrospective study comparing open and percutaneous trigger finger release in the Thai population

Background: Over the years, open surgery has been the primary treatment for trigger finger, a prevalent issue among hand illnesses. There has been some resistance to the technique's routine use, despite the fact that the percutaneous release of triggers provides a quicker recovery than surgery. As a result, the study proposed that the percutaneous release technique outperforms open surgery. The objective of this study was to compares the trigger finger surgery's open and percutaneous releases in terms of short-term results. Methods: From 2014 to 2020, 166 patients who underwent open or percutaneous release surgery for the trigger finger at Naresuan University Hospital were the subjects of this retrospective analysis. For one, three, and six weeks, the initial characteristics and post-operative hemorrhage, digital nerve and artery injury, surgical site pain, inability to flex the finger, and other outcomes were compared. The visual analog scale (VAS) score and the impairments of the arm, shoulder, and hand (DASH) score were also compared between the two groups. Results: The age, sex, and number of patients in both groups were statistically comparable. Before the procedure, there was no difference between the groups in terms of DASH and VAS scores for pain; however, at six weeks, the percutaneous release group showed a substantial difference and low VAS scores. There were no differences between the groups in terms of consequences, including wound pain, damage to digital nerves and arteries, and others. Conclusion: Based on the patients' short-term outcomes, the study found that percutaneous release of the trigger finger is just as successful as traditional open surgery.

Stenosing Flexor Tenosinovitis on Middle Finger (Trigger Finger), Surgical Treatment in a 1 Year Old Pacient. Case Report

Trigger finger, or stenosing tenosynovitis, is a common pathology of the hand, but a low incidence of this condition has been reported in children. Its pathophysiology is poorly understood and genetic association studies are lacking. There are conservative management such as immobilization with a splint, corticosteroid injection, physical rehabilitation therapy, but the definitive treatment is usually surgical, including percutaneous release of the A1 pulley and open release of the A1 pulley.

Failure rates and analysis of risk factors for percutaneous A1 pulley release of trigger digits.

This study aimed to identify the rates and risk factors for failure of percutaneous A1 pulley release. We retrospectively analysed patients who underwent percutaneous A1 pulley release between 2015 and 2019. We defined failure as (1) pain or discomfort at the final follow-up, (2) when open release or revision percutaneous release was performed, or (3) when steroid injections were administered three or more times for symptom control. A total of 331 digits from 251 patients were included. The mean follow-up duration was 47 months (minimum 24 months). Complete resolution was achieved in 287 cases (87%), but 21% required steroid injection before symptoms settled. There was failure in 44 cases (13%). Involvement of the index, middle and ring fingers was significantly different between the successful and failure groups. Percutaneous A1 pulley release has a long-term success rate of 87%. The failure rate was higher when the procedure was performed on the index, middle or ring fingers.Level of evidence: III.

Percutaneous release for trigger thumb in children under local anesthesia.

Trigger thumb surgery can be performed through open surgery or percutaneous release. Open surgery often requires hospitalization, an operating room, a surgical incision, and postoperative wound care; however, percutaneous release does not require hospitalization or surgery, and is relatively easier and faster. We aimed to assess the results of percutaneous A-1 pulley release using local anesthesia without hospitalization for the treatment of pediatric trigger thumb. In this retrospective study, we included patients operated on between March 2013 and August 2020 with the diagnosis of trigger thumb. The percutaneous release under local anesthesia was applied to all the children by one orthopedic surgeon. All percutaneous release procedures were performed in outpatient clinic conditions. There were 183 children (218 thumbs) who were enrolled in the clinic. Eighty-seven patients were male (47.5%) and 96 were female (52.5%). The average follow-up duration was 5 years (1-8.5 years). Among the 218 trigger thumb cases, 211 were satisfactory (successful result rate 96.8%). Relapse was seen in only 3 thumbs in the early postoperative period. No patient experienced neurovascular deficit or infection. The percutaneous surgical release in pediatric trigger thumb treatment is a simple, minimally invasive procedure that can be done in an outpatient setting under local anesthesia. In addition, the procedure duration is short and has minimal complication rates and maximum patient satisfaction. Level of Evidence III.

FUNCTIONAL OUTCOME FOLLOWING PERCUTANEOUS RELEASE OF TRIGGER FINGER IN A TERTIARY CARE CENTRE

Background: Trigger nger is a common clinical disorder caused by irritation of the exor tendon as it slides through the bro-osseous sheath and characterized by pain and catching as the patient exes and extends digits because of disproportion between the diameter of exor tendons and the A1 pulley. Its surgical options include open and percutaneous minimally invasive methods. A prospective study was conducted in Methods: Gauhati Medical college and Hospital over the course of 4 months in which 23 patients aged 23-66 years presenting with trigger nger were treated with percutaneous release. Percutaneous trigger nger release of A1 pulley was done with the help of 18G hypodermic needle under local anaesthetic cover as a day care procedure. Subsequently the patient was followed up at 1 week,3 weeks and 2 months. Outcome was assessed by level of satisfaction, complications, days to resume work and complications Results:All patients were completely resolved of their symptoms with no serious complications. 3 patients had temporary wound related complications which was resolved in 3 days .2 patients had temporary stiffness which resolved completely within a month. Percutaneous release of trigger nger Conclusion: is effective, convenient, cost effective day care surgery without any signicant complications and presents a suitable alternative to intralesional steroids

The ultrasound-guided percutaneous release technique for De Quervain's disease using an acupotomy.

This study aimed to compare the effectiveness and safety of the percutaneous first extensor compartment performed by acupotomy procedure with or without ultrasonic (US) guidance. The percutaneous release was performed with an acupotomy on 40 wrists of cadavers, which was divided into US guidance operation and blind operation. Each arm was dissected and assessed regarding the amount of release and the extent of neurovascular and tendon injury. An analysis of finite biomechanical elements based on wrists specimen data is analyzed to observe the stress of the first extensor tendon compartment. A prospective study observed the pain visual analogue score(VAS) and Patient-Rated Wrist Evaluation (PRWEB) changes after the ultrasound guidance or blind acupotomy treatment in 30 dQD patients. The success rate in the ultrasound-guided technique was 85%, and the blind technique was 70% in the cadaver study, both techniques without neurovascular injury. There was no statistically significant difference between the two groups in measuring the distance from the incision marks to the blood vessels and nerves (P > 0.05). According to the biomechanical analysis, the tendon friction rubs when the wrist is upright. When the wrist is flexed, the tendon and tendon sheath is stressed in the bone ridges. In this prospective study, both ultrasound guidance and blind acupotomy treatment achieved well improvements in pain and function (P < 0.05), but the results with no statistically significant between groups (P > 0.05). Both blind and US-guided percutaneous release by acupotomy of the first extensor tendon compartment can get a good result. US-guided techniques can improve the success rate during acupotomy operations, especially for beginners and followers.

Ultrasound-guided percutaneous release procedures in the transverse carpal ligament by acupotomy: A cadaveric study.

This study aimed to determine the safety and accuracy of ultrasound-guided acupotomy percutaneous loosening of the transverse carpal ligament. The 100 upper limb specimens were equally divided into the ultrasound-guided acupotomy group (U) and the nonultrasound-guided acupotomy group (N). For the U group, we simulated ultrasound-guided acupotomy loosening of the transverse carpal ligament in a human specimen, and for the N group, we performed the loosening of the transverse carpal ligament through the same approach under nonultrasound-guided conditions. The safety and accuracy of the two methods were compared through measurement. In the ultrasound-guided group, the injury rate of nerves, blood vessels and tendons caused by needle-knife release was 0%. In the non-ultrasound-guided group, the rate of nerve, blood vessel and tendon damage was 6 percent, 12 percent and 20 percent, respectively. χ 2 test (Fisher exact test) was performed for the nerve and blood vessel damage rates in the two groups (PN > 0.05, PA < 0.05), the difference in nerve damage rates was not statistically significant, but the difference in blood vessel damage rates was statistically significant. Pearson's χ 2 test was performed on the tendon injury rates of the two groups (PF < 0.05), and the difference was statistically significant. In the ultrasound-guided group, the proportion of acupotomy marks greater than or equal to half of the width of the transverse carpal ligament was 86%, and the non-ultrasound-guided group was 36%. The accuracy of the two surgical methods was tested by Pearson's χ 2 test (PL < 0.05), and the difference was statistically significant. According to the measurement, the ultrasound-guided acupotomy technology had high safety and accuracy. In this study, we designed a new method for cutting the transverse carpal ligament under ultrasound guidance, which is different from surgery. These results indicate that this is a safe and accurate method of interventional treatment of carpal tunnel syndrome.

Management of stenosing flexor tenosynovitis in primary care.

Management of stenosing flexor tenosynovitis in primary care.